Utilización de criosondas para la realización de la biopsia pulmonar transbronquial / Transbronchial lung biopsy using cryoprobes

IntroducciónLa biopsia pulmonar transbronquial (BPTB) es una técnica broncoscópica indicada en el estudio de las enfermedades pulmonares difusas, cuyo rendimiento diagnóstico es variable debido, en parte, al pequeño tamaño de las muestras obtenidas. La utilización de criosondas en la práctica de la BPTB podría permitir obtener muestras tisulares de mayor tamaño y mejor calidad. El presente trabajo tiene como objetivos describir la metodología de la técnica y su implantación en nuestro centro, así como analizar los resultados de seguridad e histológicos en los primeros pacientes.Pacientes y métodosSe incluyó a 10 pacientes tributarios de BPTB para estudio de neumopatía difusa. De un modo equiparable al método convencional, la criosonda (Erbokryo CA®, Erbe, Alemania) se introduce a través del videobroncoscopio y se dirige hacia regiones pulmonares periféricas, donde la aplicación de frío permite obtener una muestra de tejido pulmonar congelado que queda adherido al extremo de la criosonda. Se registraron la duración del procedimiento y las complicaciones durante éste, y se evaluó la calidad de las muestras obtenidas.ResultadosLa duración media (±desviación estándar) del procedimiento fue de 35±11min. Las muestras presentaban un área media de 9,5mm2 (rango: 3–25mm2), con un número medio de espacios alveolares conservados de 29,6. Ningún paciente presentó neumotórax. En 6 de los 10 pacientes se registró hemorragia tras la biopsia, que en ningún caso obligó a interrumpir el procedimiento.ConclusionesLa utilización de criosondas es viable para la realización de la BPTB y en el futuro podría mejorar el rendimiento de la técnica convencional(AU)

Background and objectivesTransbronchial lung biopsy (TBLB) is a bronchoscopy procedure used to obtain peripheral lung tissue. Small size samples and artefacts lead to variable, and usually poor, diagnostic yield. The use of cryoprobes may enable larger size and better quality biopsy samples to be obtained. The purpose of this study was to evaluate the feasibility of TBLB with cryoprobes and analyse the histological quality of samples obtained.Patients and methodsWe selected 10 patients with interstitial lung disease who were suitable for TBLB. A cryoprobe (Erbokryo CA®, Erbe, Germany) was introduced through the bronchoscope work channel. Then, under fluoroscopic control, the cryoprobe was placed in an area of the peripheral lung previously selected according to CT findings. A temperature of −89.5°C was applied for 3s and the cryoprobe and bronchoscope were removed with the frozen lung sample attached to the probe. The procedure was performed under sedation and the patient was intubated to allow bronchoscope and cryoprobe removal. Safety, duration of the procedure and histological findings has been evaluated.ResultsThere were 10 patients (64±8 years, 6 males). Procedure length was 35min. The specimen area was 9.5mm2 (range 3 to 25mm2) and the mean number of alveolar spaces was 29.62. No pneumothorax was registered. 6/10 patients had mild post-biopsy bleeding controlled with standard bronchoscopy measures.ConclusionsThe use of cryoprobes for TBLB may become an alternative technique to increase diagnostic yield(AU)

[Transbronchial lung biopsy using cryoprobes]. / Utilización de criosondas para la realización de la biopsia pulmonar transbronquial.

BACKGROUND AND OBJECTIVES: Transbronchial lung biopsy (TBLB) is a bronchoscopy procedure used to obtain peripheral lung tissue. Small size samples and artefacts lead to variable, and usually poor, diagnostic yield. The use of cryoprobes may enable larger size and better quality biopsy samples to be obtained. The purpose of this study was to evaluate the feasibility of TBLB with cryoprobes and analyse the histological quality of samples obtained. PATIENTS AND METHODS: We selected 10 patients with interstitial lung disease who were suitable for TBLB. A cryoprobe (Erbokryo CA, Erbe, Germany) was introduced through the bronchoscope work channel. Then, under fluoroscopic control, the cryoprobe was placed in an area of the peripheral lung previously selected according to CT findings. A temperature of -89.5 degrees C was applied for 3s and the cryoprobe and bronchoscope were removed with the frozen lung sample attached to the probe. The procedure was performed under sedation and the patient was intubated to allow bronchoscope and cryoprobe removal. Safety, duration of the procedure and histological findings has been evaluated. RESULTS: There were 10 patients (64+/-8 years, 6 males). Procedure length was 35 min. The specimen area was 9.5 mm2 (range 3 to 25 mm2) and the mean number of alveolar spaces was 29.62. No pneumothorax was registered. 6/10 patients had mild post-biopsy bleeding controlled with standard bronchoscopy measures. CONCLUSIONS: The use of cryoprobes for TBLB may become an alternative technique to increase diagnostic yield.