Ultrasound-guided transbronchial cryobiopsy of mediastinal and hilar lesions: a multicenter pragmatic cohort study with real-world evidence.

Autor:	Mangold MS; Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland., Franzen DP; Department of Medicine and Pulmonology, Hospital Uster, Uster, Switzerland., Hetzel J; Department of Internal Medicine-Pneumology, Cantonal Hospital Winterthur, Winterthur, Switzerland.; Department of Medical Oncology and Pneumology, Eberhard Karls Universität Tübingen, Tubingen, Germany., Latshang TD; Sleep Disorders Center and Pulmonary Division, Canton of Graubunden Hospital, Chur, Switzerland., Roeder M; Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland., Vesenbeckh SM; Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland., Ulrich S; Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland., Gaisl T; Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland., Steinack C; Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland carolin.steinack@usz.ch.
Jazyk:	angličtina
Zdroj:	BMJ open respiratory research [BMJ Open Respir Res] 2024 Dec 12; Vol. 11 (1). Date of Electronic Publication: 2024 Dec 12.
DOI:	10.1136/bmjresp-2024-002617
Abstrakt:	Background: Limited data exist on the reliability, efficacy and safety of ultrasound-guided transbronchial cryobiopsy for suspicious mediastinal and hilar lesions. This study shares findings from implementing this method and compares the results with those of the standard endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Methods: Patients undergoing diagnostic bronchoscopy for mediastinal or hilar lesions in four Swiss centres were included. The study aims to assess the diagnostic yield and safety of EBUS-guided cryobiopsy compared with EBUS-TBNA. Tunnelling to the target lesion was performed using an electric needle knife (70.8%), a 19 G- (12.4%) or a 22 G needle (16.8%). Cryobiopsies were obtained with a freezing time of 4-7 s (18.2% with a 1.7 mm probe) or 6-10 s (81.8% with a 1.1 mm probe). Results: Altogether, 137 patients were enrolled with a median follow-up of 89 days. The overall diagnostic yield was 56.2% for EBUS-TBNA and 91.2% for cryobiopsies (p<0.001). Cryobiopsies increased the diagnostic yield for benign disorders (+28.5%), uncommon tumours (+5.9%) and other metastatic cancer (+0.6%), but not for lung cancer (+0%). For lung cancer (n=27), immunohistochemistry was obtainable in 40.7% of EBUS-TBNA (median of 3 probes [IQR 3 to 3]), significantly lower than cryobiopsy's 88.9% yield (median of 4 probes [IQR 3 to 5]) (p<0.001). Adverse events were found in 23.4% of participants; 10.2% had mild to moderate bleeding, 0.7% had pneumonia, and 0.7% (one) of patients had pneumothorax following pneumomediastinum. No deaths or mediastinum infections were observed. Conclusion: Cryobiopsy of mediastinal and hilar lesions improves the diagnostic yield compared with EBUS-TBNA while maintaining a favourable safety profile. Competing Interests: Competing interests: JH reports honoraria for presentations and workshops from ERBE Elektromedizin GmbH, Tuebingen, Germany, and is an author of the German guidelines for diagnostic bronchoscopy. CS reports grants from the Zurich Cancer Foundation and the Heuberg Foundation. MSM, DF, TDL, MR, SMV, SU and TG have nothing to disclose. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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