Abstract
Introduction: The diagnostic yield of endoscopic biopsy in the central bronchial system is impaired when submucosal tumor growth is present. Conventional forceps biopsy fails to reveal conclusive histology even in cases of extrabronchial compression or other indirect tumor signs. Since endoscopic cryotechniques have increasing impact for diagnoses of malignant and inflammatory lung disease we compared the diagnostic rate of forceps and cryoprobe in patients with suspected submucosal tumor growth.
Methods: 116 patients with macroscopic submucosal tumor infiltration were investigated prospectively with forceps- and cryobiopsy from 05/2009 to 02/2011. In all cases 1-3 forceps and 1-2 cryoprobe biopsies were obtained, other biopsy methods were added as needed. Specimens underwent routine histopathological processing.
Results: Histological diagnosis was achieved with the following specimens: Forceps 4/116 pts. (3.5%), cryo 48 (41.4%), forceps/cryo 34 (29,3%), cryo/TBNA 2 (1,7%), cryo/EBUS 6 (5.2%), forceps/cryo/TBNA 2 (1,7%), forceps/cryo/EBUS 2 (1,7%), TBNA 4 (3,5%), EBUS 12 (10.3%), CT-guided biopsy 2 (1,7%). Hit ratio of forceps in contrast to cryoprobe in all combinations was 42 (36.2%) and 94 (81%) respectively. Severe hemorrhage (>3 min) as the only complication occurred in 8 (6,9%) cases.
Discussion: In case of endobronchial submucosal tumor growth we found a relevant difference of diagnostic yield and a decisive superiority of cryotechnique, which should be considered for routine use in diagnostic bronchoscopy.
- © 2011 ERS