Transbronchial lung parenchyma cryoablation with a novel flexible cryoprobe in an in vivo porcine model

Xiaoxuan Zheng; Haibin Yuan; Chuanjia Gu; Chi Yang; Fangfang Xie; Xueyan Zhang; Binkai Xu; Jiayuan Sun

doi:10.1016/j.diii.2021.08.005

Transbronchial lung parenchyma cryoablation with a novel flexible cryoprobe in an in vivo porcine model

Diagn Interv Imaging. 2022 Jan;103(1):49-57. doi: 10.1016/j.diii.2021.08.005. Epub 2021 Sep 27.

Authors

Xiaoxuan Zheng¹, Haibin Yuan², Chuanjia Gu¹, Chi Yang³, Fangfang Xie¹, Xueyan Zhang⁴, Binkai Xu³, Jiayuan Sun⁵

Affiliations

¹ Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China.
² Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China.
³ Research and Development Department, AccuTarget MediPharma (Shanghai) Co., Ltd., 201318 Shanghai, China; School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, 200093 Shanghai, China.
⁴ Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China.
⁵ Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China. Electronic address: xkyyjysun@163.com.

PMID: 34593335
DOI: 10.1016/j.diii.2021.08.005

Abstract

Purpose: The purpose of this study was to evaluate the feasibility and safety of transbronchial cryoablation with a novel flexible cryoprobe using nitrogen as the refrigerant in an in vivo porcine model of lung parenchyma.

Materials and methods: A novel flexible cryoprobe using nitrogen as the refrigerant was used for transbronchial cryoablation of lung parenchyma in six normal female pigs. The cryoprobe was delivered to the distal bronchus in the bilateral porcine lungs via the bronchoscopic working channel under virtual bronchoscopy guidance. The position was confirmed with real-time computed tomography (CT). The whole procedure included two freeze-thaw cycles (15 min and 2 min, respectively). CT images were obtained during cryoablation and at 24 h, one week, two weeks and four weeks after the treatment to assess the effectiveness and safety of the procedure. Ablation zone tissue samples were obtained at 24 h and four weeks after the cryoablation for further histopathological analysis.

Results: All ablation procedures (12/12; 100%) were performed successfully. No major complications occurred during the procedure or the observation period. The ablation zones were clearly depicted on CT with a maximal ablation zone volume at 24 h (21.88 ± 12.61 [SD] cm³) compared to 3.64 ± 2.06 (SD) cm³ and 10.73 ± 3.84 (SD) cm³ at the end of the 1st and 2nd freeze-thaw cycles, respectively (P < 0.001). Histopathological analysis revealed that a coagulative necrotic zone was formed along the target bronchus, with obvious vascular occlusion and hemorrhage 24 h after treatment. The lesions gradually formed fibrosis after four weeks.

Conclusion: The novel flexible bronchoscopy-guided cryoablation is a feasible, safe and effective modality in an in vivo porcine model of peripheral normal lung parenchyma, suggesting potential capabilities for the treatment of peripheral lung cancer in humans.

Keywords: Bronchoscopy; Cryoablation; Lung parenchyma; Nitrogen; Porcine model.

MeSH terms

Animals
Bronchoscopy
Cryosurgery*
Female
Lung / diagnostic imaging
Lung / surgery
Lung Neoplasms* / diagnostic imaging
Lung Neoplasms* / surgery
Swine
Tomography, X-Ray Computed