Dept of Internal Medicine II, University of Tuebingen, Tuebingen, Germany.
Eur Respir J. 2012 Mar;39(3):685-90. doi: 10.1183/09031936.00033011. Epub 2011 Aug 18.
Forceps, brushes or needles are currently the standard tools used during flexible bronchoscopy when diagnosing endobronchial malignancies. The new biopsy technique of cryobiopsy appears to provide better diagnostic samples. The aim of this study was to evaluate cryobiopsy over conventional endobronchial sampling. A total of 600 patients in eight centres with suspected endobronchial tumours were included in a prospective, randomised, single-blinded multicentre study. Patients were randomised to either sampling using forceps or the cryoprobe. After obtaining biopsy samples, a blinded histological evaluation was performed. According to the definitive clinical diagnosis, the diagnostic yield for malignancy was evaluated by a Chi-squared test. A total of 593 patients were randomised, of whom 563 had a final diagnosis of cancer. 281 patients were randomised to receive endobronchial biopsies using forceps and 282 had biopsies performed using a flexible cryoprobe. A definitive diagnosis was achieved in 85.1% of patients randomised to conventional forceps biopsy and 95.0% of patients who underwent cryobiopsy (p<0.001). Importantly, there was no difference in the incidence of significant bleeding. Endobronchial cryobiopsy is a safe technique with superior diagnostic yield in comparison with conventional forceps biopsy.
当诊断支气管内恶性肿瘤时，目前纤维支气管镜检查使用的标准工具是活检钳、刷子或针。冷冻活检新技术似乎可以提供更好的诊断样本。本研究旨在评估冷冻活检与传统支气管内取样的效果。在 8 个中心，共 600 例疑似支气管内肿瘤的患者纳入前瞻性、随机、单盲、多中心研究。患者随机分为活检钳或冷冻探针取样。获得活检样本后，进行盲法组织学评估。根据明确的临床诊断，采用卡方检验评估恶性肿瘤的诊断率。共随机分配了 593 例患者，其中 563 例最终诊断为癌症。281 例患者接受活检钳支气管活检，282 例患者接受柔性冷冻探针活检。随机分配到常规活检钳活检的患者中，有 85.1%得到明确诊断，而接受冷冻活检的患者中，有 95.0%得到明确诊断（p<0.001）。重要的是，两组患者严重出血的发生率没有差异。与传统活检钳相比，支气管内冷冻活检是一种安全的技术，具有更高的诊断率。
