title: Transbronchial cryobiopsy: a new tool for lung biopsies.
abstract: BACKGROUND
  Specimens from transbronchial lung biopsies lack sufficient quality due to crush artifact and are generally too small for diagnosis of diffuse lung diseases. Flexible cryoprobes have been shown to be useful in therapeutic bronchoscopy. We introduce a novel technique for obtaining lung biopsies bronchoscopically, using a flexible cryoprobe.
  
  
  OBJECTIVE
  The purpose of this study was to show the feasibility of using a cryoprobe to obtain lung biopsies during flexible bronchoscopy.
  
  
  METHODS
  Forty-one patients with radiographic signs of diffuse lung disease were selected for transbronchial biopsy. During flexible bronchoscopy, conventional transbronchial biopsies using forceps were done first. Then a flexible cryoprobe was introduced into the selected bronchus under fluoroscopic guidance. Once brought into position, the probe was cooled and then retracted with the frozen lung tissue being attached on the probe's tip. The tissue was processed for histology. After establishing a diagnosis, the specimen area was measured using a digital morphometry system.
  
  
  RESULTS
  We evaluated the biopsy samples of 41 patients. The mean specimen area was 5.82 mm(2) (0.58-20.88 mm(2)) taken by forceps compared to 15.11 mm(2) obtained using the cryoprobe (2.15-54.15 mm(2), p < 0.01). Two patients had a pneumothorax which resolved with tube thoracostomy. Biopsy-associated bleeding did not require any intervention. Transbronchial cryobiopsy contributed in a substantial number of cases to a definitive diagnosis.
  
  
  CONCLUSIONS
  Transbronchial cryobiopsy is a novel technique which allows to obtain large biopsy samples of lung parenchyma that exceed the size and quality of forceps biopsy samples. Prospective trials are needed to compare this technique with surgical lung biopsy for diagnosis of diffuse lung diseases.
authors.affiliation: Department of Pulmonary Medicine, Red Cross Medical Center, Stuttgart, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Babiak
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hetzel
authors.forename: Ganesh
authors.initials: G
authors.lastname: Krishna
authors.forename: Peter
authors.initials: P
authors.lastname: Fritz
authors.forename: Peter
authors.initials: P
authors.lastname: Moeller
authors.forename: Tahsin
authors.initials: T
authors.lastname: Balli
authors.forename: Martin
authors.initials: M
authors.lastname: Hetzel
mesh_terms: D001706:Biopsy / Q000295:instrumentation* / Q000379:methods; D001999:Bronchoscopy / Q000379:methods*; D003452:Cryosurgery; D006801:Humans; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000175:diagnosis; D012189:Retrospective Studies