Authors (including presenting author) :
Chan SE, Cheung PS, Cheng SL, Tsui SN, Lee CL
Affiliation :
Medicine & Geriatrics, United Christian Hospital
Introduction :
Endobronchial lesions can be sampled using various techniques including forceps, brushing or washing via flexible bronchoscopy. The small sample size can however hamper diagnostic yield and subject patients to repeated bronchoscopic procedures. In addition, submucosal lesions can be difficult to biopsy with aforementioned techniques. Cryobiopsy is known to yield higher diagnostic rates as it provides larger specimens with improved tissue preservation, and can be positioned to access tangential lesions. Bleeding however remains the main concern with this technique.
Objectives :
The objectives are (1) to establish the use of endobronchial cryobiopsy in our centre, (2) to evaluate the diagnostic yield, and (3) to assess the safety of this technique.
Methodology :
Cryobiopsy was performed in patients who were found to have exophytic endobronchial lesions and/or bronchial submucosal irregularities during flexible bronchoscopy. We used the cryoprobe of 1.1mm in diameter in all cases. This is the smallest commercially available cryoprobe, but has the advantage of being removed through the working channel without the need for removal of the bronchoscope en bloc with the cryoprobe. This reduces the risk of losing the endoscopic view, especially if there is significant bleeding. We also utilised endobronchial instillation of tranexamic acid in lesions with excessive contact bleeding before biopsy. The indications, pathology results and bleeding complication for each case were recorded.
Result & Outcome :
From January 2024 to December 2024, 33 patients underwent cryobiopsy of endobronchial lesions. The overall diagnostic yield was 78.8% (26 out of 33). Among patients who underwent the procedure for suspected malignancy, the diagnostic yield was 77.8% (21 out of 27). All episodes of bleeding were stopped using endobronchial instillation of cold saline, adrenaline and/or tranexamic acid endobronchially or intravenously (if this has not been used before biopsy). None of the patients required surgical interventions for haemostasis and there were no fatal events.
In conclusion, cryobiopsy is a safe technique in sampling bronchial pathology with a good diagnostic yield, even when a smaller cryoprobe is used. It also has the advantage over conventional forceps biopsy in accessing non-exophytic lesions and providing larger samples. Pre-emptive endobronchial instillation of tranexamic acid aids haemostasis, especially in cases where excessive contact bleeding is present.
