Bronchoscopic mucosal cryobiopsies as a method for studying airway disease

TY - JOUR

T1 - Bronchoscopic mucosal cryobiopsies as a method for studying airway disease

AU - Hvidtfeldt, Morten

AU - Pulga, Alexis

AU - Hostrup, Morten

AU - Sanden, Caroline

AU - Mori, Michiko

AU - Bornesund, Daisy

AU - Larsen, Klaus Richter

AU - Erjefält, Jonas S

AU - Porsbjerg, Celeste

N1 - CURIS 2019 NEXS 011

PY - 2019/1

Y1 - 2019/1

N2 - Background: Investigating disease mechanisms and treatment responses in obstructive airway diseases with invasive sampling are hampered by the small size and mechanical artefacts that conventional forceps biopsies suffer from. Endoscopic cryobiopsies are larger and more intact and are being increasingly used. However, the technique has not yet been explored for obtaining mucosa biopsies. Objective: To investigate differences in size and quality of endobronchial mucosal biopsies obtained with cryotechnique and forceps. Further, to check for eligibility of cryobiopsies to be evaluated with immunohistochemistry and in situ hybridization and to investigate tolerability and safety of the technique. Methods: Endobronchial mucosal biopsies were obtained with cryotechnique and forceps from patients with haemoptysis undergoing bronchoscopy and evaluated by quantitative morphometry, automated immunohistochemistry and in situ hybridization. Results: A total of 40 biopsies were obtained from 10 patients. Cross-sectional areas were threefold larger in cryobiopsies (median: 3.08 mm 2 (IQR: 1.79) vs 1.03 mm 2 (IQR: 1.10), P < 0.001). Stretches of intact epithelium were 8-fold longer (median: 4.61 mm (IQR: 4.50) vs 0.55 mm (IQR: 1.23), P = 0.001). Content of glands (median: 0.095 mm 2 (IQR: 0.30) vs 0.00 mm 2 (IQR: 0.01), P = 0.002) and airway smooth muscle (median: 0.25 mm 2 (IQR: 0.30) vs 0.060 mm 2 (IQR: 0.11), P = 0.02) was higher in the cryobiopsies compared with forceps biopsies. Further, the cryobiopsies had well-preserved protein antigens and mRNA. Mild to moderate bleeding was the only complication observed. Conclusion and clinical relevance: By yielding significantly larger and more intact biopsies, the cryotechnique represents a valuable new research tool to explore the bronchi in airway disease. Ultimately with the potential to create better understanding of underlying disease mechanisms and improvement of treatments.

AB - Background: Investigating disease mechanisms and treatment responses in obstructive airway diseases with invasive sampling are hampered by the small size and mechanical artefacts that conventional forceps biopsies suffer from. Endoscopic cryobiopsies are larger and more intact and are being increasingly used. However, the technique has not yet been explored for obtaining mucosa biopsies. Objective: To investigate differences in size and quality of endobronchial mucosal biopsies obtained with cryotechnique and forceps. Further, to check for eligibility of cryobiopsies to be evaluated with immunohistochemistry and in situ hybridization and to investigate tolerability and safety of the technique. Methods: Endobronchial mucosal biopsies were obtained with cryotechnique and forceps from patients with haemoptysis undergoing bronchoscopy and evaluated by quantitative morphometry, automated immunohistochemistry and in situ hybridization. Results: A total of 40 biopsies were obtained from 10 patients. Cross-sectional areas were threefold larger in cryobiopsies (median: 3.08 mm 2 (IQR: 1.79) vs 1.03 mm 2 (IQR: 1.10), P < 0.001). Stretches of intact epithelium were 8-fold longer (median: 4.61 mm (IQR: 4.50) vs 0.55 mm (IQR: 1.23), P = 0.001). Content of glands (median: 0.095 mm 2 (IQR: 0.30) vs 0.00 mm 2 (IQR: 0.01), P = 0.002) and airway smooth muscle (median: 0.25 mm 2 (IQR: 0.30) vs 0.060 mm 2 (IQR: 0.11), P = 0.02) was higher in the cryobiopsies compared with forceps biopsies. Further, the cryobiopsies had well-preserved protein antigens and mRNA. Mild to moderate bleeding was the only complication observed. Conclusion and clinical relevance: By yielding significantly larger and more intact biopsies, the cryotechnique represents a valuable new research tool to explore the bronchi in airway disease. Ultimately with the potential to create better understanding of underlying disease mechanisms and improvement of treatments.

U2 - 10.1111/cea.13281

DO - 10.1111/cea.13281

M3 - Journal article

C2 - 30244522

SN - 0954-7894

VL - 49

SP - 27

EP - 34

JO - Clinical Allergy

JF - Clinical Allergy

IS - 1

ER -