Transbronchial Cryobiopsy: A New Tool for Lung BiopsiesBabiak A. · Hetzel J. · Krishna G. · Fritz P. · Moeller P. · Balli T. · Hetzel M.
aDepartment of Pulmonary Medicine, Red Cross Medical Center, Stuttgart, bDepartment of Internal Medicine 2, University of Tübingen, Tübingen, cDepartment of Pathology, Robert Bosch Hospital, Stuttgart, and dDepartment of Pathology, University of Ulm, Ulm, Germany; eDepartment of Pulmonary Medicine, VA Palo Alto Health Care System, Stanford University Medical Center, Palo Alto, Calif., USA
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.
Jürgen Hetzel, MD
Department of Internal Medicine 2, University of Tübingen
Otfried-Müller-Str. 10, DE–72076 Tübingen (Germany)
Tel. +49 7071 298 2711, Fax +49 7071 294 598
A. Babiak and J. Hetzel contributed equally to the paper.
Received: July 28, 2008
Accepted after revision: December 3, 2008
Published online: February 21, 2009
Number of Print Pages : 6
Number of Figures : 3, Number of Tables : 1, Number of References : 14
Respiration (International Journal of Thoracic Medicine)
Vol. 78, No. 2, Year 2009 (Cover Date: July 2009)
Journal Editor: Bolliger C.T. (Cape Town)
ISSN: 0025-7931 (Print), eISSN: 1423-0356 (Online)
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