Endoscopic procedure
bleeding, atelectasis, TBLC
BLEEDING, ATELECTASIS, PNEUMOTHORAX
All procedures were performed under general anesthesia with the use of an endotracheal tube allowing the introduction of the Fogarty balloon in a separate channel (Bronchoflex-set, Rüsch.Inc, Duluth, MN, USA). To minimize the risk of atelectasis during the procedure, a positive end-expiratory pressure (PEEP) of minimum 5 cmHIn both groups, when the catheter seemed in correct position, the ENB sensor was exchanged for a rEBUS mini-probe imaging (UM- S20-17S Radial EBUS miniprobe; Olympus, Tokyo, Japan), and six forceps TBB were subsequently performed (Radial Jaw 4, Boston Scientific®, MA, USA). Then, a TBLC sample was obtained through a flexible cryoprobe of 115 cm in length and 1.9 mm (multiple-use) or 1,7 mm (single-use) in diameter (ERBE, Medizintechnik GmbH, Tubingen, Germany) inserted into the ENB catheter. Once in position, the probe was cooled for 8 s; then the catheter, the cryoprobe, and the bronchoscope were removed out of the airway, and the pre-positioned Fogarty balloon was inflated to control potential severe bleeding. For some patients in the CBCT group, no cryobiopsy was performed if the nodule appeared closer than expected to the pleura during CBCT acquisition (lesion in contact or at less than 1 cm of the pleura) and if the investigator estimated that the diagnosis could be reasonably reached with the forceps TBB only (biopsy tool located inside or in front of the lesion on CBCT reconstruction).Biopsy specimens were fixed in 10% formalin and embedded in paraffin. Hematoxylin and eosin as well as Masson's Trichrome, Giemsa staining were performed as well as immunostaining against pancytokeratins.Within three hours after the procedure, a chest radiograph was obtained to detect eventual pneumothorax. All patients stayed at hospital for one night after the procedure for monitoring in order to identify relapse of bleeding and subacute pneumothorax.