Transbronchial cryolung biopsy using supraglottic airway – Technical aspects, safety and diagnostic yield

Background and objective: Transbronchial lung cryo biopsy (TBLC) is one of the commonly performed techniques for obtaining lung parenchymal tissue for pathological diagnosis of diffuse parenchymal lung diseases.TBLC is usually done under general anaesthesia in operating room through rigid bronchoscopy, whereas the conventional forceps transbronchial lung biopsy (TBLB) is done in bronchoscopy suite under moderate to deep sedation through flexible bronchoscopy.Though cryo lung biopsy (TBLC) is more invasive and expensive than flexible forceps biopsy, its yield is far better and comparable with the gold standard surgical lung biopsy.However, TBLC may not be feasible in all settings, due lack of expertise in Rigid bronchoscopy, unfitness of the patient for general anaesthesia and rigid bronchoscopy, difficult access to operating room and dedicated anaesthesiologists, and lastly, high operating room cost.Hence, we have attempted to reproduce cryo lung biopsy by doing at the bronchoscopy suite with a supraglottic airway. Methods:We performed TBLC using a supraglottic airway as a conduit with the patient in deep sedation and spontaneous breathing (without muscle relaxants), with a prophylactic balloon in place for haemostasis (similar to the rigid bronchoscopy technique), with a cryo-freezing time of 4 to 5 seconds.Here we present the technical aspects, our data on yield, safety and complications of this method. Results:We have performed TBLC for 59 adult patients (age between 18 and 80) among which 27 were females.The mean age was 52 years.A definitive pathological diagnosis was made in 84%(n=50) of patients.The complications include, mild to moderate bleeding in 96%(n=57) of the patients and pneumothorax in 3.3%(n=2) of patients.There was no severe bleeding requiring any escalation of care or mortality.The mean procedure duration was 36 minutes, and the procedures were cost-effective in terms of operating room cost, anaesthesia, and consumables to the patient.Conclusion: TBLC using a supraglottic airway is a feasible and safe technique when performed in appropriate settings with a careful patient selection.