一项单中心随机试验，比较支气管内冷冻活检与支气管内钳取活检术在支气管内病变患者中的诊断率和安全性。

A single-centre, randomised trial to compare diagnostic yield and safety between endobronchial cryobiopsy and endobronchial forceps biopsy procedure in patients with endobronchial lesions.

作者信息

Misra Swapnendu, Bandyopadhyay Ankan, Patra Anupam, Mitra Ritabrata, Sengupta Amitava, Kundu Somenath

机构信息

Department of Pulmonary Medicine, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.

Department of Respiratory Medicine, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.

出版信息

Lung India. 2025 May 1;42(3):204-210. doi: 10.4103/lungindia.lungindia_452_24. Epub 2025 Apr 29.

DOI:10.4103/lungindia.lungindia_452_24

PMID:40296391

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12097659/

Abstract

BACKGROUND

Flexible bronchoscopy is the diagnostic tool of choice to diagnose endobronchial lesions. Pathological samples can be harvested using various techniques, for example, forceps biopsy, brushing, washing, and recently cryobiopsy. The major drawbacks of forceps biopsy technique are (a) obtaining of smaller tissues and (b) presence of crush artefacts. This results in a significant failure rate. Cryobiopsy is the procedure where application of extreme cold to the pathological tissues is used for obtaining samples. As a cryoprobe allows procurement of larger biopsy samples which is devoid of any crush artefacts, these result in better histopathology, immunohistochemistry, and identification of specific genetic mutations.

METHODS

The current trial tried to assess (i) the diagnostic yield of endobronchial cryobiopsies in comparison with endobronchial forceps biopsies and (ii) assess the duration of procedures and requirement of interventions to control bleeding, among 49 patients who had undergone forceps biopsy and 48 patients who had undergone cryobiopsy. The types of endobronchial lesions observed during bronchoscopic procedures were divided into (a) exophytic type and (b) infiltrative type. Biopsy interpretations were done by an expert pathologist.

RESULTS

Cryobiopsy compared to forceps biopsy had a statistically significant higher diagnostic yield for diagnosis of overall endobronchial lesions (P < 0.0001) for both exophytic (P = 0.015) and infiltrative (P < 0.0001) growth. Cryobiopsy obtained larger tissue (P < 0.001). No statistically significant difference was found in the incidence of haemorrhage (P = 0.378) and duration (P = 0.173) between two procedures.

CONCLUSIONS

Cryobiopsies were more successful than forceps biopsies particularly for diagnosis of infiltrative growth. The complication rate was similar between the two procedures.

摘要

背景

可弯曲支气管镜检查是诊断支气管内病变的首选诊断工具。可使用多种技术获取病理样本，例如钳取活检、刷检、冲洗，以及最近的冷冻活检。钳取活检技术的主要缺点是：（a）获取的组织较小；（b）存在挤压假象。这导致显著的失败率。冷冻活检是一种将极寒应用于病理组织以获取样本的操作。由于冷冻探头能够获取更大的活检样本且不存在任何挤压假象，因此能带来更好的组织病理学、免疫组织化学结果，并有助于识别特定的基因突变。

方法

本试验旨在评估：（i）与支气管内钳取活检相比，支气管内冷冻活检的诊断率；（ii）在49例接受钳取活检的患者和48例接受冷冻活检的患者中，评估操作持续时间以及控制出血所需干预措施的情况。支气管镜检查过程中观察到的支气管内病变类型分为：（a）外生性类型；（b）浸润性类型。活检结果由专业病理学家解读。

结果

与钳取活检相比，冷冻活检在诊断总体支气管内病变方面具有统计学显著更高的诊断率（P < 0.0001），对外生性（P = 0.015）和浸润性（P < 0.0001）生长的病变均如此。冷冻活检获取的组织更大（P < 0.001）。两种操作在出血发生率（P = 0.378）和持续时间（P = 0.173）方面未发现统计学显著差异。