Mangold Melanie Scarlett, Franzen Daniel P, Hetzel Jürgen, Latshang Tsogyal D, Roeder Maurice, Vesenbeckh Silvan M, Ulrich Silvia, Gaisl Thomas, Steinack Carolin
Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
Department of Medicine and Pulmonology, Hospital Uster, Uster, Switzerland.
BMJ Open Respir Res. 2024 Dec 12;11(1):e002617. doi: 10.1136/bmjresp-2024-002617.
Limited data exist on the reliability, efficacy and safety of ultrasound-guided transbronchial cryobiopsy for suspicious mediastinal and hilar lesions. This study shares findings from implementing this method and compares the results with those of the standard endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).
Patients undergoing diagnostic bronchoscopy for mediastinal or hilar lesions in four Swiss centres were included. The study aims to assess the diagnostic yield and safety of EBUS-guided cryobiopsy compared with EBUS-TBNA. Tunnelling to the target lesion was performed using an electric needle knife (70.8%), a 19 G- (12.4%) or a 22 G needle (16.8%). Cryobiopsies were obtained with a freezing time of 4-7 s (18.2% with a 1.7 mm probe) or 6-10 s (81.8% with a 1.1 mm probe).
Altogether, 137 patients were enrolled with a median follow-up of 89 days. The overall diagnostic yield was 56.2% for EBUS-TBNA and 91.2% for cryobiopsies (p<0.001). Cryobiopsies increased the diagnostic yield for benign disorders (+28.5%), uncommon tumours (+5.9%) and other metastatic cancer (+0.6%), but not for lung cancer (+0%). For lung cancer (n=27), immunohistochemistry was obtainable in 40.7% of EBUS-TBNA (median of 3 probes [IQR 3 to 3]), significantly lower than cryobiopsy's 88.9% yield (median of 4 probes [IQR 3 to 5]) (p<0.001). Adverse events were found in 23.4% of participants; 10.2% had mild to moderate bleeding, 0.7% had pneumonia, and 0.7% (one) of patients had pneumothorax following pneumomediastinum. No deaths or mediastinum infections were observed.
Cryobiopsy of mediastinal and hilar lesions improves the diagnostic yield compared with EBUS-TBNA while maintaining a favourable safety profile.
关于超声引导下经支气管冷冻活检术用于可疑纵隔及肺门病变的可靠性、有效性和安全性的数据有限。本研究分享了实施该方法的结果，并将其与标准的超声支气管镜引导下经支气管针吸活检术（EBUS-TBNA）的结果进行比较。
纳入在瑞士四个中心接受纵隔或肺门病变诊断性支气管镜检查的患者。该研究旨在评估与EBUS-TBNA相比，EBUS引导下冷冻活检术的诊断率和安全性。使用电针刀（70.8%）、19G针（12.4%）或22G针（16.8%）向目标病变进行穿刺。冷冻活检的冷冻时间为4 - 7秒（1.7毫米探头为18.2%）或6 - 10秒（1.1毫米探头为81.8%）。
共纳入137例患者，中位随访时间为89天。EBUS-TBNA的总体诊断率为56.2%，冷冻活检为91.2%（p<0.001）。冷冻活检提高了良性疾病（提高28.5%）、罕见肿瘤（提高5.9%）和其他转移性癌症（提高0.6%）的诊断率，但对肺癌（提高0%）没有影响。对于肺癌患者（n = 27），EBUS-TBNA中40.7%可获得免疫组化结果（中位探针数为3个[四分位间距3至3]），显著低于冷冻活检的88.9%（中位探针数为4个[四分位间距3至5]）（p<0.001）。23.4%的参与者出现不良事件；10.2%有轻度至中度出血，0.7%有肺炎，0.7%（1例）患者在纵隔积气后出现气胸。未观察到死亡或纵隔感染。
与EBUS-TBNA相比，纵隔及肺门病变的冷冻活检提高了诊断率，同时保持了良好的安全性。
