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. 2022 Dec;200(6):737-745.
doi: 10.1007/s00408-022-00578-3. Epub 2022 Oct 10.

Novel Robotic-Assisted Cryobiopsy for Peripheral Pulmonary Lesions

Catherine L Oberg  1   2 , Ryan P Lau  3 , Erik E Folch  4 , Tao He  5 , Reza Ronaghi  5 , Irawan Susanto  5 , Colleen Channick  5 , Rodrigo Garcia Tome  5 , Scott Oh  5
Affiliations

Novel Robotic-Assisted Cryobiopsy for Peripheral Pulmonary Lesions

Catherine L Oberg et al. Lung. 2022 Dec.

Abstract

Purpose: Tissue acquisition in lung cancer is vital for multiple reasons. Primary reasons reported for molecular testing failure in lung cancer biopsy specimens include insufficient amount of tumor cells provided and inadequate tissue quality. Robotic bronchoscopy is a new tool enabling peripheral pulmonary lesion sampling; however, diagnostic yield remains imperfect possibly due to the location of nodules adjacent to or outside of the airway. The 1.1-mm cryoprobe is a novel diagnostic tool and accesses tissue in a 360-degree manner, thus potentially sampling eccentric/adjacent lesions. This study examines the diagnostic yield of the cryoprobe compared to standard needle aspiration and forceps biopsy. It additionally evaluates yield for molecular markers in cases of lung cancer.

Methods: This is a retrospective analysis of 112 patients with 120 peripheral pulmonary lesions biopsied via robotic bronchoscopy using needle aspirate, forceps, and cryobiopsy.

Results: The overall diagnostic yield was 90%. Nearly 18% of diagnoses were made exclusively from the cryobiopsy sample. Molecular analysis was adequate on all cryobiopsy samples sent. Digital imaging software confirmed an increase in quantity and quality of samples taken via cryobiopsy compared to needle aspirate and traditional forceps biopsy.

Conclusion: Using the 1.1-mm cryoprobe to biopsy PPN combined with the Ion robotic bronchoscopy system is safe, feasible, and provides more diagnostic tissue than needle aspirates or traditional forceps biopsies. The combination of cryobiopsy with robotic-assisted bronchoscopy increased diagnostic yield, likely due to its 360-degree tissue acquisition which is beneficial when targeting extraluminal lesions adjacent to the airway.

Keywords: Advanced bronchoscopy; Cryobiopsy; Interventional pulmonology; Lung cancer; Lung nodule; Robotic bronchoscopy.

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Conflict of interest statement

Dr. Oberg is an educational consultant for Medtronic and Boston Scientific. Dr. Folch is a consultant for Boston Scientific, Cook, and Medtronic and has an educational grant from Intuitive Surgical. Dr. Oh is a consultant for Medtronic and Intuitive Surgical. These roles are unrelated to this study. There are no conflicts for Drs. Lau, He, Ronaghi, Susanto, Channick, and Garcia Tome.

Figures

Fig. 1
Fig. 1
Gross comparison of biopsy specimens. a 21-gauge needle specimen in formalin. b Standard forceps biopsy specimens in formalin. c 1.1-mm cryobiopsy specimens in formalin. d Frozen cryobiopsy specimen on probe. e Thawed cryobiopsy specimen on probe
Fig. 2
Fig. 2
Diagnostic yield by lesion size and biopsy modality
Fig. 3
Fig. 3
Kaposi Sarcoma. A Fine needle biopsy remnant tissue and blood clot showed minute unremarkable lung tissue with no diagnostic tissue (Top panel: Hematoxylin & Eosin stain, 200 × magnification; Bottom panel: HHV-8 immunohistochemistry, 200 × magnification); aspirate smears were acellular (not pictured) B Forceps biopsy showed one fragment of rare spindle cells with crush artifact and focal, weak HHV-8 expression (Top panel: Hematoxylin & Eosin stain, 200 × magnification; Bottom panel: HHV-8 immunohistochemistry, 200 × magnification) C Cryobiopsy showed Kaposi sarcoma with strong and diffuse HHV-8 expression (Top panel: Hematoxylin & Eosin stain, 200 × magnification; Bottom panel: HHV-8 immunohistochemistry, 200 × magnification)
See this image and copyright information in PMC

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