Cryoprobe biopsy increases the diagnostic yield in endobronchial tumor lesions

Schumann, Christian; Hetzel, Jürgen; Babiak, Alexander J.; Merk, Tobias; Wibmer, Thomas; Möller, Peter; Lepper, Philipp M.; Hetzel, Martin

doi:10.1016/j.jtcvs.2009.12.028

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 140, Issue 2 , Pages 417-421, August 2010

Cryoprobe biopsy increases the diagnostic yield in endobronchial tumor lesions

Christian Schumann, MD
- Center of Internal Medicine, Department of Internal Medicine II, University of Ulm, Ulm, Germany
- Address for reprints: Christian Schumann, MD, University of Ulm, Clinic of Internal Medicine II, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
Jürgen Hetzel, MD
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
Alexander J. Babiak, MD
- Department of Internal Medicine II, University of Tübingen, Tübingen, Germany
Tobias Merk, MD
- Clinics of Pneumology and Internal Medicine, Red Cross Hospital, Stuttgart, Germany
Thomas Wibmer, MD
- Center of Internal Medicine, Department of Internal Medicine II, University of Ulm, Ulm, Germany
Peter Möller, MD, PhD
- Department of Pathology, University of Ulm, Ulm, Germany
Philipp M. Lepper, MD
- Department of Pneumology, University Hospital of Bern (Inselspital) and University of Bern, Bern, Switzerland
Martin Hetzel, MD
- Clinics of Pneumology and Internal Medicine, Red Cross Hospital, Stuttgart, Germany

Received 12 October 2009; received in revised form 21 November 2009; accepted 13 December 2009. published online 12 March 2010.

Objective

Forceps biopsy is the standard method to obtain specimens in endoscopically visible lesions. It is common to combine forceps biopsy with cytology methods to increase the diagnostic yield. Although the flexible cryoprobe has been established for bronchoscopic interventions in malignant stenosis, the obtained biopsies, called “cryobiopsies,” have not been investigated in a large cohort of patients. The aim of this feasibility study was to prospectively evaluate the diagnostic yield and safety of cryobiopsy and forceps biopsy.

Methods

During a 6-year period, 296 patients with visible endoluminal tumor lesions were included in the study at the bronchoscopy unit of a university hospital. In the first consecutively conducted 55 cases, both techniques, forceps biopsy and cryobiopsy, were applied simultaneously. Pathologic and quantitative image analyses were performed to evaluate the size and quality of the obtained specimens. We evaluated the safety and diagnostic yield to describe the feasibility of cryobiopsy.

Results

Comparative analysis of the first conducted and randomly assigned 55 cases revealed a significantly higher diagnostic yield for cryobiopsy compared with forceps biopsy (89.1% vs 65.5%, P < .05). In this cohort, quantitative image analysis showed significantly larger biopsies regarding size and artifact-free tissue sections for cryobiopsy compared with forceps biopsy (P < .0001). The overall diagnostic yield of cryobiopsy was 89.5%. Mild bleeding occurred in 11 cases (3.7%), moderate bleeding occurred in 3 cases (1.0%), and severe bleeding occurred in 1 case (0.3%).