Image-guided transbronchial pulmonary cryoablation with a flexible cryoprobe in swine: performance and radiology-pathology correlation

Purpose To evaluate the performance of a prototype flexible transbronchial cryoprobe compared to percutaneous transthoracic cryoablation and to define cone-beam CT (CBCT) imaging and pathology cryolesion features in an in vivo swine model. Methods Transbronchial cryoablation was performed with a prototype flexible cryoprobe (3 central and 3 peripheral lung ablations in 3 swine) and compared to transthoracic cryoablation performed with a commercially available rigid cryoprobe (2 peripheral lung ablations in 1 swine). Procedural time and cryoablation success rates for endobronchial navigation and cryoneedle deployment were measured. Intraoperative CBCT imaging features of cryolesions were characterized and correlated with gross and H&E-stained sections of the explanted cryolesions. Results The flexible cryoprobe was successfully navigated and delivered to each target through a steerable guiding sheath (6/6). At 4 min post ablation, 5/6 transbronchial and 2/2 transthoracic cryolesions were visible on CBCT. The volumes on CBCT images were 55.5±8.0 cm3 for central transbronchial ablations (n=2), 72.5±8.1 cm3 for peripheral transbronchial ablations (n=3), and 79.5±11.6 cm3 for peripheral transthoracic ablations (n=2). Pneumothorax developed in one animal post transbronchial ablation and during ablation in the transthoracic cryoablation. Images of cryoablation zones on CBCT correlated well with the matched gross and histopathology sections of the cryolesions. Conclusions Transbronchial cryoablation with a flexible cryoprobe, delivered through a steerable guiding sheath, is feasible. Transbronchial cryoablation zones are imageable with CBCT with gross and histopathology similar to transthoracic cryoablation.