Applications of cryobiopsy in airway, pleural, and parenchymal disease

ABSTRACT

Introduction

Cryobiopsy is a novel diagnostic technique for thoracic diseases, which has been extensively investigated over the past 20 years. It was originally proposed for the diagnosis of endobronchial lesions and diffuse parenchymal lung disease due to limitations of conventional sampling techniques including small size and presence of artifacts.

Areas covered

We review recent evidence related to the expanding use of cryobiopsy in thoracic diseases. To identify references, the MEDLINE database was searched from database inception until May 2022 for case series, cohort studies, randomized controlled trials, systematic reviews, and meta-analyses related to cryobiopsy.

Expert opinion

Cryobiopsy has expanding applications in the field of thoracic diseases. Evidence to support transbronchial cryobiopsy as an alternative to surgical lung biopsy is increasing and was recently endorsed as a conditional recommendation by the latest American Thoracic Society guideline update for Idiopathic Pulmonary Fibrosis. Developments in technology and technique, in particular the availability of a 1.1 mm flexible cryoprobe, have extended applications to pulmonary diseases, including diagnosis of interstitial lung diseases, peripheral pulmonary lesions, and lung transplant rejection.

KEYWORDS:

• Cryobiopsy
• transbronchial biopsy
• bronchoscopy
• thoracoscopy
• endobronchial ultrasound

Article highlights

• Cryobiopsy is a mechanism of tissue acquisition that is able to obtain specimens that are larger and contain less artifact than conventional flexible forceps

• Cryobiopsy has potential applications across many thoracic diseases including those involving the airways (endobronchial cryobiopsy), parenchyma (transbronchial cryobiopsy), mediastinum (transbronchial mediastinal cryobiopsy) and pleura (thoracoscopic cryobiopsy)

• The latest American Thoracic Society Guideline Update for the diagnosis of Idiopathic Pulmonary Fibrosis now support transbronchial cryobiopsy as an acceptable alternative to surgical lung biopsy in centers with appropriate expertise

• A novel, 1.1 mm flexible cryoprobe allows for transbronchial cryobiopsy without removing the bronchoscope from the airway, improving safety of the procedure

• Efforts to standardize technique have improved safety of the procedure and will further improve the clinical utility of cryobiopsy

Declaration of interest

Dr. Thiboutot reports speaker honorarium from Erbe Elektromedizin GmbH. Dr. Yarmus holds a cryoprobe patent but has relinquished any and all personal proceeds to Johns Hopkins University. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.