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Multicenter Study
. 2024 Dec 12;11(1):e002617.
doi: 10.1136/bmjresp-2024-002617.

Ultrasound-guided transbronchial cryobiopsy of mediastinal and hilar lesions: a multicenter pragmatic cohort study with real-world evidence

Melanie Scarlett Mangold  1 , Daniel P Franzen  2 , Jürgen Hetzel  3   4 , Tsogyal D Latshang  5 , Maurice Roeder  1 , Silvan M Vesenbeckh  1 , Silvia Ulrich  1 , Thomas Gaisl  1 , Carolin Steinack  6
Affiliations
Multicenter Study

Ultrasound-guided transbronchial cryobiopsy of mediastinal and hilar lesions: a multicenter pragmatic cohort study with real-world evidence

Melanie Scarlett Mangold et al. BMJ Open Respir Res. .

Abstract

Background: Limited data exist on the reliability, efficacy and safety of ultrasound-guided transbronchial cryobiopsy for suspicious mediastinal and hilar lesions. This study shares findings from implementing this method and compares the results with those of the standard endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

Methods: Patients undergoing diagnostic bronchoscopy for mediastinal or hilar lesions in four Swiss centres were included. The study aims to assess the diagnostic yield and safety of EBUS-guided cryobiopsy compared with EBUS-TBNA. Tunnelling to the target lesion was performed using an electric needle knife (70.8%), a 19 G- (12.4%) or a 22 G needle (16.8%). Cryobiopsies were obtained with a freezing time of 4-7 s (18.2% with a 1.7 mm probe) or 6-10 s (81.8% with a 1.1 mm probe).

Results: Altogether, 137 patients were enrolled with a median follow-up of 89 days. The overall diagnostic yield was 56.2% for EBUS-TBNA and 91.2% for cryobiopsies (p<0.001). Cryobiopsies increased the diagnostic yield for benign disorders (+28.5%), uncommon tumours (+5.9%) and other metastatic cancer (+0.6%), but not for lung cancer (+0%). For lung cancer (n=27), immunohistochemistry was obtainable in 40.7% of EBUS-TBNA (median of 3 probes [IQR 3 to 3]), significantly lower than cryobiopsy's 88.9% yield (median of 4 probes [IQR 3 to 5]) (p<0.001). Adverse events were found in 23.4% of participants; 10.2% had mild to moderate bleeding, 0.7% had pneumonia, and 0.7% (one) of patients had pneumothorax following pneumomediastinum. No deaths or mediastinum infections were observed.

Conclusion: Cryobiopsy of mediastinal and hilar lesions improves the diagnostic yield compared with EBUS-TBNA while maintaining a favourable safety profile.

Keywords: Bronchoscopy; Lung Cancer; Non-Small Cell Lung Cancer; Pulmonary lymphoma; Sarcoidosis.

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Conflict of interest statement

Competing interests: JH reports honoraria for presentations and workshops from ERBE Elektromedizin GmbH, Tuebingen, Germany, and is an author of the German guidelines for diagnostic bronchoscopy. CS reports grants from the Zurich Cancer Foundation and the Heuberg Foundation. MSM, DF, TDL, MR, SMV, SU and TG have nothing to disclose.

Figures

Figure 1
Figure 1. Study flow.
Figure 2
Figure 2. Illustrative macroscopic comparison between three endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration samples (left) and three cryoprobes (right) from the same mediastinal lymph node.
Figure 3
Figure 3. Changes in diagnostic categories with endobronchial ultrasound-guided transbronchial needle aspiration and cryobiopsy. The height of the bars is directly proportional to the relative changes in the whole cohort (n=137). The largest increase in the diagnostic yield of cryobiopsies occurs for benign disorders and uncommon tumours.
See this image and copyright information in PMC

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