Radial EBUS-Guided Cryobiopsy of Peripheral Lung Lesions With Flexible Bronchoscopy Without Using Guide-Sheath.

BACKGROUND: A guide-sheath (GS) is conventionally used as a conduit for biopsy forceps under the guidance of radial endobronchial ultrasound (REBUS) for sampling the peripheral pulmonary lesions (PPLs). As compared with forceps, the cryoprobe has the advantage of obtaining larger samples. There is a paucity of literature on the use of cryobiopsy for PPL. We evaluated the diagnostic yield and safety of the REBUS-guided cryobiopsy (REBUS-CB) without using GS for the diagnosis of PPL. METHODS: We retrospectively analyzed the database of 126 patients with PPL between November 2015 and December 2019. The REBUS-CB was performed using a flexible bronchoscopy without GS. Multidisciplinary consensus diagnostic yield was determined and procedural complications were recorded. RESULTS: The histopathologic diagnosis by REBUS-CB, which is the primary objective of the study was obtained in 99 (78.6%) of total 126 cases. Yield was significantly higher in central lesions as compared to adjacent lesions visualized by the REBUS probe (81.4% versus 53.8%, P=0.021) but not significantly different between large (≥30 mm) and small (<30 mm) lesions (81.6% versus 71.8%, P=0.214). The average largest diameter of biopsy specimens was 6.9 mm (range 1-12, SD 2.132). We witnessed moderate bleeding in 7 (5.6%) and post procedure hypoxic respiratory failure in 4 (3.2%) cases which could be managed without escalation of care. CONCLUSION: The REBUS-CB from peripheral lung lesions are feasible even without using GS and significantly large samples can be obtained.

Evaluation of Gall Bladder Stones Using Susceptibility Weighted Imaging.

OBJECTIVE: To evaluate the visualization of gallbladder stones on susceptibility-weighted imaging (SWI). MATERIALS AND METHODS: Imaging data from 47 patients who underwent clinically indicated cholecystectomy was reviewed. Breath-hold SWI was added to the magnetic resonance imaging protocol and magnitude and phase data was reviewed for gall-stones visualization. Phase signature, that is, diamagnetic, paramagnetic, or mixed, was also noted in the stones. Magnetic susceptibility value of surgically extracted gallstones were imaged ex vivo (n = 37). RESULTS: In 45 of 47 cases, gallstones were surgically confirmed. In 43 cases, gallstones were visualized in the SWI. In 1 case, although routine imaging failed, stones were visualized on SWI. In 29 diamagnetic, 7 paramagnetic and 9 cases mixed phase were seen. In an ex vivo study, magnetic susceptibility of stones was found ranging between -0.102 and -0.916 ppm for diamagnetic and 0.203 and 486 ppm for paramagnetic stones. CONCLUSIONS: Gallbladder stones can be visualized with SWI and may be added to the routine magnetic resonance imaging protocol for its evaluation.