Transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lesions: a randomised trial
- Jing Zhang1,
- Jie-Ru Guo1,
- Zan-Sheng Huang1,
- Wan-Lei Fu2,
- Xian-Li Wu1,
- Na Wu3,
- Wolfgang M. Kuebler4,
- Felix J.F. Herth5 and
- Ye Fan1
- 1Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China
- 2Department of Pathology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
- 3Department of Epidemiology, College of Preventive Medicine, Third Military Medical University, Chongqing, China
- 4Institute of Physiology, Charité Universitätsmedizin, Berlin, Germany
- 5Department of Pneumology and Critical Care Medicine, Thoraxklinik, and Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
- Felix J. Herth, Department of Pneumology and Critical Care Medicine, Thoraxklinik, and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany. E-mail: felix.herth{at}med.uni-heidelberg.de; or Ye Fan, MD; Department of Respiratory Disease, Xinqiao Hospital, Third Military Medical University, Chongqing, China. E-mail: fanye2008728{at}googlemail.com
Abstract
Background Guidelines recommend endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) as an initial investigation technique for mediastinal nodal staging in lung cancer. However, EBUS-TBNA can be limited by the inadequacy of intact tissues, which might restrict its diagnostic yield in mediastinal lesions of certain etiologies. We have previously shown that EBUS-guided transbronchial mediastinal cryobiopsy can provide intact samples with greater volume.
Methods This randomised study determined the diagnostic yield and safety of transbronchial mediastinal cryobiopsy monitored by endosonography for the diagnosis of mediastinal lesions. Patients with mediastinal lesion of 1 cm or more in the short axis were recruited. Following identification of the mediastinal lesion by linear EBUS, fine-needle aspiration and cryobiopsy were sequently performed in a randomised order. Primary endpoints were diagnostic yield defined as the percentage of patients for whom mediastinal biopsy provided a definite diagnosis, and procedure-related adverse events.
Results One hundred and ninety-seven patients were enrolled and randomly allocated. The overall diagnostic yield was 79.9% and 91.8% for TBNA and transbronchial mediastinal cryobiopsy, respectively (p=0.001). Diagnostic yields were similar for metastatic lymphadenopathy (94.1% versus 95.6%, p=0.58), while cryobiopsy was more sensitive than TBNA in uncommon tumors (91.7% versus 25.0%, p=0.001) and benign disorders (80.9% versus 53.2%, p=0.004). No significant differences in diagnostic yield were detected between TBNA first and cryobiopsy first groups. We observed 2 cases of pneumothorax and 1 case of pneumomediastinum.
Conclusions Transbronchial cryobiopsy performed under EBUS guidance is a safe and useful approach that offers diagnostic histological samples of mediastinal lesions.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Zhang has nothing to disclose.
Conflict of interest: Dr. Guo has nothing to disclose.
Conflict of interest: Dr. Huang has nothing to disclose.
Conflict of interest: Dr. Fu has nothing to disclose.
Conflict of interest: Dr. Wu has nothing to disclose.
Conflict of interest: Dr. Wu has nothing to disclose.
Conflict of interest: Dr. Kuebler has nothing to disclose.
Conflict of interest: Dr. Herth reports personal fees for adboard activities and lecture fees from Pulmonx, Erbe, Olympus, and Uptake, outside the submitted work.
Conflict of interest: Dr. Fan has nothing to disclose.
This is a PDF-only article. Please click on the PDF link above to read it.
- Received January 8, 2021.
- Accepted April 27, 2021.
- Copyright ©The authors 2021. For reproduction rights and permissions contact permissions{at}ersnet.org