Background: Specimens from transbronchial lung biopsies lack sufficient quality due to crush artifact and are generally too small for diagnosis of diffuse lung diseases. Flexible cryoprobes have been shown to be useful in therapeutic bronchoscopy. We introduce a novel technique for obtaining lung biopsies bronchoscopically, using a flexible cryoprobe. Objectives: The purpose of this study was to show the feasibility of using a cryoprobe to obtain lung biopsies during flexible bronchoscopy. Methods: Forty-one patients with radiographic signs of diffuse lung disease were selected for transbronchial biopsy. During flexible bronchoscopy, conventional transbronchial biopsies using forceps were done first. Then a flexible cryoprobe was introduced into the selected bronchus under fluoroscopic guidance. Once brought into position, the probe was cooled and then retracted with the frozen lung tissue being attached on the probe’s tip. The tissue was processed for histology. After establishing a diagnosis, the specimen area was measured using a digital morphometry system. Results: We evaluated the biopsy samples of 41 patients. The mean specimen area was 5.82 mm2 (0.58–20.88 mm2) taken by forceps compared to 15.11 mm2 obtained using the cryoprobe (2.15–54.15 mm2, p < 0.01). Two patients had a pneumothorax which resolved with tube thoracostomy. Biopsy-associated bleeding did not require any intervention. Transbronchial cryobiopsy contributed in a substantial number of cases to a definitive diagnosis. Conclusions: Transbronchial cryobiopsy is a novel technique which allows to obtain large biopsy samples of lung parenchyma that exceed the size and quality of forceps biopsy samples. Prospective trials are needed to compare this technique with surgical lung biopsy for diagnosis of diffuse lung diseases.

Keywords:
Transbronchial biopsy, Cryobiopsy, Interventional bronchoscopy, Interstitial lung disease
1.
Katzenstein AL, Myers JL: Idiopathic pulmonary fibrosis: clinical relevance of pathologic classification. Am J Respir Crit Care Med 1998;157:1301–1315.
2.
Berbescu EA, Katzenstein AL, Snow JL, Zisman DA: Transbronchial biopsy in usual interstitial pneumonia. Chest 2006;129:1126–1131.
3.
Utz JP, Ryu JH, Douglas WW, Hartman TE, Tazelaar HD, Myers JL, Allen MS, Schroeder DR: High short-term mortality following lung biopsy for usual interstitial pneumonia. Eur Respir J 2001;17:175–179.
4.
Sheski FD, Mathur PN: Endoscopic treatment of early-stage lung cancer. Cancer Control 2000;7:35–44.
5.
Deygas N, Froudarakis M, Ozenne G, Vergnon JM: Cryotherapy in early superficial bronchogenic carcinoma. Chest 2001;120:26–31.
6.
Mathur PN, Wolf KM, Busk MF, Briete WM, Datzman M: Fiberoptic bronchoscopic cryotherapy in the management of tracheobronchial obstruction. Chest 1996;110:718–723.
7.
Maiwand MO, Asimakopoulos G: Cryosurgery for lung cancer: clinical results and technical aspects. Technol Cancer Res Treat 2004;3:143–150.
8.
Hetzel M, Hetzel J, Schumann C, Marx N, Babiak A: Cryorecanalization: a new approach for the immediate management of acute airway obstruction. J Thorac Cardiovasc Surg 2004;127:1427–1431.
9.
Reddy AJ, Govert JA, Sporn TA, Wahidi MM: Broncholith removal using cryotherapy during flexible bronchoscopy: a case report. Chest 2007;132:1661–1663.
10.
Hetzel J, Hetzel M, Hasel C, Moeller P, Babiak A: Old meets modern: the use of traditional cryoprobes in the age of molecular biology. Respiration 2008;76:193–197.
11.
Babiak A, Schumann C, Hetzel J, Hetzel M: Transbronchial cryobiopsy as a new diagnostic method: a feasibility study. Eur Respir J 2004;48(suppl):491s.
12.
Hunninghake GW, Zimmerman MB, Schwartz DA, King TE Jr, Lynch J, Hegele R, Waldron J, Colby T, Muller N, Lynch D, Galvin J, Gross B, Hogg J, Toews G, Helmers R, Cooper JA Jr, Baughman R, Strange C, Millard M: Utility of a lung biopsy for the diagnosis of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2001;164:193–196.
13.
Raghu G, Mageto YN, Lockhart D, Schmidt RA, Wood DE, Godwin JD: The accuracy of the clinical diagnosis of new-onset idiopathic pulmonary fibrosis and other interstitial lung disease: a prospective study. Chest 1999;116:1168–1174.
14.
Wahidi MM, Rocha AT, Hollingsworth JW, Govert JA, Feller-Kopman D, Ernst A: Contraindications and safety of transbronchial lung biopsy via flexible bronchoscopy: a survey of pulmonologists and review of the literature. Respiration 2005;72:285–295.
© 2009 S. Karger AG, Basel
2009
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