Endobronchial ultrasound guided transbronchial cryobiopsy in peripheral lung lesions
- Autores: Mohamed Samy Torky
- Directores de la Tesis: José Luis Mate Sanz (dir. tes.), Felipe Cristobal Andreo García (dir. tes.)
- Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2018
- Idioma: español
- Tribunal Calificador de la Tesis: Jaume Ferrer Sancho (presid.), Virginia Pajares Ruiz (secret.), M. Haro Estarriol (voc.)
- Programa de doctorado: Programa de Doctorado en Medicina por la Universidad Autónoma de Barcelona
- Materias:
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- Resumen
Introduction: Radial probe endobronchial ultrasound (RP-EBUS) is a modern technique for diagnosis of peripheral lung lesions. The addition of transbronchial cryobiopsy (TBCB) could increase the diagnostic value for RP-EBUS.
Objectives: The main objective is to evaluate the efficacy and safety of RP-EBUS guided TBCB for diagnosis of peripheral lung lesions. Secondary objectives are detecting factors that could affect the efficacy of RP-EBUS guided biopsy and evaluating the efficacy of the procedure when TBCB is contraindicated.
Methods: 60 patients with peripheral lung diseases were included and divided into two groups. Group I included 45 patients who were eligible for TBCB and they subjected to forceps transbronchial biopsy (forceps TBB) and TBCB guided by RP-EBUS. Group II included 15 patients who were not eligible for TBCB and they subjected only to forceps TBB and / or cytology retrieval procedures guided by RP-EBUS. The diagnostic outcomes including digital assessment for qualitative and quantitative measures of collected samples were detected. Also, the associated complications were recorded.
Results: In group I, forceps TBB had sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of; 67.5%, 100%, 100%, 18.8% and 69.8% respectively. While TBCB had sensitivity, specificity, PPV, NPV and accuracy of 75%, 100%, 100%, 23.1%, 76.7% respectively. TBCB has achieved higher diagnostic values and better quality of samples. The sensitivity in group II was 80% and the overall results including both groups were sensitivity, specificity, PPV, NPV and accuracy of 85.2%, 100%, 100%, 42.8% and 86.7% respectively. Regarding the complications, 12 patients (20%) had bleeding but 11 (18.3%) of them had moderate bleeding (grade II) and only one patient (1.7%) had significant bleeding (grade III). One patient (1.7%) had pneumothorax and another patient (1.7%) suffered from hypoxemia.
Conclusions: RP-EBUS guided TBCB is a safe and effective technique for diagnosis of peripheral lung lesions. TBCB could achieve higher diagnostic value than forceps TBB due to better quantity and quality of the samples. Proper selection of included patients is essential to avoid serious complications that could be associated with TBCB.
