The ThinICE protocol: the combination of cryobiopsy and ultraThin bronchoscopy for the peripheral lung nodule

Introduction: Given the current challenges in sampling in not directly visibile lesions (eg, sample size and quality) we propose an alternative to standard practice: a novel technique using the “ultrathin” 3mm bronchoscope with the 1.1mm cryoprobe as sampling tool. Objective: The main aim was to prove the safety and feasability of the proposed technique, measured as occurence of Adverse Events. Secondary aim included: Diagnostic Yeld, Operative time duration, adequacy and quality of both ROSE and histology evaluation. Methods: The study monocentric, retrospective study between two groups. The “ultrathin” in which sampling was conducted with the ultrathin instrument and the 1.1mm cryoprobe (UT). The “conventional” in which sampling is obtained using the “standard” 4 or 6mm bronchoscope with forceps (FBS-Tbbx) Results: We enrolled 9 pts or the UT group and 10 for the conventional. We registered similar occurence of AEs between the two groups (4/9 UT vs 5/10 FBS-Tbbx ); mainly intraoperative bleeding which was controlled endoscopically. None of the registered AEs required further invasive procedures. The DYs were also comparable (77 vs 80%). Notably in all cases ROSE showed a richer cellularity than conventional biopsy. Operative time were similar in both groups (mean duration 39,4vs 39,2 mins). Discussion: The combination of the ultrathin instrument and the 1.1 mm cryoprobe is a safe and feasable alternative to what is considered standard practice. It could also prove to be superior given the bronchial selectivity of the instrument and the size and quality of the sample provided using the 1.1mm cryoprobe but further research is needed.