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Irene Mommers



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    P2.05 - Interventional Diagnostic/Pulmonology (ID 168)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Interventional Diagnostics/Pulmonology
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.05-02 - Added Value of Transbronchial Cryobiopsy Sampling in Navigation Bronchoscopy for Small Pulmonary Nodules (Now Available) (ID 1442)

      10:15 - 18:15  |  Author(s): Irene Mommers

      • Abstract
      • Slides

      Background

      There is an increased demand for diagnostic procedures for incidental nodules and suspected early stage lung cancer detected on CT. Endobronchial diagnosis using advanced techniques have been able to increase diagnostic yield when compared to previous (semi-) blind transbronchial biopsy. Yet even when state of the art techniques such as intra-operative cone beam CT imaging (cbCT), radial ultrasound miniprobes and / or electromagnetic navigation technology (EMN) are used, in up to 30% of procedures no final histological diagnosis is made even when these small (<2cm) lesions are reached. In this study we aim to investigate the added value of transbronchial cbCT controlled cryobiopsy for peripheral pulmonary nodule evaluation.

      Method

      From a case series of 97 patients who underwent navigation bronchoscopy with histological sampling using either forceps biopsy, cryobiopsy or both were included for analysis. In our routine 6-10 forceps biopsy samples are obtained and when possible followed by a single or repeated cryobiopsy using 3-dimensional cbCT imaging guidance for confirmation for target lesion access during sampling. Retrospective evaluation of specimen quality was performed by a blinded expert pathologist [KG] using a visual analog score for specimen quality classification (range 1-5: very poor to very good). Student T and Pearson chi-square testing were used.

      Result

      The mean nodule size was 14 mm (range 4-43mm). In total 37 cryobiopsy specimens were obtained (from n=33 patients). In 31 samples direct comparison of cryobiopsy and forceps biopsy specimens was available from the same target lesions. The cryobiopsy specimens were larger and showed a better quality than the forceps biopsies, with a mean specimen quality score of 4.2 ± 0,2 compared with 2.9 ± 0,2 (p<0.001). However, the overall sensitivity to prove malignant or benign origin of nodules using cryobiopsy was 43% (16 out of 37) compared to 78% (76 out of 97) for forceps biopsies (p<0.001).

      Conclusion

      Navigation bronchoscopy guided cryobiopsy sampling for small peripheral pulmonary nodules is feasible and renders specimens of significantly better quality with less artefacts and larger size. However, the diagnostic yield is still inferior to forceps biopsy. This can likely be attributed to probe stiffness resulting in mis-alignment in these small nodules and to the fact that the complex navigation procedure allows for obtaining only one single cryobiopsy sample in the vast majority of cases.

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