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Interventional
Cryotherapy & Transbronchial Cryobiopsy
Added by Dr. Andrew · Last updated 2024-01-15
Overview
Cryotherapy uses extreme cold (-89°C) delivered via a flexible cryoprobe to freeze and destroy endobronchial tissue (tumor debulking, granulation tissue) or to obtain large, well-preserved tissue biopsies. Cryobiopsy has become an important tool for ILD diagnosis.
Key Points
- 1Cryotherapy (ablation): freeze-thaw cycles destroy tissue; used for endobronchial tumor debulking, granulation tissue, papillomas
- 2Cryobiopsy (biopsy): freeze-adhere technique — probe freezes tissue, extracted with specimen attached
- 3Cryobiopsy vs forceps TBB: larger specimens (5–10x), better preserved architecture, higher diagnostic yield for ILD
- 4Diagnostic yield for ILD: cryobiopsy ~80% vs forceps TBB ~50% vs VATS ~90%
- 5Complications: bleeding (most common, 5–15%), pneumothorax (2–5%), acute exacerbation of ILD (<1%)
- 6Fluoroscopy guidance recommended to reduce pneumothorax risk
Clinical Pearls
- Cryobiopsy for ILD: discuss at multidisciplinary team (MDT) meeting — pathology + radiology + pulmonology
- Balloon tamponade: have Fogarty balloon ready for hemostasis during cryobiopsy
- Probe size: 1.9 mm probe for standard bronchoscopes; 2.4 mm for larger specimens
- Freeze time: 3–5 seconds for biopsy; 20–30 seconds for ablation
Board High-Yield
Exam Focus- Cryobiopsy yield for ILD: ~80% — between forceps TBB (50%) and VATS (90%)
- Advantage over forceps: larger, better-preserved specimens with intact architecture
- Main complication: bleeding — have balloon tamponade ready
- ILD cryobiopsy: requires MDT discussion for diagnosis (pathology + radiology + clinical)
- Cryotherapy for endobronchial tumor: palliative debulking — not curative
ABIM Exam Weight
5%
Interventional Pulmonology represents approximately 5% of the PCCM certification exam.