Elucidating diagnostic efficacy and safety of the procedure: cryobiopsy of endobronchial lesions with a flexible bronchoscope (original) (raw)
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Radial Endobronchial Ultrasound-guided Transbronchial Cryobiopsy
Journal of bronchology & interventional pulmonology, 2019
Background: Transbronchial lung cryobiopsy (TBLC) is a novel technique that has proved its diagnostic value in various diffuse parenchymal lung diseases (DPLD). However, there is substantial variability among interventional pulmonologists in procedural technique, diagnostic yield, and complication rate. Radial endobronchial ultrasound (R-EBUS) is useful for identification of ground-glass opacity lesions and can help identify target lung parenchyma. We aim to evaluate R-EBUS in TBLC histopathologic diagnosis for patients with DPLD. Methods: This was a prospective observational study of patients with clinical and radiologic features suggestive of DPLD who underwent TBLC. The R-EBUS probe was initially advanced to the desired lobe under fluoroscopic guidance until reaching 1 cm from the pleura. R-EBUS images were identified looking for either blizzard or mixed blizzard signs. TBLC samples were sent to pathology and microbiology laboratories for diagnostic analysis. Procedural complications were recorded. Results: In total, 40 patients (16 women/24 men) with a mean age of 63 years were included. The mean area of the samples was 36.2 mm 2 (9 to 189 mm 2) with mean number of samples per procedure of 3.45 (1 to 6). Definitive diagnosis was obtained in 37 patients (92.5%). The most frequent histopathologic patterns were: usual interstitial pneumonia (37.5%), nonspecific interstitial pneumonia (17.5%), and pulmonary infection (7.5%). There were 2 pneumothoraces (5%) and 5 cases of moderate bleeding (12.5%). Conclusion: The use of R-EBUS to locate and select target lung biopsy site before TBLC might increase diagnostic yield. Randomized studies comparing TBLC histopathologic diagnosis with and without R-EBUS are needed to ascertain its clinical value.
How many samples would be optimal for endobronchial cryobiopsy?
Surgical Endoscopy, 2016
Background Cryobiopsy, which provides larger specimens without crush artifact, is a good option for the diagnosis of visible endobronchial tumors. While there are several papers on diagnostic performance, application protocols vary between centers. In this study, we aimed to find the optimal number of cryobiopsies in endobronchial tumors. Methods We prospectively involved cases with a visible endobronchial tumor in which conventional diagnostic measures failed and/or a therapeutic interventional bronchoscopy was planned. Endobronchial tumor was visualized, and four cryobiopsies were taken with a dedicated flexible probe. The samples were evaluated by a pathologist who was blinded to the order of the biopsies. The cumulative performances of one to four cryobiopsies were compared, and a complication analysis was conducted. Results A total of 50 patients were involved. Four cryobiopsies were taken from 49 patients, and a single biopsy was taken from one case. The sensitivities of one, two, three and four biopsies were 82, 93.9, 93.9 and 95.9 %, respectively. The difference in performance of one and two biopsies was significant (p = 0.031), but the third and fourth biopsies were found to be unnecessary (p = 1.0 for second versus third and p = 1.0 for second versus fourth). Bleeding risk increased when C3 cryobiopsies were taken (Odds Ratio 2.758). Conclusions When the diagnostic benefits and complication rates were considered, two cryobiopsies were found to be optimal for endobronchial tumors. In patients with nondiagnostic conventional bronchoscopy, endobronchial tumors may be diagnosed by cryobiopsy.
Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement
Lung India
Background: Bronchoscopic lung cryobiopsy (BLC) is a novel technique for obtaining lung tissue for the diagnosis of diffuse parenchymal lung diseases. The procedure is performed using several different variations of technique, resulting in an inconsistent diagnostic yield and a variable risk of complications. There is an unmet need for standardization of the technical aspects of BLC. Methodology: This is a position statement framed by a group comprising experts from the fields of pulmonary medicine, thoracic surgery, pathology, and radiology under the aegis of the Indian Association for Bronchology. Sixteen questions on
Prospective cohort of cryobiopsy in interstitial lung diseases: a single center experience
BMC Pulmonary Medicine, 2022
Rationale: Transbronchial cryobiopsy has been increasingly used to diagnose interstitial lung diseases. However, there is uncertainty regarding its accuracy and risks, mainly due to a paucity of prospective or randomized trials comparing cryobiopsy to surgical biopsy. Objectives: To evaluate the diagnostic yield and complications of cryobiopsy in patients selected by multidisciplinary discussion. Methods: This was a prospective cohort from 2017 to 2019. We included consecutive patients with suspected interstitial lung diseases being considered for lung biopsy presented at our multidisciplinary meeting. Measurements and main results: Of 112 patients, we recommended no biopsy in 31, transbronchial forceps biopsy in 16, cryobiopsy in 54 and surgical biopsy in 11. By the end of the study, 34 patients had had cryobiopsy and 24 patients, surgical biopsy. Overall pathologic and multidisciplinary diagnostic yield of cryobiopsy was 47.1% and 61.8%, respectively. The yield increased over time for both pathologic (year 1: 28.6%, year 2: 54.5%, year 3: 66.7%, p = 0.161) and multidisciplinary (year 1: 50%, year 2: 63.6%, year 3: 77.8%, p = 0.412) diagnosis. Overall rate of grade 4 bleeding after cryobiopsy was 11.8%. Cryobiopsy required less chest tube placement (11.8% vs 100%, p < 0.001) and less hospitalizations compared to surgical biopsy (26.5% vs 95.7%, p < 0.001), but hospitalized patients had a longer median hospital stay (2 days vs 1 day, p = 0.004). Conclusions: Diagnostic yield of cryobiopsy increased over time but the overall grade 4 bleeding rate was 11.8%.
Respiration; international review of thoracic diseases
Transbronchial cryobiopsies (TBCB) have recently been introduced as a promising and safer alternative to surgical lung biopsy in the diagnostic approach to diffuse parenchymal lung diseases (DPLD). Despite a substantial and expanding body of literature, the technique has not yet been standardized and its place in the diagnostic algorithm of DPLD remains to be defined. In part, this reflects concerns over the diagnostic yield and safety of the procedure, together with the rapid spread of the technique without competency and safety standards; furthermore, there is a substantial procedural variability among centers and interventional pulmonologists. We report this expert statement proposed during the third international conference on "Transbronchial Cryobiopsy in Diffuse Parenchymal Lung Disease" (Ravenna, October 27-28, 2016), which formulates evidence- and expert-based suggestions on the indications, contraindications, patient selection, and procedural aspects of the proced...
Pulmonology, 2021
Background: Transbronchial lung cryobiopsy (TBLC) is frequently described for the diagnosis of diffuse parenchymal lung diseases (DPLD). A few studies have reported transbronchial cryobiopsy for the diagnosis of peripheral pulmonary lesions (PPL's). We aimed to study the utility and safety of transbronchial cryobiopsy for the diagnosis of PPL's. Methods: We performed a systematic search of the PubMed and Embase databases to extract the relevant studies. We then performed a meta-analysis to calculate the diagnostic yields of transbronchial cryobiopsy and bronchoscopic forceps biopsy. Results: Following a systematic search, we identified nine relevant studies (300 patients undergoing cryobiopsy). All used Radial Endobronchial Ultrasound (R-EBUS) for PPL localization. The pooled diagnostic yield of transbronchial cryobiopsy was 77% (95% CI, 71%-84%) (I2 = 38.72%, p = 0.11). The diagnostic yield of forceps biopsy was 72% (95% CI, 60%-83%) (I2 = 78.56%, p < 0.01). The diagnostic yield of cryobiopsy and forceps biopsy was similar (RR 1.05, 95% CI 0.96-1.15), with a 5% risk difference for diagnostic yield (95% CI, −6% to 15%). There was significant heterogeneity (I2 = 57.2%, p = 0.017), and no significant publication bias. One severe bleeding and three pneumothoraxes requiring intercostal drain (ICD) placement (major complication rate 4/122, 1.8%) were reported with transbronchial cryobiopsy.