Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lesions: safety, feasibility and diagnostic yield – experience in 50 cases
Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the technique of choice in the study of mediastinal and hilar lesions; however, it can be affected by the insufficiency of intact biopsy samples, which might decrease its diagnostic yield for certain condition...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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European Respiratory Society
2023-04-01
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| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/9/2/00448-2022.full |
| _version_ | 1797809399698292736 |
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| author | Miguel Ariza-Prota Javier Pérez-Pallarés Alejandro Fernández-Fernández Lucía García-Alfonso Juan A. Cascón Héctor Torres-Rivas Luis Fernández-Fernández Inmaculada Sánchez Maria Gil Marta García-Clemente Francisco López-González |
| author_facet | Miguel Ariza-Prota Javier Pérez-Pallarés Alejandro Fernández-Fernández Lucía García-Alfonso Juan A. Cascón Héctor Torres-Rivas Luis Fernández-Fernández Inmaculada Sánchez Maria Gil Marta García-Clemente Francisco López-González |
| author_sort | Miguel Ariza-Prota |
| collection | DOAJ |
| description | Background
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the technique of choice in the study of mediastinal and hilar lesions; however, it can be affected by the insufficiency of intact biopsy samples, which might decrease its diagnostic yield for certain conditions, thus requiring re-biopsies or additional diagnostic procedures such as mediastinoscopy when the probability of malignancy remains high. Our objectives were to 1) attempt to reproduce this technique in the same conditions that we performed EBUS-TBNA, i.e. in the bronchoscopy suite and under moderate sedation; 2) describe the method used for its execution; 3) determine its feasibility by accessing different lymph node stations applying our method; and 4) analyse the diagnostic yield and its complications.
Methods
This was a prospective study of 50 patients who underwent EBUS-TBNA and EBUS-guided transbronchial mediastinal cryobiopsy (TMC) in a single procedure using a 22-G TBNA needle and a 1.1-mm cryoprobe subsequently between January and August 2022. Patients with mediastinal lesions >1 cm were recruited, and EBUS-TBNA and TMC were performed in the same lymph node station.
Results
The diagnostic yield was 82% and 96% for TBNA and TMC, respectively. Diagnostic yields were similar for sarcoidosis, while cryobiopsy was more sensitive than TBNA in lymphomas and metastatic lymph nodes. As for complications, there was no pneumothorax and in no case was there significant bleeding. There were no complications during the procedure or in the follow-up of these patients.
Conclusions
TMC following our method is a minimally invasive, rapid and safe technique that can be performed in a bronchoscopy suite under moderate sedation, with a higher diagnostic yield than EBUS-TBNA, especially in cases of lymphoproliferative disorders and metastatic lymph nodes or when more biopsy sample is needed for molecular determinations. |
| first_indexed | 2024-03-13T06:52:07Z |
| format | Article |
| id | doaj.art-da1827f8b41f4816b318b2ad6e5fa4f7 |
| institution | Directory Open Access Journal |
| issn | 2312-0541 |
| language | English |
| last_indexed | 2024-03-13T06:52:07Z |
| publishDate | 2023-04-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj.art-da1827f8b41f4816b318b2ad6e5fa4f72023-06-07T13:31:08ZengEuropean Respiratory SocietyERJ Open Research2312-05412023-04-019210.1183/23120541.00448-202200448-2022Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lesions: safety, feasibility and diagnostic yield – experience in 50 casesMiguel Ariza-Prota0Javier Pérez-Pallarés1Alejandro Fernández-Fernández2Lucía García-Alfonso3Juan A. Cascón4Héctor Torres-Rivas5Luis Fernández-Fernández6Inmaculada Sánchez7Maria Gil8Marta García-Clemente9Francisco López-González10 Division of Respiratory Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain Division of Respiratory Medicine, Hospital Universitario Santa Lucía, Cartagena, Spain Division of Respiratory Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain Division of Respiratory Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain Division of Respiratory Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain Division of Pathology, Hospital Universitario Central de Asturias, Oviedo, Spain Division of Pathology, Hospital Universitario Central de Asturias, Oviedo, Spain Division of Nursery, Hospital Universitario Central de Asturias, Oviedo, Spain Division of Nursery, Hospital Universitario Central de Asturias, Oviedo, Spain Division of Respiratory Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain Division of Respiratory Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the technique of choice in the study of mediastinal and hilar lesions; however, it can be affected by the insufficiency of intact biopsy samples, which might decrease its diagnostic yield for certain conditions, thus requiring re-biopsies or additional diagnostic procedures such as mediastinoscopy when the probability of malignancy remains high. Our objectives were to 1) attempt to reproduce this technique in the same conditions that we performed EBUS-TBNA, i.e. in the bronchoscopy suite and under moderate sedation; 2) describe the method used for its execution; 3) determine its feasibility by accessing different lymph node stations applying our method; and 4) analyse the diagnostic yield and its complications. Methods This was a prospective study of 50 patients who underwent EBUS-TBNA and EBUS-guided transbronchial mediastinal cryobiopsy (TMC) in a single procedure using a 22-G TBNA needle and a 1.1-mm cryoprobe subsequently between January and August 2022. Patients with mediastinal lesions >1 cm were recruited, and EBUS-TBNA and TMC were performed in the same lymph node station. Results The diagnostic yield was 82% and 96% for TBNA and TMC, respectively. Diagnostic yields were similar for sarcoidosis, while cryobiopsy was more sensitive than TBNA in lymphomas and metastatic lymph nodes. As for complications, there was no pneumothorax and in no case was there significant bleeding. There were no complications during the procedure or in the follow-up of these patients. Conclusions TMC following our method is a minimally invasive, rapid and safe technique that can be performed in a bronchoscopy suite under moderate sedation, with a higher diagnostic yield than EBUS-TBNA, especially in cases of lymphoproliferative disorders and metastatic lymph nodes or when more biopsy sample is needed for molecular determinations.http://openres.ersjournals.com/content/9/2/00448-2022.full |
| spellingShingle | Miguel Ariza-Prota Javier Pérez-Pallarés Alejandro Fernández-Fernández Lucía García-Alfonso Juan A. Cascón Héctor Torres-Rivas Luis Fernández-Fernández Inmaculada Sánchez Maria Gil Marta García-Clemente Francisco López-González Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lesions: safety, feasibility and diagnostic yield – experience in 50 cases ERJ Open Research |
| title | Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lesions: safety, feasibility and diagnostic yield – experience in 50 cases |
| title_full | Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lesions: safety, feasibility and diagnostic yield – experience in 50 cases |
| title_fullStr | Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lesions: safety, feasibility and diagnostic yield – experience in 50 cases |
| title_full_unstemmed | Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lesions: safety, feasibility and diagnostic yield – experience in 50 cases |
| title_short | Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lesions: safety, feasibility and diagnostic yield – experience in 50 cases |
| title_sort | endobronchial ultrasound guided transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lesions safety feasibility and diagnostic yield experience in 50 cases |
| url | http://openres.ersjournals.com/content/9/2/00448-2022.full |
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