Cryobiopsy with radial‐endobronchial ultrasound (Cryo‐Radial) has comparable diagnostic yield with higher safety in comparison with computed tomography‐guided transthoracic biopsy for peripheral pulmonary lesions : an exploratory randomised study
Abstract Background Computed tomography‐guided transthoracic biopsy (CT‐TTB) is the ‘gold standard’ biopsy for lung nodules. Radial‐endobronchial ultrasound (R‐EBUS) bronchoscopy is another recommended biopsy but carries a lower diagnostic yield. Addition of cryobiopsy with R‐EBUS (Cryo‐Radial) has shown promising results. There are no studies comparing CT‐TTB with Cryo‐Radial biopsy. Aim The co‐primary aims were the diagnostic yeild and safety. The secondary aim: ability to test epidermal growth factor receptor (EGFR). Methods A randomised controlled, multicentre exploratory study was conducted at three tertiary hospitals. Patients with nodules >1 cm on CT of the chest were randomised to CT‐TTB or Cryo‐Radial. With Cryo‐Radial, patients had 1–3 cryo‐biopsies in addition to at least one R‐EBUS biopsy through the 2.6 mm guide sheath. Results Forty‐eight patients were randomised: 22 to CT‐TTB and 26 to Cryo‐Radial. Sixteen in the CT‐TTB and 20 in the Cryo‐Radial received the allocated biopsy. The diagnostic yield was CT‐TTB 93.8% (15/16) versus Cryo‐Radial 85% (17/20) P= 0.61 and the odds ratio was 0.37. For 5/13 (38%), a diagnosis was solely made on cryobiopsy. Eleven (78%) of 14 in CT‐TTB versus 7/10 (70%) Cryo‐Radial were suitable for EGFR testing P= 0.66, with odds ratio 0.63. Pneumothorax occurrence was 44% (7/16) in CT‐TTB versus 4.2% (1/24) in Cryo‐Radial. Two (12.5%) of 16 CT‐TTB required chest drain insertion. Conclusion Cryo‐Radial is comparable in diagnostic yield and ability to perform EGFR testing with a significantly lower risk of pneumothorax, compared with CT‐TTB. Cryo‐Radial has the additional advantage of mediastinal staging during the same procedure with Linear‐EBUS and is a promising first‐line tool in the diagnostic method of lung cancer..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:53 |
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| Enthalten in: |
Internal Medicine Journal - 53(2023), 8, Seite 1390-1399 |
| Beteiligte Personen: |
Herath, Samantha [VerfasserIn] |
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| Anmerkungen: |
© 2023 Royal Australasian College of Physicians |
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| Umfang: |
10 |
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| doi: |
10.1111/imj.15833 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
WLY015988163 |
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| 245 | 1 | 0 | |a Cryobiopsy with radial‐endobronchial ultrasound (Cryo‐Radial) has comparable diagnostic yield with higher safety in comparison with computed tomography‐guided transthoracic biopsy for peripheral pulmonary lesions |b an exploratory randomised study |
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| 520 | |a Abstract Background Computed tomography‐guided transthoracic biopsy (CT‐TTB) is the ‘gold standard’ biopsy for lung nodules. Radial‐endobronchial ultrasound (R‐EBUS) bronchoscopy is another recommended biopsy but carries a lower diagnostic yield. Addition of cryobiopsy with R‐EBUS (Cryo‐Radial) has shown promising results. There are no studies comparing CT‐TTB with Cryo‐Radial biopsy. Aim The co‐primary aims were the diagnostic yeild and safety. The secondary aim: ability to test epidermal growth factor receptor (EGFR). Methods A randomised controlled, multicentre exploratory study was conducted at three tertiary hospitals. Patients with nodules >1 cm on CT of the chest were randomised to CT‐TTB or Cryo‐Radial. With Cryo‐Radial, patients had 1–3 cryo‐biopsies in addition to at least one R‐EBUS biopsy through the 2.6 mm guide sheath. Results Forty‐eight patients were randomised: 22 to CT‐TTB and 26 to Cryo‐Radial. Sixteen in the CT‐TTB and 20 in the Cryo‐Radial received the allocated biopsy. The diagnostic yield was CT‐TTB 93.8% (15/16) versus Cryo‐Radial 85% (17/20) P= 0.61 and the odds ratio was 0.37. For 5/13 (38%), a diagnosis was solely made on cryobiopsy. Eleven (78%) of 14 in CT‐TTB versus 7/10 (70%) Cryo‐Radial were suitable for EGFR testing P= 0.66, with odds ratio 0.63. Pneumothorax occurrence was 44% (7/16) in CT‐TTB versus 4.2% (1/24) in Cryo‐Radial. Two (12.5%) of 16 CT‐TTB required chest drain insertion. Conclusion Cryo‐Radial is comparable in diagnostic yield and ability to perform EGFR testing with a significantly lower risk of pneumothorax, compared with CT‐TTB. Cryo‐Radial has the additional advantage of mediastinal staging during the same procedure with Linear‐EBUS and is a promising first‐line tool in the diagnostic method of lung cancer. | ||
| 700 | 1 | |a Wong, Conroy |4 aut | |
| 700 | 1 | |a Dawkins, Paul |4 aut | |
| 700 | 1 | |a Veale, Andrew |4 aut | |
| 700 | 1 | |a Yap, Elaine |4 aut | |
| 700 | 1 | |a Williamson, Jonathan |4 aut | |
| 700 | 1 | |a Low, Irene |4 aut | |
| 700 | 1 | |a Mahajan, Hema |4 aut | |
| 700 | 1 | |a Prvan, Tania |4 aut | |
| 700 | 1 | |a Barnard, Stuart |4 aut | |
| 700 | 1 | |a Hawkins, Stewart |4 aut | |
| 700 | 1 | |a Cookson, Dan |4 aut | |
| 700 | 1 | |a Singh, Tushar |4 aut | |
| 700 | 1 | |a Ing, Alvin |4 aut | |
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