Kho Sze Shyang, Chai Chan Sin, Ismail Adam Malik
Division of Respiratory Medicine, Department of Medicine Sarawak General Hospital, Ministry of Health Malaysia Kuching Malaysia.
Department of Pathology Sarawak General Hospital, Ministry of Health Malaysia Kuching Malaysia.
Respirol Case Rep. 2024 Aug 11;12(8):e01450. doi: 10.1002/rcr2.1450. eCollection 2024 Aug.
Bleeding mitigation is an important part of any transbronchial lung cryobiopsy (TBLC) procedure, either for interstitial lung disease (ILD) or peripheral pulmonary lesions (PPL). The two-scope technique has been previously described for ILD and PPL-TBLC, but it has its own limitations and technical and logistical complexities. In this case series, we describe a modified two-scope technique that enhances the conventional two-scope technique by maintaining a small equipment footprint and longer bronchoscopic vision without the need for intra-procedure switching of bronchoscopes. Three cases of PPLs were navigated by standard radial endobronchial ultrasound and biopsied with the 1.1 mm flexible ultrathin cryoprobe. All cases achieved a conclusive diagnosis with adequate specimens for immunohistochemical staining and molecular analysis; only Grade 1 bleeding reported in two cases. The challenges and limitations of this modified two-scope technique were also explored in this series.
对于间质性肺疾病（ILD）或周围性肺病变（PPL）的任何经支气管肺冷冻活检（TBLC）程序而言，减轻出血都是重要的一环。双镜技术此前已被描述用于ILD和PPL-TBLC，但它有自身的局限性以及技术和后勤方面的复杂性。在本病例系列中，我们描述了一种改良的双镜技术，该技术通过保持较小的设备占地面积和更长的支气管镜视野来增强传统双镜技术，而无需在手术过程中切换支气管镜。3例PPL通过标准的径向支气管内超声进行导航，并使用1.1毫米柔性超薄冷冻探头进行活检。所有病例均获得了明确诊断，有足够的标本用于免疫组织化学染色和分子分析；仅2例报告有1级出血。本系列还探讨了这种改良双镜技术的挑战和局限性。
