The cryobiopsy of peripheral pulmonary nodules in different modalities of navigational bronchoscopy

Abstract

SUMMARY Introduction Peripheral pulmonary nodules (PPNs) can be a radiological manifestation of early-stage lung cancer. Pathohistological diagnosis is required before treatment. Materials and methods We present the first results of PPNs cryobiopsy using a 1.1 mm flexible cryoprobe at Special Hospital Radiochirurgia Zagreb, with different modalities of navigational bronchoscopy. For nodules in the intermediate zone of the lung parenchyma, a combination of virtual bronchoscopic navigation (VBN), ultrathin bronchoscope (UTB), and radial probe endobronchial ultrasound (RP-EBUS) was used. For nodules in the peripheral, outer third of the lung parenchyma, electromagnetic navigational bronchoscopy with integrated digital tomosynthesis (DT-ENB) was employed. Results A pathohistological diagnosis of PPNs was confirmed in 37 of 42 patients (88%). All had a positive RP-EBUS finding immediately before sample collection for histological analysis, regardless of the navigation modality or nodule characteristics. Of the five patients in whom a histological diagnosis was not confirmed, four patients (80%) had a negative radial ultrasound finding. According to CTCAE, grade 2 complications were recorded in 12% of the patients, and grade 3 complications in 2% of the patients. Conclusion A high level of successful diagnosis of early-stage lung cancer was achieved using navigational bronchoscopy and cryobiopsy for PPNs.