Center of Internal Medicine, Department of Internal Medicine II, University of Ulm, Ulm, Germany.
J Thorac Cardiovasc Surg. 2010 Aug;140(2):417-21. doi: 10.1016/j.jtcvs.2009.12.028. Epub 2010 Mar 11.
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.
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.
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%).
Cryobiopsy is safe and increases the diagnostic yield in endobronchial tumor lesions. The method also is feasible under routine conditions.
活检钳活检是获取内镜下可见病变标本的标准方法。通常将活检钳活检与细胞学方法相结合，以提高诊断率。虽然柔性冷冻探针已在恶性狭窄的支气管镜介入中确立，但尚未在大量患者的大样本中研究获得的活检，称为“冷冻活检”。本可行性研究的目的是前瞻性评估冷冻活检和活检钳活检的诊断率和安全性。
在大学医院的支气管镜单位，在 6 年期间，共纳入 296 例可见腔内肿瘤病变的患者。在前 55 例连续进行的病例中，同时应用了这两种技术，即活检钳活检和冷冻活检。进行了病理和定量图像分析，以评估获得标本的大小和质量。我们评估了安全性和诊断率，以描述冷冻活检的可行性。
对前 55 例和随机分配的 55 例进行比较分析，发现冷冻活检的诊断率明显高于活检钳活检（89.1%比 65.5%，P <.05）。在该队列中，定量图像分析显示冷冻活检的活检标本在大小和无伪影的组织切片方面明显大于活检钳活检（P <.0001）。冷冻活检的总体诊断率为 89.5%。11 例（3.7%）发生轻度出血，3 例（1.0%）发生中度出血，1 例（0.3%）发生严重出血。
冷冻活检安全，可提高支气管内肿瘤病变的诊断率。该方法在常规条件下也是可行的。
