Comparison of cryobiopsy and forceps biopsy for the diagnosis of mediastinal lesions: A randomised clinical trial

IF 10.4 2区医学 Q1 RESPIRATORY SYSTEM Pulmonology Pub Date : 2024-09-01 DOI:10.1016/j.pulmoe.2023.12.002

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Abstract

Introduction

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the standard approach for lung cancer staging. However, its diagnostic utility for other mediastinal diseases might be hampered by the limited tissue retrieved. Recent evidence suggests the novel sampling strategies of forceps biopsy and cryobiopsy as auxiliary techniques to EBUS-TBNA, considering their capacity for larger diagnostic samples.

Methods

This study determined the added value of forceps biopsy and cryobiopsy for the diagnosis of mediastinal diseases. Consecutive patients with mediastinal lesions of 1 cm or more in the short axis were enrolled. Following completion of needle aspiration, three forceps biopsies and one cryobiopsy were performed in a randomised pattern. Primary endpoints included diagnostic yield defined as the percentage of patients for whom mediastinal biopsy led to a definite diagnosis, and procedure-related complications.

Results

In total, 155 patients were recruited and randomly assigned. Supplementing EBUS-TBNA with either forceps biopsy or cryobiopsy increased diagnostic yield, with no significant difference between EBUS-TBNA plus forceps biopsy and EBUS-TBNA plus cryobiopsy (85.7 % versus 91.6 %, P = 0.106). Yet, samples obtained by additional cryobiopsies were more qualified for lung cancer molecular testing than those from forceps biopsies (100.0 % versus 89.5 %, P = 0.036). When compared directly, the overall diagnostic yield of cryobiopsy was superior to forceps biopsy (85.7 % versus 70.8 %, P = 0.001). Cryobiopsies produced greater samples in shorter procedural time than forceps biopsies. Two (1.3 %) cases of postprocedural pneumothorax were detected.

Conclusions

Transbronchial mediastinal cryobiopsy might be a promising complementary tool to supplement traditional needle biopsy for increased diagnostic yield and tissue harvesting.

Trial registration

ChiCTR2000030373

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冷冻活检与镊子活检在纵隔病变诊断中的比较：随机临床试验

导言支气管内超声引导下经支气管针吸术（EBUS-TBNA）是肺癌分期的标准方法。然而，它对其他纵隔疾病的诊断效用可能会因提取的组织有限而受到影响。最近的证据表明，考虑到镊子活检和冷冻活检能获取更多的诊断样本，因此这两种新型取样策略可作为 EBUS-TBNA 的辅助技术。研究对象为纵隔短轴病变达 1 厘米或以上的连续患者。在完成针吸后，以随机模式进行了三次镊子活检和一次冷冻活检。主要终点包括诊断率（即通过纵隔活检获得明确诊断的患者比例）和手术相关并发症。EBUS-TBNA辅以镊子活检或冷冻活检可提高诊断率，EBUS-TBNA加镊子活检与EBUS-TBNA加冷冻活检之间无显著差异（85.7%对91.6%，P = 0.106）。然而，额外冷冻活检获得的样本比钳夹活检获得的样本更适合进行肺癌分子检测（100.0% 对 89.5%，P = 0.036）。如果直接比较，冷冻活检的总体诊断率要高于钳活检（85.7% 对 70.8%，P = 0.001）。冷冻活组织检查比钳取活检在更短的手术时间内获得更多样本。结论经支气管纵隔冷冻活检可能是一种很有前途的补充工具，可作为传统针活检的补充，以提高诊断率和组织采集率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pulmonology Medicine-Pulmonary and Respiratory Medicine

CiteScore

14.30

自引率

5.10%

发文量

159

审稿时长

19 days

期刊介绍： Pulmonology (previously Revista Portuguesa de Pneumologia) is the official journal of the Portuguese Society of Pulmonology (Sociedade Portuguesa de Pneumologia/SPP). The journal publishes 6 issues per year and focuses on respiratory system diseases in adults and clinical research. It accepts various types of articles including peer-reviewed original articles, review articles, editorials, and opinion articles. The journal is published in English and is freely accessible through its website, as well as Medline and other databases. It is indexed in Science Citation Index Expanded, Journal of Citation Reports, Index Medicus/MEDLINE, Scopus, and EMBASE/Excerpta Medica.