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Radial Probe Ultrasound-Guided Cryobiopsy
Ilya G Berim1, Ali I Saeed, Ahmed Awab
1Departments of *Pulmonary, Critical Care and Sleep Medicine §Pathology, Creighton University, Omaha, NE †Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of New Mexico, Albuquerque, NM ‡Department of Medicine, Section of Pulmonary Diseases and Critical Care, Center for Interventional Pulmonology, University of Oklahoma, Oklahoma City, OK ∥Department of Internal Medicine, Pulmonary, Critical Care and Sleep Medicine, Faith Regional Healthcare System, Norfolk, NE.
Cryobiopsy improves diagnostic yield for interstitial lung disease but risks bleeding. Combining radial ultrasound with fluoroscopy may help identify safe targets, potentially reducing bleeding complications during this lung biopsy procedure.
Area of Science:
- Pulmonology
- Interventional Pulmonology
- Medical Imaging
Background:
- Fluoroscopy-guided transbronchial forceps biopsy offers limited diagnostic value for interstitial lung disease (ILD).
- Cryobiopsy demonstrates higher diagnostic yield in ILD due to larger tissue samples and preserved lung architecture.
- Cryobiopsy is associated with increased risks of pneumothorax and significant airway bleeding.
Purpose of the Study:
- To evaluate the utility of radial endobronchial ultrasound (EBUS) in conjunction with fluoroscopy for guiding cryobiopsy in patients with suspected ILD.
- To assess the potential of this combined imaging approach to mitigate bleeding risks associated with cryobiopsy.
Main Methods:
- Radial endobronchial ultrasound was employed to identify lung parenchyma targets adjacent to major blood vessels.
- Fluoroscopy was used for airway localization and marking prior to cryoprobe insertion.
- A 3-second cryobiopsy was performed after confirming target localization via combined imaging.
Main Results:
- Radial ultrasound facilitated the identification of lung parenchyma targets without adjacent major blood vessels.
- The described technique allows for precise localization of the cryoprobe before biopsy.
- Simultaneous use of radial ultrasound and fluoroscopy shows promise in potentially decreasing bleeding complications.
Conclusions:
- Combining radial ultrasound with fluoroscopy may enhance the safety of cryobiopsy for diagnosing interstitial lung disease.
- This integrated imaging approach aids in selecting optimal biopsy sites, minimizing vascular injury.
- Further research is warranted to confirm the reduction in bleeding complications in ILD patients undergoing cryobiopsy.
