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Title: | Cryobiopsy with radial-endobronchial ultrasound (Cryo-Radial) has comparable diagnostic yield with higher safety in comparison to computed tomography-guided transthoracic biopsy for peripheral pulmonary lesions: An exploratory randomised study |
Authors: | Herath, S.;Wong, C.;Dawkins, P.;Veale, A.;Yap, E.;Williamson, J.;Low, I.;Mahajan, Hema;Prvan, T.;Barnard, S.;Hawkins, S.;Cookson, D.;Singh, Tushar;Ing, A. |
WSLHD Author: | Mahajan, Hema;Singh, Tushar |
Issue Date: | 2023 |
Citation: | Internal Medicine Journal 53(8):1390-1399, 2023 |
Abstract: | BACKGROUND: Computed tomography-guided transthoracic biopsy (CT-TTB) is the 'gold standard' biopsy for lung nodules. Radial-endobronchial ultrasound (R-EBUS) bronchoscopy is another recommended biopsy but carries a lower diagnostic yield. Addition of cryobiopsy with R-EBUS (Cryo-Radial) has shown promising results. There are no studies comparing CT-TTB with Cryo-Radial biopsy. AIM: The co-primary aims were the diagnostic yeild and safety. The secondary aim: ability to test epidermal growth factor receptor (EGFR). METHODS: A randomised controlled, multicentre exploratory study was conducted at three tertiary hospitals. Patients with nodules >1 cm on CT of the chest were randomised to CT-TTB or Cryo-Radial. With Cryo-Radial, patients had 1-3 cryo-biopsies in addition to at least one R-EBUS biopsy through the 2.6 mm guide sheath. RESULTS: Forty-eight patients were randomised: 22 to CT-TTB and 26 to Cryo-Radial. Sixteen in the CT-TTB and 20 in the Cryo-Radial received the allocated biopsy. The diagnostic yield was CT-TTB 93.8% (15/16) versus Cryo-Radial 85% (17/20) P = 0.61 and the odds ratio was 0.37. For 5/13 (38%), a diagnosis was solely made on cryobiopsy. Eleven (78%) of 14 in CT-TTB versus 7/10 (70%) Cryo-Radial were suitable for EGFR testing P = 0.66, with odds ratio 0.63. Pneumothorax occurrence was 44% (7/16) in CT-TTB versus 4.2% (1/24) in Cryo-Radial. Two (12.5%) of 16 CT-TTB required chest drain insertion. CONCLUSION: Cryo-Radial is comparable in diagnostic yield and ability to perform EGFR testing with a significantly lower risk of pneumothorax, compared with CT-TTB. Cryo-Radial has the additional advantage of mediastinal staging during the same procedure with Linear-EBUS and is a promising first-line tool in the diagnostic method of lung cancer. |
URI: | https://wslhd.intersearch.com.au/wslhdjspui/handle/1/8148 |
DOI: | https://dx.doi.org/10.1111/imj.15833 |
Journal: | Internal Medicine Journal |
Type: | Journal Article |
Study or Trial: | Randomized Controlled Trial Multicenter Study |
Department: | Pathology |
Facility: | Westmead |
Keywords: | Pneumothorax Lung Neoplasms Endosonography Bronchoscopy |
Appears in Collections: | Westmead Hospital 2019 - 2024 |
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