Division of Respiratory Medicine, Department of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia.
Department of Pathology, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia.
BMC Pulm Med. 2020 Jun 3;20(1):158. doi: 10.1186/s12890-020-01199-3.
Lung cancer is frequently situated peripherally in the upper lobes of the lung. Acquiring adequate tissue from this difficult-to-reach area remains a challenge. Transbronchial cryobiopsy (TBCB) has the ability to acquire larger specimens, but the rigidity of the standard 1.9 mm and 2.4 mm cryoprobes frequently poses challenges when used with a guide sheath (GS). The novel 1.1 mm cryoprobe, being both smaller and more flexible, may address this limitation. We describe the usage of this 1.1 mm flexible cryoprobe with GS in the biopsy of solitary pulmonary nodules (SPN) in the apical segment of the upper lobe in two cases.
Both procedures were conducted with advanced airway under total intravenous anaesthesia. 2.6 mm GS was used in combination with a 2.2 mm rEBUS probe, using a therapeutic bronchoscope. Case 1 describes a SPN in the apical segment of the right upper lobe that was inconclusive by forceps biopsy due to GS displacement and inadequate biopsy depth. A steerable GS combined with the novel cryoprobe subsequently overcame this issue. Case 2 describes a SPN in the apical segment of the left upper lobe in which the standard cryoprobe failed to advance through the GS due to steep angulation. It also highlights with shorter activation time, the novel cryoprobe enable biopsied tissue to be retrieved through the GS while the bronchoscope-GS remains wedgend in the airway segment. There were no bleeding or pneumothorax complications in both cases, and histopathological examination confirmed adenocarcinoma of the lung.
The 1.1 mm flexible cryoprobe in combination with GS and therapeutic bronchoscope offers an option to acquire adequate tissue in difficult-to-reach regions in the lung such as the apical segment of upper lobes. Further prospective series to evaluate its performance and safety in SPN biopsy is highly anticipated.
肺癌常位于肺上叶的周边部位。从这个难以到达的区域获取足够的组织仍然是一个挑战。经支气管冷冻活检（TBCB）有能力获取更大的标本，但标准的 1.9mm 和 2.4mm 冷冻探针的刚性在使用导鞘（GS）时经常带来挑战。新型 1.1mm 冷冻探针更小且更灵活，可能会解决这个限制。我们描述了在两例病例中使用这种带有 GS 的 1.1mm 柔性冷冻探针对肺上叶尖段孤立性肺结节（SPN）进行活检的情况。
这两个程序都是在全静脉麻醉下经高级气道进行的。2.6mm GS 与 2.2mm rEBUS 探头一起使用，采用治疗性支气管镜。病例 1 描述了一个位于右肺上叶尖段的 SPN，由于 GS 移位和活检深度不足，使用活检钳进行活检结果不确定。随后，使用可转向的 GS 和新型冷冻探针解决了这个问题。病例 2 描述了一个位于左肺上叶尖段的 SPN，由于角度陡峭，标准冷冻探针无法通过 GS 推进。它还强调了新型冷冻探针具有较短的激活时间，使活检组织能够通过 GS 取回，而支气管镜-GS 仍然楔入气道段。这两个病例均无出血或气胸并发症，组织病理学检查证实为肺腺癌。
1.1mm 柔性冷冻探针与 GS 和治疗性支气管镜结合，为在肺的难以到达区域（如肺上叶尖段）获取足够的组织提供了一种选择。高度期待进一步的前瞻性系列研究来评估其在 SPN 活检中的性能和安全性。
