Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement (original) (raw)
Related papers
Diagnostic Yield and Safety of Bronchoscopic Lung Cryobiopsy in Evaluation of Lung Mass
Cureus, 2021
Background A mass lesion in the lung is a common finding seen on chest radiology. The prognosis of patients with mass lesions in the lung is capricious as malignancy is a consideration. It is essential to diagnose the underlying aetiology at the earliest with minimally invasive procedures for prompt treatment of the case. Bronchoscopic lung cryobiopsy (BLC) is a newer interventional technique in pulmonary medicine for the diagnosis of mass lesions in the lung. Materials and methods This is a retrospective study of patients reporting to a tertiary care centre who were radiologically (by computed tomography scan of the chest) diagnosed with a mass lesion of the lung and who underwent BLC during the period from January 2018 to January 2021. We analysed the diagnostic yield of the technique defined as a positive tissue diagnosis after the histopathological examination (HPE) along with the safety of the procedure. Results During the above period, we evaluated 70 patients who were diagnosed radiologically with mass lesions of the lung and underwent BLC. We obtained tissue diagnoses for 66 cases and the result of four cases was inconclusive. The diagnostic yield of the BLC procedure was 94.29%. There was no mortality and complications were minimal bleeding and small pneumothorax. Conclusion BLC is a newer technique for obtaining lung tissue via a flexible bronchoscope obviating the need for open lung biopsy. The main advantage of the technique is providing larger tissue samples with minimal or no side effects without undergoing multiple procedures as compared to other bronchoscopic or surgical methods for obtaining a diagnosis from lung tissue. BLC is a safer and promising technique in diagnosing mass lesions of the lung with better yield.
Lung Cryobiopsy Outside of the Operating Room: A Safe Alternative to Surgical Biopsy
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 2021
Objective Transbronchial lung cryobiopsy (TBLC) is a promising technique that can provide a histologic diagnosis in interstitial lung diseases (ILD) and is an alternative to surgical lung biopsy. The main concerns with the procedure are safety and diagnostic accuracy. The technique is applicable in patients unable to undergo surgical biopsy due to severe comorbidities or when patient transport to the operating room is dangerous. This study reports the initial experience with TBLC on a thoracic surgical service as a first attempt at diagnosis in patients with diffuse parenchymal lung diseases (DPLD). Methods Between May 2018 and July 2020, 32 patients underwent TBLC using bedside flexible bronchoscopy for suspected ILD on a thoracic surgical endoscopy service. Retrospective evaluation of the procedure details, complications, and diagnostic yield were analyzed and reported. Results A total of 89 pathological samples were obtained (mean 2.8 per patient). Pneumothorax and minor bleeding...
The clinical respiratory journal, 2017
Most data on transbronchial lung cryobiopsy (TBLC) are from single centers, with little evidence on the outcome of different methods for performing TBLC. To report the diagnostic yield and safety of TBLC with different procedural techniques. Retrospective multicenter study of subjects who underwent TBLC for the diagnosis of diffuse parenchymal lung diseases (DPLDs). The procedure was performed using various methods: flexible or rigid bronchoscopy, with or without the use of fluoroscopy or occlusion balloon. 128 subjects (59% women) with a mean age of 48.9 years were included. The overall diagnostic yield of TBLC was 78.1%, with a definite multidisciplinary diagnosis made in 57 (44.5%) subjects. On a multivariate analysis, the diagnostic yield was associated with number of biopsies taken (aOR [95% CI], 2.17 [1.29-3.67]). The incidence of pneumothorax was lower in subjects who underwent TBLC with fluoroscopic guidance (5.9% vs. 20.9%), (aOR [95% CI], 0.26 [0.07-0.94]). Moderate-to-sev...
Bronchoscopic Cryobiopsy for the Diagnosis of Diffuse Parenchymal Lung Disease
PLoS ONE, 2013
Background: Although in some cases clinical and radiographic features may be sufficient to establish a diagnosis of diffuse parenchymal lung disease (DPLD), surgical lung biopsy is frequently required. Recently a new technique for bronchoscopic lung biopsy has been developed using flexible cryo-probes. In this study we describe our clinical experience using bronchoscopic cryobiopsy for diagnosis of diffuse lung disease. Methods: A retrospective study of subjects who had undergone bronchoscopic cryobiopsy for evaluation of DPLD at an academic tertiary care center from January 1, 2012 through January 15, 2013 was performed. The procedure was performed using a flexible bronchoscope to acquire biopsies of lung parenchyma. H&E stained biopsies were reviewed by an expert lung pathologist. Results: Twenty-five eligible subjects were identified. With a mean area of 64.2 mm 2 , cryobiopsies were larger than that typically encountered with traditional transbronchial forceps biopsy. In 19 of the 25 subjects, a specific diagnosis was obtained. In one additional subject, biopsies demonstrating normal parenchyma were felt sufficient to exclude diffuse lung disease as a cause of dyspnea. The overall diagnostic yield of bronchoscopic cryobiopsy was 80% (20/25). The most frequent diagnosis was usual interstitial pneumonia (UIP) (n = 7). Three of the 25 subjects ultimately required surgical lung biopsy. There were no significant complications. Conclusion: In patients with suspected diffuse parenchymal lung disease, bronchoscopic cryobiopsy is a promising and minimally invasive approach to obtain lung tissue with high diagnostic yield.
Annals of the Academy of Medicine, Singapore
Diffuse parenchymal lung disease (DPLD) is encountered not only in pulmonary medicine as idiopathic interstitial pneumonias or interstitial lung disease (ILD), but also in transplant medicine, infectious disease, connective tissue diseases and drug-induced ILDs. 1 The incidence of DPLD in Singapore is currently unknown but its prevalence appears to be increasing worldwide. For example, the incidence of idiopathic pulmonary fibrosis in North America and Europe is 3 to 9 cases per 100,000 person-years and in South America and East Asia, it is reported as <4 cases per 100,000 person-years. 2 Treatment of DPLD is different ranging from steroids to antimicrobials to withdrawal of an implicated drug. Therefore, it is imperative to establish an accurate diagnosis. Data show that samples from transbronchial biopsy via flexible bronchoscopy may only provide a confirmed diagnosis in 20% to 30% of patients with ILD, even when combined with clinical and high resolution computed tomography (CT) input. 3 Biopsy samples are limited in size 3 and subject to crush artefact 4 from both the closure of forceps, as well as withdrawal through the narrow working channel of the scope. Surgical lung biopsies have a diagnostic yield of 93% to 98% but mortality ranges from 1.7% to 2.7%. 4-6 In addition, mortality is significantly higher in non-elective biopsies (16%) and risks are related to age and co-morbidities. 5 These factors have driven research in obtaining high quality lung biopsy specimens in a safer manner. Bronchoscopic cryobiopsies can obtain larger specimens 7 and meta-analyses data suggest that the diagnostic yield for DPLD is 83.7%. 6 The Joule-Thomson effect of a rapidly expanding gas (carbon dioxide) is utilised to reduce the temperature of the cryoprobe tip to-79°C. This causes cryo-adherence to tissue which then allows large biopsies to be taken. Because the scope and the cryoprobe are removed together in order to recover the sample without passing through the working channel of the bronchoscope, there is the added advantage of avoiding crush artifact. 8 Cryobiopsies have a procedure-related mortality of 0.3% and median hospitalisation is 2.6 days. 4 There is also evidence to show that bronchoscopic cryobiopsies are able to increase the diagnostic confidence in the multidisciplinary diagnosis of idiopathic pulmonary fibrosis.
Transbronchial Lung Cryobiopsy in Interstitial Lung Diseases: Best Practice
Respiration
The lung biopsy in interstitial lung disease (ILD) represents an important diagnostic step when the clinical and radiological data are insufficient for a firm diagnosis. A growing body of evidence suggests the utility of transbronchial lung cryobiopsy (TBLC) in the diagnostic algorithm of ILD as it allows, compared to transbronchial lung biopsy with conventional forceps, a better identification of complex histological patterns-such as usual interstitial pneumonia-and can provide information which has a clinical impact on the multidisciplinary discussion similar to that provided by surgical lung biopsy. Performed correctly, it appears to have a better safety profile than surgery. The decision to perform a lung biopsy should be a multidisciplinary decision process where it is felt that there is sufficient diagnostic doubt after a careful clinical evaluation including review of the computed tomograms of the thorax. The presence of severe pulmonary hypertension (> 50 mm Hg), poor lung function (FVC < 50%), or dismissed gas transfer (DLCO of < 35%) are considered relative contraindications for TBLC. Anticoagulants and antiplatelet drugs should be discontinued for the minimum period required for the specific drugs. The greatest consideration should be given to ensure the biopsy is performed safely and we recommend the use of either an endotracheal tube or rigid bronchoscopy. Deep sedation or general anesthesia allow better control of the procedure and a better patient experience. Prophylactic balloon blockers should be used to tamponade any bleeding and also to prevent overspill of blood from the segment that is being sampled. The procedure should be performed under fluoroscopy to ensure that samples are ideally obtained about 10 mm from the pleural edge. The cryoprobe is activated for about 5 s for the first biopsy and then adjusted according to the sample size obtained. With a careful standardized approach it is possible to obtain good-quality lung specimens for diagnosis in a safe manner.
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...
Respiration, 2016
literature (MEDLINE and Embase for all original articles on the DY and safety of TBLC in ILDs up to July 2015). Results: A total of 150 patients underwent SLB and 297 underwent TBLC. The median time of hospitalization was 6.1 days (SLB) and 2.6 days (TBLC; p < 0.0001). Mortality due to adverse events was observed for 2.7% (SLB) and 0.3% (TBLC) of the patients. Pneumothorax was the most common complication after TBLC (20.2%). No severe bleeding was observed. TBLC was diagnostic for 246 patients (82.8%), SLB for 148 patients (98.7%, p = 0.013). A meta-analysis of 15 investigations including 781 patients revealed an overall DY of 0.81 (0.75-0.87); the overall pooled probability of developing a pneumothorax, as retrieved from 15 studies including 994 patients, was 0.06 (95% CI 0.02-0.11). Conclusion: Cryobiopsy is safe and has lower complication and mortality rates compared to SLB. TBLC might, therefore, be considered the
Trans-bronchial lung cryobiopsy in patients at high-risk of complications
BMC Pulmonary Medicine, 2021
Background The surgical lung biopsy (SLB) is the recommended sampling technique when the pathological analysis of the lung is required in the work-up of an interstitial lung disease (ILD) but trans-bronchial lung cryobiopsy (TBLC) is increasingly recognized as an alternative approach. As TBLCs have lower mortality and morbidity risks than SLB, this study aimed to investigate the safety of TBLCs in patients at higher risk of complications and for whom SLB was not considered as an alternative. Method This prospective study was conducted in two hospitals in which TBLCs were performed in patients with body mass index (BMI) > 35, and/or older than 75 years, and/or with severely impaired lung function (FVC < 50% or DLCO < 30%), and/or systolic pulmonary artery pressure > 45 mmHg, and/or a clinically significant cardiac disease. Patients with any of these risk factors constituted the high-risk group. Clinical outcomes were compared with those obtained in patients without these ...