Skip to main content

Main menu

  • Home
  • Current issue
  • Early View
  • Archive
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Institutional open access agreements
    • Peer reviewer login
    • WoS Reviewer Recognition Service
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • Early View
  • Archive
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Institutional open access agreements
    • Peer reviewer login
    • WoS Reviewer Recognition Service
  • Alerts
  • Subscriptions

Performance of transbronchial cryobiopsy in eccentrically and adjacently orientated radial endobronchial ultrasound lesions

Sze Shyang Kho, Swee Kim Chan, Mei Ching Yong, Siew Teck Tie
ERJ Open Research 2019 5: 00135-2019; DOI: 10.1183/23120541.00135-2019
Sze Shyang Kho
Division of Respiratory Medicine, Dept of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Sze Shyang Kho
  • For correspondence: bzk99@hotmail.com
Swee Kim Chan
Division of Respiratory Medicine, Dept of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mei Ching Yong
Division of Respiratory Medicine, Dept of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Siew Teck Tie
Division of Respiratory Medicine, Dept of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Figures

  • Tables
  • FIGURE 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 1

    Radial endobronchial ultrasound orientation. a) Concentric orientation; b) eccentric orientation; c) adjacent orientation.

  • FIGURE 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 2

    Representative case 1. a) Axial computed tomography thorax demonstrates a 2.2 cm peripheral pulmonary lesion over right upper lobe posterior segment; b) radial endobronchial ultrasound revealed an eccentrically orientated lesion; c) placement of 1.9 mm cryoprobe with prophylactic blocking balloon at the ostium of posterior segment of right upper lobe; d) single planar fluoroscopy demonstrating placement of cryoprobe (without guide sheath) and blocking balloon; e) forceps biopsy revealing only bronchial epithelium (haematoxylin and eosin stain (HE), 100-fold magnification); f) cryobiopsy revealing chronic granulomatous inflammation suggestive of tuberculosis (HE, 400-fold magnification).

  • FIGURE 3
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 3

    Representative case 2. a,b) Axial computed tomography thorax demonstrates a solitary pulmonary nodule at anterior segment of right upper lobe in lung and mediastinal window; c) adjacently orientated radial endobronchial ultrasound lesion at target segment; d) placement of cryoprobe via guide sheath into the lesion via fluoroscopy guidance; e) forceps biopsy revealing only superficial peribronchial tissue with cartilage (haematoxylin and eosin stain (HE), ×40-fold magnification); f,g) cryobiopsy confirmed squamous cell carcinoma with positive cytokeratin (CK) 5/6 staining (f, HE, 400-fold magnification; g, CK 5/6 stain, 100-fold magnification).

  • FIGURE 4
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 4

    Performance of transbronchial cryobiopsy versus forceps biopsy in concentrically orientated versus eccentrically and adjacently oriented lesions.

Tables

  • Figures
  • TABLE 1

    Characteristics of patients, target lesions and procedure details

    OverallForceps biopsyCryobiopsyp-value
    Subjects1147638
    Patient characteristics
     Age years58.5 (49.8–68.3)60 (50–70)56 (47.8–64.5)0.210
     Sex
      Male78 (68.4)53 (69.7)25 (65.8)0.669
      Female36 (31.6)23 (30.3)13 (34.2)
    Target lesion characteristics
     Size cm3.48 (2.63–4.51)3.50 (2.65–4.81)3.39 (2.59–4.19)0.637
     Lobe
      Upper lobe69 (60.5)46 (60.5)23 (60.5)0.976
      Middle lobe/lingular16 (14.1)11 (14.5)5 (13.2)
      Lower lobe29 (25.4)19 (25.0)10 (26.3)
     Location
      Inner third20 (17.5)15 (19.7)5 (13.2)0.172
      Middle third45 (39.5)33 (43.4)12 (31.6)
      Outer third49 (43.0)28 (36.8)21 (55.3)
     Orientation
      Concentric49 (43.0)35 (46.1)14 (36.8)0.248
      Eccentric47 (41.2)32 (42.1)15 (39.5)
      Adjacent18 (15.8)9 (11.8)9 (23.7)
    Procedure characteristics
     Time min45 (35.8–60)40.5 (35–51.5)50.0 (45–60)<0.01
     Airway
      Transnasal91 (79.8)69 (90.8)22 (57.9)<0.001
      Advanced airway23 (20.2)7 (9.2)16 (42.1)
     Fluoroscopy91 (79.8)56 (73.7)35 (92.1)<0.05
     Guide sheath94 (82.5)72 (94.7)22 (57.9)<0.001

    Data are presented as n, median (interquartile range) or n (%), unless otherwise stated. Bold type represents statistical significance.

    • TABLE 2

      Factors influencing diagnostic yield in eccentric and adjacent lesions

      Diagnostic yieldp-value
      Biopsy method
       Forceps biopsy48.8 (20/41)<0.05
       Cryobiopsy75.0 (18/24)
      Lesion size
       <3 cm56.7 (17/30)0.786
       ≥3 cm60.0 (21/35)
      Airway
       Transnasal54.9 (28/51)0.266
       Advanced airway71.4 (10/14)
      Fluoroscopy
       With59.6 (31/52)0.706
       Without53.8 (7/13)
      Guide sheath
       With54.7 (29/53)0.198
       Without75.0 (9/12)

      Data are presented as % (n/N), unless otherwise stated. n=65. Bold type represents statistical significance.

      • TABLE 3

        Histologies for all conclusive lesions in the eccentric and adjacent groups

        OverallForceps biopsyCryobiopsy
        Conclusive histology38 (58.5)20 (48.8)18 (75.0)
         Malignant
          Adenocarcinoma lung17 (44.8)9 (45.0)8 (44.4)
          Squamous cell carcinoma4 (10.5)3 (15.0)1 (5.6)
          Metastatic sarcoma1 (2.6)1 (5.0)0 (0.0)
         Benign
          Nodular lymphoid hyperplasia1 (2.6)0 (0.0)1 (5.6)
         Infection
          Tuberculosis
           Granulomatous inflammation9 (23.8)3 (15.0)6 (33.3)
           Necrotic tissue with guide sheath positive for Xpert MTB/RIF1 (2.6)1 (5.0)0 (0.0)
           Chronic inflammation with therapeutic response to    antituberculous drug4 (10.5)2 (10.0)2 (11.1)
          Chronic inflammation with guide sheath culture positive for    Penicillium1 (2.6)1 (5.0)0 (0.0)
        Inconclusive histology27 (41.5)21 (51.2)6 (25.0)
         Nondiagnostic
          Bronchial epithelium13 (48.2)12 (57.2)1 (16.7)
          Chronic inflammation5 (18.5)3 (14.2)2 (33.2)
          Fibrotic alveolar septa2 (7.4)1 (4.8)1 (16.7)
          Necrotic tissue2 (7.4)1 (4.8)1 (16.7)
          Fibrocollagenous tissue1 (3.7)1 (4.8)0 (0.0)
          Haemorrhagic lung tissue3 (11.1)3 (14.2)0 (0.0)
          Entrapped gland1 (3.7)0 (0.0)1 (16.7)

        Data are presented as n (%), unless otherwise stated. n=65.

        PreviousNext
        Back to top
        Vol 5 Issue 4 Table of Contents
        ERJ Open Research: 5 (4)
        • Table of Contents
        • Index by author
        Email

        Thank you for your interest in spreading the word on European Respiratory Society .

        NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

        Enter multiple addresses on separate lines or separate them with commas.
        Performance of transbronchial cryobiopsy in eccentrically and adjacently orientated radial endobronchial ultrasound lesions
        (Your Name) has sent you a message from European Respiratory Society
        (Your Name) thought you would like to see the European Respiratory Society web site.
        CAPTCHA
        This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
        Print
        Citation Tools
        Performance of transbronchial cryobiopsy in eccentrically and adjacently orientated radial endobronchial ultrasound lesions
        Sze Shyang Kho, Swee Kim Chan, Mei Ching Yong, Siew Teck Tie
        ERJ Open Research Oct 2019, 5 (4) 00135-2019; DOI: 10.1183/23120541.00135-2019

        Citation Manager Formats

        • BibTeX
        • Bookends
        • EasyBib
        • EndNote (tagged)
        • EndNote 8 (xml)
        • Medlars
        • Mendeley
        • Papers
        • RefWorks Tagged
        • Ref Manager
        • RIS
        • Zotero
        Share
        Performance of transbronchial cryobiopsy in eccentrically and adjacently orientated radial endobronchial ultrasound lesions
        Sze Shyang Kho, Swee Kim Chan, Mei Ching Yong, Siew Teck Tie
        ERJ Open Research Oct 2019, 5 (4) 00135-2019; DOI: 10.1183/23120541.00135-2019
        del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
        Full Text (PDF)

        Jump To

        • Article
          • Abstract
          • Abstract
          • Introduction
          • Materials and methods
          • Results
          • Discussion
          • Acknowledgement
          • Footnotes
          • References
        • Figures & Data
        • Info & Metrics
        • PDF

        Subjects

        • Lung imaging
        • Tweet Widget
        • Facebook Like
        • Google Plus One

        More in this TOC Section

        Original articles

        • Endobronchial autologous BM-MSCs in IPF patients
        • Effect of β-blockers on the risk of COPD exacerbations
        • Recurrence of symptoms after childhood LRTI
        Show more Original articles

        Lung imaging

        • Characterisation of hemidiaphragm dysfunction using DCR
        • Lung ultrasound assessment for pneumothorax
        • Diaphragmatic motion recorded by M-mode ultrasonography
        Show more Lung imaging

        Related Articles

        Navigate

        • Home
        • Current issue
        • Archive

        About ERJ Open Research

        • Editorial board
        • Journal information
        • Press
        • Permissions and reprints
        • Advertising

        The European Respiratory Society

        • Society home
        • myERS
        • Privacy policy
        • Accessibility

        ERS publications

        • European Respiratory Journal
        • ERJ Open Research
        • European Respiratory Review
        • Breathe
        • ERS books online
        • ERS Bookshop

        Help

        • Feedback

        For authors

        • Instructions for authors
        • Publication ethics and malpractice
        • Submit a manuscript

        For readers

        • Alerts
        • Subjects
        • RSS

        Subscriptions

        • Accessing the ERS publications

        Contact us

        European Respiratory Society
        442 Glossop Road
        Sheffield S10 2PX
        United Kingdom
        Tel: +44 114 2672860
        Email: journals@ersnet.org

        ISSN

        Online ISSN: 2312-0541

        Copyright © 2023 by the European Respiratory Society