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Steinack C, Gaspert A, Gautschi F, Hage R, Vrugt B, Soltermann A, Schuurmans MM, Franzen D. Transbronchial Cryobiopsy Compared to Forceps Biopsy for Diagnosis of Acute Cellular Rejection in Lung Transplants: Analysis of 63 Consecutive Procedures. LIFE (BASEL, SWITZERLAND) 2022; 12:life12060898. [PMID: 35743931 PMCID: PMC9225122 DOI: 10.3390/life12060898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/25/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
Abstract
Background: Acute cellular rejection (ACR) is a complication after lung transplantation (LTx). The diagnosis of ACR is based on histologic findings using transbronchial forceps biopsy (FB). However, its diagnostic accuracy is limited because of the small biopsy size and crush artifacts. Transbronchial cryobiopsy (CB) provides a larger tissue size compared with FB. Methods: FB and CB were obtained consecutively during the same bronchoscopy (February 2020–April 2021). All biopsies were scored according to the ISHLT criteria by three pathologists. Interobserver agreement was scored by the kappa index. We assessed the severity of bleeding and the presence of pneumothorax. Results: In total, 35 lung transplant recipients were included, and 126 CBs and 315 FBs were performed in 63 consecutive bronchoscopies. ACR (A1–A3, minimal–moderate) was detected in 18 cases (28.6%) by CB, whereas ACR was detected in 3 cases (4.8%) by FB. Moderate and severe bleeding complicated FB and CB procedures in 23 cases (36.5%) and 1 case (1.6%), respectively. Pneumothorax occurred in 6.3% of patients. The interobserver agreement was comparable for both CB and FB. Conclusions: CB provided an improved diagnostic yield for ACR diagnosis, leading to reclassification and changes in treatment strategies in 28.6% of cases. Prospective studies should better define the role of CB after LTx.
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Affiliation(s)
- Carolin Steinack
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.G.); (R.H.); (M.M.S.); (D.F.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
- Correspondence:
| | - Ariana Gaspert
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
- Department of Pathology and Molecular Pathology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Fiorenza Gautschi
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.G.); (R.H.); (M.M.S.); (D.F.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
| | - René Hage
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.G.); (R.H.); (M.M.S.); (D.F.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
| | - Bart Vrugt
- Department of Pathology, Cantonal Hospital Münsterlingen, 8596 Münsterlingen, Switzerland;
| | | | - Macé Matthew Schuurmans
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.G.); (R.H.); (M.M.S.); (D.F.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
| | - Daniel Franzen
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.G.); (R.H.); (M.M.S.); (D.F.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
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Piro R, Taddei S, Fontana M, Scelfo C, Casalini E, Facciolongo N. Lung "holes" after cryobiopsy: a case report. BMC Pulm Med 2021; 21:274. [PMID: 34425803 PMCID: PMC8381528 DOI: 10.1186/s12890-021-01640-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transbronchial lung cryobiopsy is a safe technique increasingly used in the study of lung diseases. Until now, only a case of pneumatocele was described but this interesting condition is probably underestimated because CT scan is routinely not performed after transbronchial lung cryobiopsies. CASE PRESENTATION We report a case of a woman presenting two pneumatoceles after lung cryobiopsies performed for the study of an interstitial lung disease. The finding was obtained with a CT scan performed because of the appearance of hemoptysis, four days after the biopsies. CONCLUSIONS Small cavitations could develop after cryobiopsies in the absence of an active infection. Studies that prospectively perform CT scan of the chest in patients who have undergone these samplings could be useful to know the incidence of iatrogenic lesions.
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Affiliation(s)
- Roberto Piro
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Via Amendola 2, 42123, Reggio Emilia, Italy.
| | - Sofia Taddei
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Via Amendola 2, 42123, Reggio Emilia, Italy
| | - Matteo Fontana
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Via Amendola 2, 42123, Reggio Emilia, Italy
| | - Chiara Scelfo
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Via Amendola 2, 42123, Reggio Emilia, Italy
| | - Eleonora Casalini
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Via Amendola 2, 42123, Reggio Emilia, Italy
| | - Nicola Facciolongo
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Via Amendola 2, 42123, Reggio Emilia, Italy
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