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Ruaro B, Tavano S, Confalonieri P, Pozzan R, Hughes M, Braga L, Volpe MC, Ligresti G, Andrisano AG, Lerda S, Geri P, Biolo M, Baratella E, Confalonieri M, Salton F. Transbronchial lung cryobiopsy and pulmonary fibrosis: A never-ending story? Heliyon 2023; 9:e14768. [PMID: 37025914 PMCID: PMC10070648 DOI: 10.1016/j.heliyon.2023.e14768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Background The diagnostic process of pulmonary fibrosis (PF) is often challenging, requires a collaborative effort of several experts, and often requires bioptic material, which can be difficult to obtain, both in terms of quality and technique. The main procedures available to obtain such samples are transbronchial lung cryobiopsy (TBLC) and surgical lung biopsy (SLB). Objective The purpose of this paper is to review the evidence for the role of TBLC in the diagnostic-therapeutic process of PF. Methods A comprehensive review was performed to identify articles to date that addressed the role of TBLC in the diagnostic-therapeutic process of PF using the PubMed® database. Results The reasoned search identified 206 papers, including 21 manuscripts (three reviews, one systematic review, two guidelines, two prospective studies, three retrospective studies, one cross-sectional study, one original article, three editorials, three clinical trials, and two unclassifiable studies), which were included in the final review. Conclusions TBLC is gaining increasing efficacy and improving safety profile; however, there are currently no clear data demonstrating its superiority over SLB. Therefore, the two techniques should be considered with careful rationalization on a case-by-case basis. Further research is needed to further optimize and standardize the procedure and to thoroughly study the histological and molecular characteristics of PF.
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Feasibility and Safety of Transbronchial Lung Cryobiopsy for Diagnosis of Acute Respiratory Failure with Mechanical Ventilation in Intensive Care Unit. Diagnostics (Basel) 2022; 12:diagnostics12122917. [PMID: 36552923 PMCID: PMC9777199 DOI: 10.3390/diagnostics12122917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/24/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute hypoxemic respiratory failure is common in intensive care units (ICUs). Lung biopsies may be required to make a definitive diagnosis in patients with unknown etiologies. The feasibility of transbronchial lung cryobiopsy is undetermined in patients with respiratory failure in the ICU. METHODS Patients who underwent bronchoscopy examinations with transbronchial lung cryobiopsy (TBLC) between July 2018 and December 2019 were retrospectively analyzed through medical chart review. The procedures were performed by well-experienced interventional pulmonologists. RESULTS Ten patients underwent bronchoscopy examinations with TBLC in the ICU at Chang Gung Memorial Hospital during the study period. In all patients, the diagnosis was made via pathological analysis. One patient developed pneumothorax and required chest tube placement after the procedure. None of the patients had bleeding requiring blood transfusion, and no deaths were directly related to the procedure. CONCLUSIONS TBLC is a feasible technique to obtain lung pathology in patients with acute respiratory diseases of unknown etiologies. While the complication rate may be acceptable, the procedure should be performed by experienced interventional pulmonologists. However, airway blockers and fluoroscopy are highly recommended when used according to the current guideline. We do not encourage TBLC to be performed without having airway blockers available at the bedside.
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Ronaghi R, Oh S. Transbronchial Lung Cryobiopsy for Diffuse Parenchymal Lung Disease. Semin Respir Crit Care Med 2022; 43:536-540. [PMID: 35777417 DOI: 10.1055/s-0042-1748918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Transbronchial lung cryobiopsy (TBLC) offers a minimally invasive option for the diagnosis of diffuse parenchymal lung diseases, of which interstitial lung diseases comprise the most common diagnoses. It has a high diagnostic yield with prognostic and therapeutic implications. TBLC has a favorable safety profile compared with surgical lung biopsy, but associated complications include pneumothorax and bleeding. However, TBLC techniques remain variable. Here we review the latest techniques described to maximize diagnostic yield and mitigate complications of TBLC as well as how this modality has been incorporated into guidelines.
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Affiliation(s)
- Reza Ronaghi
- Division of Pulmonary and Critical Care Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Scott Oh
- Division of Pulmonary and Critical Care Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, California
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Falerno I, Tamburro R, Collivignarelli F, Della Salda L, Navas L, Terragni R, Crisi PE, Paolini A, Simeoni F, Vignoli M. Comparison between Image-Guided Transbronchial Cryobiopsies and Thoracoscopic Lung Biopsies in Canine Cadaver: A Pilot Study. Animals (Basel) 2022; 12:ani12111388. [PMID: 35681852 PMCID: PMC9179493 DOI: 10.3390/ani12111388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/04/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary A definitive diagnosis for most pulmonary diseases is possible only through histopathological examination. The literature describes different methods of lung biopsy sampling depending on the case. However, for the diagnosis of diffuse interstitial pulmonary diseases and some peripheral neoplasms, the gold standard is represented by surgical lung biopsies. Given their invasiveness and the high percentage of risk for the patient, in most cases they are not carried out, resulting in a serious diagnostic gap. In human medicine, transbronchial lung cryobiopsies have been introduced as an alternative, which have shown high efficacy and reduced invasiveness. This study aims to evaluate the feasibility of the new technique in dogs by subjecting dog cadavers to pulmonary cryobiopsy and surgical lung biopsies, and to compare the samples obtained for histopathological quality. In total, 42 tissue samples were compared. Pulmonary cryobiopsies were smaller than surgical biopsies but with high levels of agreement upon histological evaluation. This study demonstrates the feasibility of the technique in dogs and the collection of specimens with size and histological features comparable to those from surgical biopsies. Abstract To date, the only method of sampling lung tissue with a high diagnostic yield is represented by surgical lung biopsies (SLB), which are highly invasive and have a high risk/benefit ratio. In humans, transbronchial lung cryobiopsies (TBLC) have recently been introduced, which are described to be less invasive and able to significantly increase diagnostic confidence in most patients with interstitial lung diseases. The aim of this study was to evaluate the feasibility and diagnostic yield of TBLC compared to SLB in small animals. A total of 21 pulmonary cryobiopsies under fluoroscopic and real-time CT fluoroscopic guidance and 21 video-assisted thoracoscopic surgery (VATS) lung biopsies were collected from three dog cadavers. Upon histological examination, cryobiopsy samples were smaller than VATS biopsies, but were still large enough to reach a specific diagnosis or to allow pattern recognition. Morphological features on TBLC and SLB were concordant in all cases. Cryobiopsy samples showed fewer artifacts and a higher percentage of alveolar tissue than VATS samples. TBLC is a feasible and useful alternative to SLB for lung histopathological examination in dogs. The effectiveness and reduced invasiveness of TBLC compared to SLB could represent many advantages in the diagnosis of diffuse lung diseases in small animals.
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Affiliation(s)
- Ilaria Falerno
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
- Correspondence: (I.F.); (L.D.S.)
| | - Roberto Tamburro
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
| | - Francesco Collivignarelli
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
| | - Leonardo Della Salda
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
- Correspondence: (I.F.); (L.D.S.)
| | - Luigi Navas
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy;
| | | | - Paolo Emidio Crisi
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
| | - Andrea Paolini
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
| | - Francesco Simeoni
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
| | - Massimo Vignoli
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
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Rivière F, Cazes A, Bylicki O, Le Floch H, Gaspard W, Cornetto MA, Charton F, Margery J, Grassin F. Single-centre experience of transbronchial cryobiopsy as a first choice method for the diagnosis of interstitial lung disease. Indian J Thorac Cardiovasc Surg 2022; 38:142-148. [PMID: 35221552 PMCID: PMC8857330 DOI: 10.1007/s12055-021-01299-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/04/2021] [Accepted: 11/07/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The diagnosis of interstitial lung disease is based on clinical and biological analysis associated with computed tomography (CT) pattern after discussion in multidisciplinary discussion. Lung transbronchial cryobiopsy has emerged with acceptable diagnostic reliability and low morbidity and mortality. The goal of our work is to describe our experience with lung cryobiopsy. METHODS This is monocentric and retrospective analysis of prospectively collected data on epidemiological, clinical, biological, CT, respiratory and histological features of patients with lung transbronchial cryobiopsy between January 1st, 2017, and July 1st, 2020. RESULTS Lung transbronchial cryobiopsy has been done for 23 patients with sex ratio M/F of 1.1, majority of smoker/former smoker. Thirty-nine percent of procedures were complicated by pneumothorax. On the haemorrhagic level, we reported 1 grade 2 bleeding (no serious bleeding). An histological diagnosis was obtained for 19 patients (82%). Only 4 patients needed to discuss surgical lung biopsy: 2 (8.6%) surgical lung biopsy, 1 refused surgical lung biopsy and 1 patient lost to follow-up. CONCLUSION Our results suggest that transbronchial lung cryobiopsy may be considered the first diagnostic modality instead of surgical lung biopsy for interstitial lung disease in appropriate patients. Larger studies are, however, needed to confirm our observations.
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Affiliation(s)
- Frédéric Rivière
- Respiratory Department, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - Aurélie Cazes
- Anatomopathological Department, Bichat Teaching Hospital, Paris, France
| | - Olivier Bylicki
- Respiratory Department, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - Hervé Le Floch
- Respiratory Department, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - Wanda Gaspard
- Respiratory Department, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - Marie Alice Cornetto
- Respiratory Department, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - France Charton
- Respiratory Department, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - Jacques Margery
- Respiratory Department, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - Frédéric Grassin
- Respiratory Department, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
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Scala R, Guidelli L. Clinical Value of Bronchoscopy in Acute Respiratory Failure. Diagnostics (Basel) 2021; 11:diagnostics11101755. [PMID: 34679452 PMCID: PMC8534926 DOI: 10.3390/diagnostics11101755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
Bronchoscopy may be considered the “added value” in the diagnostic and therapeutic pathway of different clinical scenarios occurring in acute respiratory critically ill patients. Rigid bronchoscopy is mainly employed in emergent clinical situations due to central airways obstruction, haemoptysis, and inhaled foreign body. Flexible bronchoscopy (FBO) has larger fields of acute applications. In intensive care settings, FBO is useful to facilitate intubation in difficult airways, guide percutaneous dilatational tracheostomy, and mucous plugs causing lobar/lung atelectasis. FBO plays a central diagnostic role in acute respiratory failure caused by intra-thoracic tumors, interstitial lung diseases, and suspected severe pneumonia. “Bronchoscopic” sampling has to be considered when “non-invasive” techniques are not diagnostic in suspected ventilator-associated pneumonia and in non-ventilated immunosuppressed patients. The combined use of either noninvasive ventilation (NIV) or High-flow nasal cannula (HFNC) with bronchoscopy is useful in different scenarios; the largest body of proven successful evidence has been found for NIV-supported diagnostic FBO in non-ventilated high risk patients to prevent and avoid intubation. The expected diagnostic/therapeutic goals of acute bronchoscopy should be balanced against the potential severe risks (i.e., cardio-pulmonary complications, bleeding, and pneumothorax). Expertise of the team is fundamental to achieve the best rate of success with the lowest rate of complications of diagnostic and therapeutic bronchoscopic procedures in acute clinical circumstances.
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Davidsen JR, Skov IR, Louw IG, Laursen CB. Implementation of transbronchial lung cryobiopsy in a tertiary referral center for interstitial lung diseases: a cohort study on diagnostic yield, complications, and learning curves. BMC Pulm Med 2021; 21:67. [PMID: 33632180 PMCID: PMC7908747 DOI: 10.1186/s12890-021-01438-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/12/2021] [Indexed: 02/07/2023] Open
Abstract
Background Transbronchial lung cryobiopsy (TBLC) has been introduced as an alternative to surgical lung biopsy (SLB) in the diagnostics of interstitial lung diseases (ILD). Despite controversy on safety, TBLC is increasingly implemented in ILD centers with an apparent diagnostic yield comparable to SLB. The aim of this study was to assess TBLC implementation experiences from a tertiary Danish ILD center regarding diagnosis, complications, and learning curves for TBLC performance. Methods TBLC was prospectively performed in a cohort of patients with unclassifiable ILD based on a preceding multidisciplinary clinical and radiological revision. TBLC was performed as an outpatient procedure with the patients in general anesthesia using a flexible bronchoscope with 1.9 or 2.4 mm cryoprobes. Learning curves for TBLC performance were calculated using cumulated sum (CUSUM) scores for diagnostic yield, pneumothorax, and bleeding. Results From February 2017 to March 2020 141 patients (86 (61%) men, median age 69 years [IQR, 60–74 years]) had TBLC performed. A histological and confirmative diagnosis was made in 101 patients (75.2%) and 124 patients (87.9%, i.e. clinical diagnostic yield), respectively, in whom idiopathic interstitial pneumonias constituted the majority (67.3%) of the clinical diagnoses. We observed 2 deaths (1.4%) within 30 days of TBLC, but no procedure-related mortality or severe bleeding. Moderate bleeding occurred in 23 patients (16.3%), pneumothorax in 21 patients (14.9%) with only 14 patients (9.9%) requiring a pleural drain. Based on the CUSUM score analysis, the diagnostic yield obtained was satisfactory throughout the period. Conclusion This study reports experiences of outpatient TBLC implementation in a tertiary referral ILD center from the largest investigated TBLC cohort in Scandinavia The diagnostic yield and prevalence of complications obtained by TBLC from this single center study on unclassifiable ILD support outpatient TBLC as a valuable and safe alternative to SLB to diagnose ILD in well-selected patients. The learning curves for TBLC were acceptable in the hands of experienced bronchoscopists.
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Affiliation(s)
- Jesper Rømhild Davidsen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark. .,Department of Respiratory Medicine, South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Kloevervaenget 2, 5000, Odense C, Denmark. .,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Inge Raadal Skov
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ida Guldbæk Louw
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Department of Respiratory Medicine, South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Kloevervaenget 2, 5000, Odense C, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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8
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Mehrad M, Colby TV, Rossi G, Cavazza A. Transbronchial Cryobiopsy in the Diagnosis of Fibrotic Interstitial Lung Disease. Arch Pathol Lab Med 2021; 144:1501-1508. [PMID: 32320274 DOI: 10.5858/arpa.2020-0007-ra] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Transbronchial cryobiopsy is an emerging procedure to obtain lung tissue for diagnosis of interstitial lung disease and has gained popularity because it is less invasive and has a lower rate of complications compared with nonselective surgical lung biopsy. OBJECTIVE.— To provide an overview of the status of the medical literature regarding transbronchial cryobiopsy. DATA SOURCES.— A literature search was performed using PubMed search engine. The terms "cryobiopsy" or "cryoprobe" and "interstitial lung disease" or "diffuse parenchymal lung disease" or "pulmonary fibrosis" were used, with the search concluding at the end of November 2019. CONCLUSIONS.— While the diagnostic yield of transbronchial cryobiopsy is slightly lower than surgical lung biopsy, a growing amount of literature suggests that with a multidisciplinary approach cryobiopsy provides diagnostic and prognostic information approaching that of surgical lung biopsy with lower morbidity and mortality.
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Affiliation(s)
- Mitra Mehrad
- From the Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Mehrad)
| | - Thomas V Colby
- the Department of Pathology, Mayo Clinic, Scottsdale, Arizona (Colby)
| | - Giulio Rossi
- the Pathology Unit, Azienda USL della Romagna, St. Maria delle Croci Hospital, Ravenna, Italy (Rossi)
| | - Alberto Cavazza
- and the Pathology Unit, Azienda USL/IRCCS di Reggio Emilia, Reggio Emilia, Italy (Cavazza)
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9
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Abstract
Transbronchial cryobiopsy, a new diagnostic procedure in patients with diffuse lung disease, provides larger and better-preserved lung specimens compared to forceps biopsy. The diagnostic yield of cryobiopsy is much better than that of forceps biopsy and slightly lower than that of surgical lung biopsy, but with a lower complication rate compared to the latter. Literature suggests that in the multidisciplinary approach to patients with diffuse lung disease cryobiopsy provides diagnostic and prognostic information similar to surgical lung biopsy. Cryobiopsy can also be performed in some patients unsuitable for surgical biopsy, yet in whom histologic input is needed.
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10
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Pannu JK, Roller LJ, Lentz RJ, Rickman OB, Aboudara MC, Chen H, Maldonado F. Cryobiopsy With Radial UltraSound Guidance (CYRUS): A Pilot Randomized Controlled Study. J Bronchology Interv Pulmonol 2020; 28:21-28. [PMID: 32694482 DOI: 10.1097/lbr.0000000000000699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 06/12/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Major airway bleeding is the most feared complication of transbronchial cryobiopsy (TBC). Radial endobronchial ultrasound (REBUS) has been used to assess the peripheral lung, primarily to identify pulmonary nodules, and also peripheral blood vessels. Using REBUS-guided TBC to avoid peripheral vasculature might reduce bleeding risk. This prospective randomized double-blind pilot trial was designed to investigate the feasibility of study procedures and inform the power calculation and clinical significance of a future large randomized trial. METHODS Consecutive TBCs were randomized to be performed with or without REBUS guidance in the same patient. A nonblinded operator obtained each biopsy while a blinded second operator managed the bleeding after each biopsy and determined when hemostasis had been obtained. Feasibility of study procedures and the ability to recruit patients were of primary interest. Time to hemostasis after each biopsy was also examined. RESULTS Forty TBCs were performed in 10 patients (4 biopsies per patient) over an enrollment period of 6 months. The time to control bleeding between biopsies was not statistically different between intervention and control arms [-14.3 (-120.1 to 92.0) s, P=0.7878]. Mean bleeding time was 139.4±59.895 seconds (REBUS 132.25± 89.305 s, non-REBUS 146.55±82.043 s). A trend towards the decreased grade of bleeding and less need for additional interventions was observed with REBUS use, but this difference did not reach statistical significance in this pilot investigation. CONCLUSION Our findings suggest that REBUS-guided TBC is feasible. We did not observe any statistically significant difference in time to hemostasis or bleeding grade in this pilot study.
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Affiliation(s)
| | - Lance J Roller
- Division of Allergy, Pulmonary and Critical Care Medicine
| | - Robert J Lentz
- Division of Allergy, Pulmonary and Critical Care Medicine.,Department of Veterans Affairs Medical Center, Nashville, TN
| | - Otis B Rickman
- Division of Allergy, Pulmonary and Critical Care Medicine
| | - Matthew C Aboudara
- Department of Pulmonary Critical Care Medicine, St. Luke's Health System, University of Missouri at Kansas City, Kansas City, MO
| | - Heidi Chen
- Department of Biostatistics, Vanderbilt University Medical Center
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Wang W, Xu J, Liu C, Feng R, Zhao J, Gao N, Jiang L, Zhang X, Han X, Ren L, Zhao X, Liu Y. The significance of multidisciplinary classifications based on transbronchial pathology in possible idiopathic interstitial pneumonias. Medicine (Baltimore) 2020; 99:e20930. [PMID: 32664089 PMCID: PMC7360311 DOI: 10.1097/md.0000000000020930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Surgical lung biopsy is regarded as the golden standard for the diagnosis of idiopathic interstitial pneumonias (IIPs). Here, we attempted to show the diagnostic accuracy of multidisciplinary classifications based on transbronchial pathology including transbronchial lung cryobiopsy (TBLC) , bronchoalveolar lavage fluid (BALF) and endobronchial ultrasound-guided transbronchial needle aspiration biopsy (EBUS-TBNA).Patients with suspected interstitial lung diseases admitted from June 1, 2016 to December 31, 2018 were involved. Patients with known causes of interstitial lung diseases and typical idiopathic pulmonary fibrosis diagnosed through clinical, radiological information were excluded. Patients with atypical idiopathic pulmonary fibrosis and possible IIPs accepted transbronchial pathological evaluation. Initial multidisciplinary diagnosis (MDD) classifications were made depending on clinical, radiological and transbronchial pathological information by a multidisciplinary team (MDT). The final MDD classifications were confirmed by subsequent therapeutic effects. All patients were followed up for at least 6 months.A total of 70 patients were finally involved. The samples of lung parenchyma extracted through TBLC were enough for confirmation of pathological diagnoses in 68.6% (48/70) cases. Samples of 6 cases were extracted by EBUS-TBNA. Bacteriological diagnoses were positive in 1 case by BALF. Pathological diagnoses of 77.1% (54/70) cases were achieved through TBLC, EBUS-TBNA and BALF. During the follow up study, the pulmonary lesions of 60% patients were improved, 11.43% were relapsed when glucocorticoid was reduced to small dose or withdrawal, 14.29% were leveled off and 8.57% were progressed. The diagnoses of 4 patients with progressed clinical feature were revised. As a result, 94.3% initial MDD classifications based on transbronchial pathology were consistent with the final MDD, and the difference of diagnostic yield wasn't significant between initial and final MDD (Z = -1.414, P = .157).Classifications of IIPs based on transbronchial pathology were useful and quite agreed with final MDD.
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Affiliation(s)
| | | | | | - Ruie Feng
- Department of Pathology, Dalian Municipal Central Hospital affiliated of Dalian Medical University, Dalian, China
| | - Junjun Zhao
- Department of Pathology, Peking Union Medical College Hospital, Beijing, China
| | - Na Gao
- Department of Respiratory
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12
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Complications and hospital admission in the following 90 days after lung cryobiopsy performed in interstitial lung disease. Respir Med 2020; 165:105934. [PMID: 32308202 DOI: 10.1016/j.rmed.2020.105934] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 12/12/2022]
Abstract
Transbronchial lung cryobiopsy (TBLC) is an emerging technique for the diagnosis of interstitial lung disease (ILD), but its risk benefit ratio has been questioned. The objectives of this research were to describe any adverse events that occur within 90 days following TBLC and to identify clinical predictors that could help to detect the population at risk. METHODS We conducted an ambispective study including all patients with suspected ILD who underwent TBLC. Data were collected concerning the safety profile of this procedure and compared to various clinical variables. RESULTS Overall, 257 TBLCs were analysed. Complications were observed in 15.2% of patients; nonetheless, only 5.4% of all patients required hospital admission on the day of the procedure. In the 30 and 90 days following the TBLC, rates of readmission were 1.3% and 3.5% and of mortality were 0.38%, and 0.78% respectively. Two models were built to predict early admission (AUC 0.72; 95% CI 0.59-0.84) and overall admission (AUC 0.76; 95% CI 0.67-0.85). CONCLUSIONS Within 90 days after TBLC, 8.9% of patients suffered a complication serious enough to warrant hospital admission. Modified MRC dyspnoea score ≥2, FVC<50%, and a Charlson Comorbidity Index score ≥2 were factors that predicted early and overall admission.
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13
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Kania A, Misiaszek M, Vašáková M, Szlubowski A, Bugalho A, Pankowski J, Szołkowska M, Roden AC, Celejewska-Wójcik N, Nastałek P, Gnass M, Sładek K. Cryobiopsy in the diagnosis of idiopathic pulmonary hemosiderosis: a case report. J Thorac Dis 2019; 11:3195-3201. [PMID: 31463151 DOI: 10.21037/jtd.2019.07.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Aleksander Kania
- Department of Pulmonology, II Chair of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Misiaszek
- Department of Pulmonology, II Chair of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Martina Vašáková
- Department of Respiratory Medicine, Thomayer Hospital and 1st Medical Faculty of Charles University, Prague, Czech Republic
| | - Artur Szlubowski
- Bronchoscopy Unit, Pulmonary Hospital Zakopane, Zakopane, Poland
| | - Antonio Bugalho
- Hospital CUF Infante Santo e CUF Descobertas, Instituto CUF Oncologia (I.C.O.), NOVA Medical School, Lisbon, Portugal
| | | | - Małgorzata Szołkowska
- Pathology Department, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Natalia Celejewska-Wójcik
- Department of Pulmonology, II Chair of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Nastałek
- Department of Pulmonology, II Chair of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej Gnass
- Bronchoscopy Unit, Pulmonary Hospital Zakopane, Zakopane, Poland
| | - Krzysztof Sładek
- Department of Pulmonology, II Chair of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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14
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Reyfman PA, Walter JM, Joshi N, Anekalla KR, McQuattie-Pimentel AC, Chiu S, Fernandez R, Akbarpour M, Chen CI, Ren Z, Verma R, Abdala-Valencia H, Nam K, Chi M, Han S, Gonzalez-Gonzalez FJ, Soberanes S, Watanabe S, Williams KJN, Flozak AS, Nicholson TT, Morgan VK, Winter DR, Hinchcliff M, Hrusch CL, Guzy RD, Bonham CA, Sperling AI, Bag R, Hamanaka RB, Mutlu GM, Yeldandi AV, Marshall SA, Shilatifard A, Amaral LAN, Perlman H, Sznajder JI, Argento AC, Gillespie CT, Dematte J, Jain M, Singer BD, Ridge KM, Lam AP, Bharat A, Bhorade SM, Gottardi CJ, Budinger GRS, Misharin AV. Single-Cell Transcriptomic Analysis of Human Lung Provides Insights into the Pathobiology of Pulmonary Fibrosis. Am J Respir Crit Care Med 2019; 199:1517-1536. [PMID: 30554520 PMCID: PMC6580683 DOI: 10.1164/rccm.201712-2410oc] [Citation(s) in RCA: 735] [Impact Index Per Article: 147.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/14/2019] [Indexed: 11/30/2022] Open
Abstract
Rationale: The contributions of diverse cell populations in the human lung to pulmonary fibrosis pathogenesis are poorly understood. Single-cell RNA sequencing can reveal changes within individual cell populations during pulmonary fibrosis that are important for disease pathogenesis. Objectives: To determine whether single-cell RNA sequencing can reveal disease-related heterogeneity within alveolar macrophages, epithelial cells, or other cell types in lung tissue from subjects with pulmonary fibrosis compared with control subjects. Methods: We performed single-cell RNA sequencing on lung tissue obtained from eight transplant donors and eight recipients with pulmonary fibrosis and on one bronchoscopic cryobiospy sample from a patient with idiopathic pulmonary fibrosis. We validated these data using in situ RNA hybridization, immunohistochemistry, and bulk RNA-sequencing on flow-sorted cells from 22 additional subjects. Measurements and Main Results: We identified a distinct, novel population of profibrotic alveolar macrophages exclusively in patients with fibrosis. Within epithelial cells, the expression of genes involved in Wnt secretion and response was restricted to nonoverlapping cells. We identified rare cell populations including airway stem cells and senescent cells emerging during pulmonary fibrosis. We developed a web-based tool to explore these data. Conclusions: We generated a single-cell atlas of pulmonary fibrosis. Using this atlas, we demonstrated heterogeneity within alveolar macrophages and epithelial cells from subjects with pulmonary fibrosis. These results support the feasibility of discovery-based approaches using next-generation sequencing technologies to identify signaling pathways for targeting in the development of personalized therapies for patients with pulmonary fibrosis.
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Affiliation(s)
- Paul A. Reyfman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - James M. Walter
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Nikita Joshi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | | | | | - Stephen Chiu
- Division of Thoracic Surgery, Department of Surgery
| | | | | | - Ching-I Chen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Ziyou Ren
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Rohan Verma
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | | | - Kiwon Nam
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Monica Chi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - SeungHye Han
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | | | - Saul Soberanes
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Satoshi Watanabe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | | | - Annette S. Flozak
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | | | | | | | | | - Cara L. Hrusch
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois; and
| | - Robert D. Guzy
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois; and
| | - Catherine A. Bonham
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois; and
| | - Anne I. Sperling
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois; and
| | - Remzi Bag
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois; and
| | - Robert B. Hamanaka
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois; and
| | - Gökhan M. Mutlu
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois; and
| | | | - Stacy A. Marshall
- Department of Biochemistry and Molecular Genetics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ali Shilatifard
- Department of Biochemistry and Molecular Genetics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Luis A. N. Amaral
- Department of Chemical and Biological Engineering, Weinberg College of Arts and Sciences, Northwestern University, Evanston, Illinois
| | | | - Jacob I. Sznajder
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - A. Christine Argento
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
- Division of Thoracic Surgery, Department of Surgery
| | - Colin T. Gillespie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
- Division of Thoracic Surgery, Department of Surgery
| | - Jane Dematte
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Manu Jain
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Benjamin D. Singer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
- Department of Biochemistry and Molecular Genetics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Karen M. Ridge
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Anna P. Lam
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Ankit Bharat
- Division of Thoracic Surgery, Department of Surgery
| | | | - Cara J. Gottardi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
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15
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Samitas K, Kolilekas L, Vamvakaris I, Gkogkou C, Filippousis P, Gaga M, Zervas E. Introducing transbronchial cryobiopsies in diagnosing diffuse parenchymal lung diseases in Greece: Implementing training into clinical practice. PLoS One 2019; 14:e0217554. [PMID: 31158264 PMCID: PMC6546271 DOI: 10.1371/journal.pone.0217554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 05/14/2019] [Indexed: 02/07/2023] Open
Abstract
Introduction Diffuse parenchymal lung diseases (DPLD) constitute a heterogeneous group of disorders, sometimes requiring surgical lung biopsies (SLB) to obtain a definite diagnosis. Transbronchial cryobiopsy (TBCB) is a new promising interventional bronchoscopic method of obtaining lung tissue that is gaining ground against SLB. Methods Fifty consecutive patients with indeterminate DPLD (definite/possible UIP excluded), after expert panel review referral, were retrospectively analyzed from January 2016 to August 2018. Patients underwent TBCB under deep sedation with endotracheal intubation and spontaneous breathing at a single, tertiary-care, reference hospital. Results A total of 110 TBCBs (2.7 per patient, range 1 to 4) were performed. Frequent complications included mild pneumothorax in 5 patients (10%), requiring only oxygen supplementation, and bleeding in 31 patients (62%) that was mild in 19 patients and moderate in 12 patients. No serious bleeding was observed. There was zero mortality and no serious adverse events. Adequate samples for diagnostic purposes were obtained in 46 patients (92%) and pathologic histologic diagnosis was reached in 40 patients (80%). The most frequent histopathological patterns were organizing pneumonia (OP) (25%) and non-specific interstitial pneumonia (NSIP) (15%). After an expert panel review of all cases a final diagnosis was achieved in 38 patients, corresponding to a diagnostic yield of 76% for TBCB. Conclusion Our single center cohort demonstrates that establishing TBCBs as a new technique is safe and feasible after proper training in specialized centers, resulting in low complication rates and adequate diagnostic yields.
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Affiliation(s)
- Konstantinos Samitas
- Respiratory Medicine Dept. and Asthma Center, Athens Chest Hospital “Sotiria”, Athens, Greece
- Central Bronchoscopy Unit, Athens Chest Hospital “Sotiria”, Athens, Greece
| | - Lykourgos Kolilekas
- Respiratory Medicine Dept. and Asthma Center, Athens Chest Hospital “Sotiria”, Athens, Greece
| | | | | | - Petros Filippousis
- Dept. of Medical Imaging and Interventional Radiology, Athens Chest Hospital “Sotiria”, Athens, Greece
| | - Mina Gaga
- Respiratory Medicine Dept. and Asthma Center, Athens Chest Hospital “Sotiria”, Athens, Greece
- Central Bronchoscopy Unit, Athens Chest Hospital “Sotiria”, Athens, Greece
| | - Eleftherios Zervas
- Respiratory Medicine Dept. and Asthma Center, Athens Chest Hospital “Sotiria”, Athens, Greece
- Central Bronchoscopy Unit, Athens Chest Hospital “Sotiria”, Athens, Greece
- * E-mail:
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16
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Machado D, Vaz D, Neves S, Campainha S. Bronchial Laceration as a Complication of Transbronchial Lung Cryobiopsy. Arch Bronconeumol 2018; 54:348-350. [DOI: 10.1016/j.arbres.2018.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 01/07/2018] [Indexed: 01/15/2023]
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17
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Ortiz G, Garay M, Capelozzi V, Cardinal-Fernández P. Airway Pathological Alterations Selectively Associated With Acute Respiratory Distress Syndrome and Diffuse Alveolar Damage - Narrative Review. Arch Bronconeumol 2018; 55:31-37. [PMID: 29853259 DOI: 10.1016/j.arbres.2018.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/16/2018] [Accepted: 03/07/2018] [Indexed: 12/12/2022]
Abstract
Acute respiratory distress syndrome (ARDS) is a frequent and life-threatening entity. Recently, it has been demonstrated that diffuse alveolar damage (DAD), which is considered the histological hallmark in spite of presenting itself in only half of living patients with ARDS, exerts a relevant effect in the ARDS outcome. Despite the fact that the bronchial tree constitutes approximately 1% of the lung volume, discovering a relation between DAD and bronchial tree findings could be of paramount importance for a few reasons; (a) it could improve the description of ARDS with DAD as a clinical-pathological entity, (b) it could subrogate DAD findings with the advantage of their more accessible and safer analysis and (c) it could allow the discovery of new therapeutic targets. This narrative review is focused on pathological airway changes associated to Diffuse Alveolar Damage in the context of Acute Respiratory Distress Syndrome. It is organized into five sections: main anatomical and functional features of the human airway, why it is necessary to study airway features associated to DAD in patients with ARDS, pathological airway changes associated with DAD in animal models of ARDS, pathological airway changes associated with DAD in patients with ARDS, and the newest techniques for studying the histology of the bronchial tree and lung parenchyma.
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Affiliation(s)
- Guillermo Ortiz
- Universidad del Bosque, Bogotá, Colombia; Universidad de Barcelona, Barcelona, Spain
| | | | - Vera Capelozzi
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Pablo Cardinal-Fernández
- Emergency Department, Hospital Universitario HM Sanchinarro, Madrid, Spain; HM Research Foundation, Madrid, Spain.
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Cooley J, Balestra R, Aragaki-Nakahodo AA, Caudell Stamper DN, Sriprasart T, Swank Z, Baughman RP, Benzaquen S. Safety of performing transbronchial lung cryobiopsy on hospitalized patients with interstitial lung disease. Respir Med 2018; 140:71-76. [PMID: 29957284 DOI: 10.1016/j.rmed.2018.05.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Transbronchial lung cryobiopsy (TBLC) has become a popular option for tissue diagnosis of interstitial lung disease (ILD), however reports vary regarding the safety of this procedure. Herein, we evaluate the safety of transbronchial cryobiopsy in hospitalized patients, comparing adverse events to outpatient procedures. METHODS AND MEASUREMENTS This is a single center, retrospective chart review of all TBLC performed for suspected ILD between November 2013 and March 2017. Biopsies were performed by a board certified interventional pulmonologist or interventional pulmonology fellow using a two-scope technique. RESULTS One hundred fifty-nine cryobiopsies were performed for the diagnosis of ILD. Rates of adverse events are as follows: pneumothorax 11%, persistent air leak 1.3%, moderate-severe bleeding 3.8%, ICU transfer within 48 h 3.1%, and all cause 30-day mortality 1.9%. No deaths were attributed to the procedure. Comparing adverse events between hospitalized patients and outpatients, rates of pneumothorax were 24% vs 9.9%, persistent air leak 5.9% vs 0.7%, ICU transfer 12% vs 2.1%, and 30-day mortality 5.9% vs 1.4%. However, no differences were statistically significant. CONCLUSION Practitioners should recognize that while cryobiopsies are a high-yield, safe, and cost-effective alternative to surgical lung biopsy, not all procedures carry the same risk profiles. Hospitalized patients may have a greater propensity for pneumothorax, persistent air leak, transfer to the ICU, and 30-day mortality.
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Affiliation(s)
- Joseph Cooley
- Department of Internal Medicine, University of Cincinnati Medical Center, USA.
| | - Rick Balestra
- Providence Health & Services of Oregon and Southwest Washington, Division of Pulmonary and Critical Care Medicine, USA
| | | | | | - Thitiwat Sriprasart
- Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Zulma Swank
- Department of Internal Medicine, University of Cincinnati Medical Center, USA
| | - Robert P Baughman
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati Medical Center, USA
| | - Sadia Benzaquen
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati Medical Center, USA
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Dhooria S, Mehta RM, Srinivasan A, Madan K, Sehgal IS, Pattabhiraman V, Yadav P, Sivaramakrishnan M, Mohan A, Bal A, Garg M, Agarwal R. The safety and efficacy of different methods for obtaining transbronchial lung cryobiopsy in diffuse lung diseases. CLINICAL RESPIRATORY JOURNAL 2017; 12:1711-1720. [PMID: 29105361 DOI: 10.1111/crj.12734] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 08/17/2017] [Accepted: 10/30/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Most data on transbronchial lung cryobiopsy (TBLC) are from single centers, with little evidence on the outcome of different methods for performing TBLC. OBJECTIVE To report the diagnostic yield and safety of TBLC with different procedural techniques. MATERIALS AND METHODS 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. RESULTS In total, 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 diagnosis on multidisciplinary discussion made in 57 (44.5%) subjects. On a multivariate analysis, the diagnostic yield was associated with the number of biopsies taken {ajdusted odds ratio [AOR] [95% confidence interval (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-severe bleeding occurred less frequently when an occlusion balloon was used [1.8% vs 35.7%; AOR (95% CI), 0.02 (0.001-0.18)], after adjusting for age, use of fluoroscopy, number of biopsies obtained and number of lobes sampled. Four deaths occurred; 2 because of acute exacerbation of idiopathic pulmonary fibrosis. CONCLUSIONS Transbronchial lung cryobiopsy was found to offer a reasonable yield in the diagnosis of DPLDs. The incidence of pneumothorax and moderate-to-severe bleeding was lower with the use of fluoroscopy and an occlusion balloon, respectively.
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Affiliation(s)
- Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Ravindra M Mehta
- Department of Pulmonary, Critical Care and Sleep Medicine, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Arjun Srinivasan
- Department of Pulmonology, Allergy and Sleep Medicine, Royal Care Hospital, Coimbatore, Tamil Nadu, India
| | - Karan Madan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Vallandramam Pattabhiraman
- Department of Pulmonology, Allergy and Sleep Medicine, Royal Care Hospital, Coimbatore, Tamil Nadu, India
| | - Pavan Yadav
- Department of Pulmonary, Critical Care and Sleep Medicine, Apollo Hospitals, Bengaluru, Karnataka, India
| | - Mahadevan Sivaramakrishnan
- Department of Pulmonology, Allergy and Sleep Medicine, Royal Care Hospital, Coimbatore, Tamil Nadu, India
| | - Anant Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Mandeep Garg
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
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20
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Gelzinis TA. Supraglottic Airway Device for Transbronchial Lung Cryobiopsy. J Cardiothorac Vasc Anesth 2017; 31:1348-1350. [DOI: 10.1053/j.jvca.2017.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Indexed: 12/27/2022]
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21
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Jee AS, Corte TJ, Wort SJ, Eves ND, Wainwright CE, Piper A. Year in review 2016: Interstitial lung disease, pulmonary vascular disease, pulmonary function, paediatric lung disease, cystic fibrosis and sleep. Respirology 2017; 22:1022-1034. [PMID: 28544189 DOI: 10.1111/resp.13080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/18/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Adelle S Jee
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Tamera J Corte
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen J Wort
- Pulmonary Hypertension Department, Royal Brompton Hospital and Imperial College, London, UK
| | - Neil D Eves
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, British Columbia, Canada
| | - Claire E Wainwright
- School of Medicine, Lady Cilento Children's Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Amanda Piper
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
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22
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Safety and Feasibility of Pleural Cryobiopsy Compared to Forceps Biopsy During Semi-rigid Pleuroscopy. Lung 2017; 195:371-375. [DOI: 10.1007/s00408-017-9998-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/11/2017] [Indexed: 10/19/2022]
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23
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Aiello M, Bertorelli G, Bocchino M, Chetta A, Fiore-Donati A, Fois A, Marinari S, Oggionni T, Polla B, Rosi E, Stanziola A, Varone F, Sanduzzi A. The earlier, the better: Impact of early diagnosis on clinical outcome in idiopathic pulmonary fibrosis. Pulm Pharmacol Ther 2017; 44:7-15. [PMID: 28257817 DOI: 10.1016/j.pupt.2017.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/03/2017] [Accepted: 02/27/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a complex disease with a highly variable clinical course and generally poor prognosis. Classified as a rare disease, significant increases in incidence have been recorded worldwide in recent years. Left untreated IPF is extremely debilitating with substantial personal, social and economic implications. OBJECTIVES To discuss how IPF is diagnosed and managed in real life clinical practice with particular reference to Italy and to determine how new and effective therapies can be incorporated into a patient-centred management approach in order to improve the lives of patients with IPF. OUTCOMES Barriers to early diagnosis are discussed. Cited reasons for delays in diagnosing IPF in Italy include: inherent difficulties in diagnosis; lack of knowledge/awareness of the condition among point-of-contact healthcare professionals; delays in referral to centres of excellence and underestimation of symptoms by both patients and healthcare workers. Valid therapeutic options with demonstrated efficacy in slowing the decline in lung function are now available for patients with IPF. The ASCEND trial confirmed the effects of pirfenidone, approved for the treatment of IPF on the basis of the four phase III trials. Nintedanib, a tyrosine kinase inhibitor that targets the PDGF receptors α/β, FGF receptors 1 to 3, and VEGF receptors 1-3, is approved in the USA and the EU for the treatment of IPF. The TOMORROW and the INPULSIS placebo controlled trials in patients with IPF confirm the efficacy and safety of nintedanib and recent interim analyses endorse its long-term effects in slowing disease progression. CONCLUSIONS The importance of early and accurate diagnosis of IPF cannot be underestimated and it is the duty of all healthcare professionals to be vigilant to the symptoms of IPF and to involve a multidisciplinary team in diagnosing and managing IPF early in the course of disease.
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Affiliation(s)
- Marina Aiello
- Department of Clinical and Experimental Medicine, Respiratory Disease and Lung Function Unit, University of Parma, Italy.
| | - Giuseppina Bertorelli
- Department of Clinical and Experimental Medicine, Respiratory Disease and Lung Function Unit, University of Parma, Italy.
| | - Marialuisa Bocchino
- Department of Clinical Medicine and Surgery, Section of Respiratory Disease, University of Naples Federico II, Italy.
| | - Alfredo Chetta
- Department of Clinical and Experimental Medicine, Respiratory Disease and Lung Function Unit, University of Parma, Italy.
| | - Alfeo Fiore-Donati
- Direttore UOC di Pneumologia ed UTSIR, ASL 01 Abruzzo OC San Salvatore, L'Aquila, Italy.
| | - Alessandro Fois
- Department of Clinical and Experimental Medicine- Lung Disease Unit, University of Sassari, Italy.
| | - Stefano Marinari
- Pneumology Department, SS Annunziata Hospital, University of Chieti, Italy.
| | - Tiberio Oggionni
- Cardiothoracic and Vascular Department, Pneumology Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
| | - Biagio Polla
- Department of Pneumology, AO "SS. Antonio e Biagio", Alessandria, Italy.
| | - Elisabetta Rosi
- Department of Cardiology and Thoracic Medicine, Respiratory Disease Unit, AOU Careggi, Florence, Italy.
| | - Anna Stanziola
- Department of Clinical Medicine and Surgery, Section of Respiratory Disease, University of Naples Federico II, Italy.
| | - Francesco Varone
- Cardio-Thoracic Department, Fondazione Policlinico Universitario "A. Gemelli", Roma, Italy.
| | - Alessandro Sanduzzi
- Department of Clinical Medicine and Surgery, Section of Respiratory Disease, University of Naples Federico II, Italy.
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24
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Kronborg-White S, Folkersen B, Rasmussen TR, Voldby N, Madsen LB, Rasmussen F, Poletti V, Bendstrup E. Introduction of cryobiopsies in the diagnostics of interstitial lung diseases - experiences in a referral center. Eur Clin Respir J 2017; 4:1274099. [PMID: 28326178 PMCID: PMC5328381 DOI: 10.1080/20018525.2016.1274099] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/15/2016] [Indexed: 10/25/2022] Open
Abstract
Introduction: Transbronchial cryobiopsies (cTBB) has emerged as a new method for obtaining lung tissue biopsies in the diagnosis of interstitial lung diseases (ILDs). Until now, it has been used in a few highly specialized interventional centers and has shown promising results in obtaining a definite diagnosis of ILDs. Method: All patients undergoing a cTBB between November 2015 and June 2016 were included in this case series study. Data on patient demographics, high-resolution computed tomography patterns, size and number of biopsies, histology patterns, the contribution to a confident diagnosis and complications were registered. Results: Thirty-eight patients underwent cTBB in the period. cTBB contributed to the diagnosis in 28 (74%) of the 38 patients. Only few complications were observed; pneumothorax was the most frequent complication (10 patients, 26%). In six patients, local bleeding occurred during the procedure and was easily controlled by a Fogarty catheter balloon and in some cases tranexamic acid. Conclusion: Performing cTBB in the diagnostics of ILDs is a safe and feasible procedure. cTBB resulted in a confident diagnosis in 74% of cases.
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Affiliation(s)
- Sissel Kronborg-White
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital , Denmark
| | - Birgitte Folkersen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital , Denmark
| | - Torben Riis Rasmussen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital , Denmark
| | - Nina Voldby
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital , Denmark
| | | | - Finn Rasmussen
- Department of Radiology, Aarhus University Hospital , Denmark
| | - Venerino Poletti
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark; Department of Diseases of the Thorax, Ospedale Morgagni, Forli, Italy
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital , Denmark
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