Corcione Nadia, Pecoraro Alfonso, Fidecicchi Andrea, Campione Severo, Zuccatosta Lina, Failla Giuseppe
Interventional Pulmonology Unit, Department of Pulmonology, Oncology and Hematology, Antonio Cardarelli Hospital, Naples, Italy.
Epidemiology Unit, Department of Public Health, Antonio Cardarelli Hospital, Naples, Italy.
Thorac Res Pract. 2025 Jun 26;26(4):183-190. doi: 10.4274/ThoracResPract.2025.2024-12-4. Epub 2025 Apr 8.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used to diagnose mediastinal lesions; however, small cytology samples from EBUS-TBNA may be inadequate in cases of benign lung diseases, hematologic disorders, and to assess the molecular profile of primary lung cancer (PLC). EBUS-guided transbronchial mediastinal cryobiopsy (TMC) obtains histological samples and potentially implies a higher diagnostic yield (DY) than EBUS-TBNA. The clinical impact of this technique and the perioperative patient management are still unclear. Our aim was to critically analyze our experience with TMC.
A single center retrospective study was conducted to evaluate TMC DY and perioperative routine over 11 months (February 2023-January 2024).
Forty-one patients were included. The overall DY was 41.5% and 95.1% for EBUS-TBNA and TMC, respectively. TMC provided a higher DY than EBUS-TBNA in cases of hematologic disorders, benign diseases, and uncommon tumors (31% for EBUS-TBNA and 100% for TMC; 95% confidence interval (CI): 52.1-85.8, < 0.001). For PLC, the DY and the assessment of immunohistochemical marker expression did not significantly differ between the two techniques (80% for EBUS-TBNA and 100% for TMC; 95% CI: -4.79-44.8, = 0.13). The management of antithrombotic therapy was the same as that of EBUS-TBNA. Sedatives were administered to achieve deep sedation. After the procedure, no step-up in the level of care was observed, either in outpatients or in patients with a Charlson Comorbidity Index ≥5.
TMC had a better DY than EBUS-TBNA in hematologic disorders, benign lung disease, and uncommon tumors, with an optimal tolerability profile.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）广泛用于诊断纵隔病变；然而，对于良性肺部疾病、血液系统疾病以及评估原发性肺癌（PLC）的分子特征而言，EBUS-TBNA获取的小细胞样本可能并不充分。EBUS引导下经支气管纵隔冷冻活检术（TMC）可获取组织学样本，其诊断率可能高于EBUS-TBNA。该技术的临床影响及围手术期患者管理仍不明确。我们的目的是对我们的TMC经验进行批判性分析。
进行了一项单中心回顾性研究，以评估11个月（2023年2月至2024年1月）期间TMC的诊断率及围手术期常规情况。
纳入41例患者。EBUS-TBNA和TMC的总体诊断率分别为41.5%和95.1%。在血液系统疾病、良性疾病和罕见肿瘤病例中，TMC的诊断率高于EBUS-TBNA（EBUS-TBNA为31%，TMC为100%；95%置信区间（CI）：52.1-85.8，P<0.001）。对于PLC，两种技术的诊断率及免疫组化标志物表达评估无显著差异（EBUS-TBNA为80%，TMC为100%；95%CI：-4.79-44.8，P=0.13）。抗血栓治疗的管理与EBUS-TBNA相同。给予镇静剂以实现深度镇静。术后，门诊患者或Charlson合并症指数≥5的患者均未观察到护理级别升级。
在血液系统疾病、良性肺部疾病和罕见肿瘤中，TMC的诊断率优于EBUS-TBNA，且耐受性良好。
