Transbronchial lung cryobiopsy guided by radial mini-probe endobronchial ultrasound in interstitial lung diseases - a multicenter prospective study.

INTRODUCTION: Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). Ageneral anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing it's safety could result in wider use. Prospective, observational study was conducted in three Polish pulmonology centers to evaluate safety and diagnostic yield of TBLC under conscious sedation, without intubation and bronchial blockers and with radial-EBUS guidance instead of fluoroscopy. MATERIAL AND METHODS: In patients suspected of ILD, in accordance with high resolution computer tomography (HRCT) selected lung segments were examined with radial-EBUS mini probe without aguide sheath. If the lung infiltrations were visible this locations were preferred. If not, specimens were taken from two different segments of the same lobe. Two to five biopsies with freezing time 5-8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels. RESULTS: From March 2017 to September 2019 - 114 patients (M: 59, F: 55) of mean (SD) age 54 (14) years were included to the study on the basis of medical history and HRCT. Histopathology was conclusive in 90 (79%) patients and included 16 different diagnoses (sarcoidosis, EAA, COP predominantly). 24 inconclusive biopsies of unclassifiable pulmonary fibrosis were followed up. Complications included five cases (4.4%) of pneumothorax requiring achest tube drainage and aminor and moderate bleeding in few cases. There was no need for use of balloon bronchial blockers. CONCLUSIONS: TBLC under conscious sedation guided by radial EBUS mini-probe is novel, reasonable and safe technique for histological diagnosis of ILDs.

Fast cytological evaluation of lymphatic nodes obtained during transcervical extended mediastinal lymphadenectomy.

OBJECTIVES: Evaluation of the diagnostic efficiency of the intraoperative cytological examination of lymphatic nodes obtained during transcervical extended mediastinal lymphadenectomy (TEMLA). METHODS: All mediastinal nodes obtained during consecutive TEMLA operations in patients with confirmed lung cancer were examined. Cytological imprints from cross sections of nodes were performed, fixed in 96 proof alcohol and stained with Haematoxylin-Eosin. The cytological slides were evaluated by light microscopy intraoperatively, and a standard paraffin histological examination of the same nodes was done afterwards for confirmation of the final diagnosis. RESULTS: Intraoperative cytological studies were performed in 63 patients (17 women and 46 men; overall in 453 mediastinal nodal stations) from 1 April 2009 to 28 February 2011. The mean number of nodes/procedure was 27.8. The mean time of performance of the examination was 37 min, including 7 min for smears, 13 min for staining and 17 min for microscopic examination (overall 37 min). The cytological study discovered neoplasmatic cells in 12 of 63 patients, nodal stations in 22 of 453 and nodes in 44 of 1724. According to the analysis of the 63 patients, the imprint cytology technique had a sensitivity of 92.3%, specificity of 100%, accuracy of 98.4%, positive predictive value of 100% and negative predictive value of 98.0%, as was confirmed by the final histopathological examination. CONCLUSIONS: (i) Cytological imprints examination was characterized by a very high specificity and sensitivity, is technically simpler and faster and allows for the examination of several dozens of lymphatic nodes during a single TEMLA procedure within an acceptable time, and after the exclusion of N2 nodes enables the simultaneous performance of a radical lung resection. (ii) The presented technique was the alternative for the traditional histopathological examination of the material frozen in cryostat.