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Thrainsson L, Halldorsson AB, Ingason AB, Isaksson HJ, Gudmundsson G, Gudbjartsson T. Surgical lung biopsy for suspected interstitial lung disease with video-assisted thoracoscopic surgery is safe, providing exact histological and disease specific diagnosis for tailoring treatment. J Thorac Dis 2024; 16:99-112. [PMID: 38410568 PMCID: PMC10894428 DOI: 10.21037/jtd-23-1107] [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: 07/25/2023] [Accepted: 11/10/2023] [Indexed: 02/28/2024]
Abstract
Background Surgical lung biopsy (SLB) is required for diagnosis in patients with suspected interstitial lung disease (ILD) if other less invasive diagnostic methods are non-conclusive. We evaluated the outcome of SLB by using centralized databases in a whole-nation patient-cohort. Methods A population-based retrospective study on 68 consecutive patients (mean age 58 years, 58.8% males) that underwent SLB in Iceland between the years 2008 and 2020. Patient information was obtained from patient charts and peri- and postoperative complications were registered together with 30- and 90-day mortality. Computed tomography (CT) scans, histological biopsies and spirometry results were reviewed, and overall survival (Kaplan-Meier) estimated. Mean follow-up was 61.3 months (range, 3-155 months). Results Out of 68 SLB-patients 41 (60.3%) had preoperatively undergone non-conclusive transbronchial biopsies (TBB) obtained with bronchoscopy. Spirometry showed forced vital capacity (FVC) 3.0 L and forced expiratory volume in 1 second (FEV1) 2.3 L, or 73.0% and 71.6% of predicted value, respectively. Video-assisted thoracoscopic surgery (VATS) technique was used in all cases and provided a histologic and disease specific diagnosis in 92.6% of cases; most often being nonspecific interstitial pneumonia (NSIP) (29.4%) and usual interstitial pneumonia (UIP) (23.5%). One patient (1.5%) sustained a major postoperative complication (excessive bleeding) and seven patients (10.3%) minor complications. Median chest tube time and length of stay was 1 and 2 days, respectively. No patients died <90 days postoperatively. Overall survival at 1 and 5 years was 95.6% and 73.5%, respectively, and 5-year survival for NSIP and UIP was 85% and 43.7%, respectively. Long-term mortality for UIP was four times higher when compared with NSIP and other diagnosis. Conclusions Lung biopsy with VATS-technique provided a definitive histological and disease specific diagnosis in majority of cases. The procedure is safe, reflected in low complication-rates and short hospital stay, and can therefore be used to diagnose and tailor treatment of ILD patients.
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Affiliation(s)
- Leifur Thrainsson
- Division of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | | | | | - Helgi J. Isaksson
- Division of Pathology, Landspitali University Hospital, Reykjavik, Iceland
| | - Gunnar Gudmundsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Division of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Tomas Gudbjartsson
- Division of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Katgi N, Çimen P, Çirak AK, Şimşek T, Ceylan KC, Samancilar Ö, Duman E, Erer OF, Tuksavul FF. Complication and cost analysis of transbronchial lung cryobiopsy and awake video-assisted thoracic surgery in diagnosis of interstitial lung disease. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2022; 39:e2022005. [PMID: 35494167 PMCID: PMC9007030 DOI: 10.36141/svdld.v39i1.12293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/17/2021] [Indexed: 12/05/2022]
Abstract
AIM AND INTRODUCTION Diagnosing of interstitial lung disease (ILD) is difficult and expensive. The standard diagnostical approaches to ILD are bronchoalveolar lavage, transbronchial lung biopsy, transbronchial lung cryobiopsy (TBLC) and surgical lung biopsy (SLB). SLB is gold standard for the confident diagnosis of ILD but because of the poor performance of the patients it's use is limited. We conducted a retrospective study to point out that TBLC plays an important role in diagnosis of ILD and has fewer complications and lower cost than awake video-assisted thoracic surgery (AVATS). MATERIAL AND METHODS 132 patients who underwent TBLC and AVATS with a pre-diagnosis of ILD in our hospital between 2015 and 2020 were evaluated retrospectively. Diagnosis rates, complications and costs were recorded. RESULTS There were no non-diagnostic materials in 44 patients in AVATS arm. Prolonged air leak was observed in 11(25.0%) of the patients, and six of them (13.6%) were discharged with Heimlich Valve (HV). Median length of stay in the hospital was 8 days, while average patient cost was $515.9 (415.2-2662.9) in the AVATS arm. Non-diagnostic material was obtained from 10 (11.3%) of 88 patients in TBLC arm. Six (6.8%) of them had pneumothorax, only one of them required a chest tube. No patient was discharged with HV (p=0.001). Median cost for each patient with a median hospital stay of 2.0 (1.0-21.0) (p<0.001) days was $171.9 (80.8-1493.3) (p<0.001). DISCUSSION Although TBLC is behind AVATS in terms of diagnostic accuracy, it may be an alternative diagnostic tool in the diagnosis of interstitial lung disease due to its acceptable safety profile and cost-effectiveness.
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Affiliation(s)
- Nuran Katgi
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Pinar Çimen
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Ali Kadri Çirak
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Tarik Şimşek
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Kenan Can Ceylan
- Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Özgür Samancilar
- Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Elif Duman
- Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Onur Fevzi Erer
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Fatma Fevziye Tuksavul
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
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Koslow M, Edell ES, Midthun DE, Mullon JJ, Kern RM, Nelson DR, Sakata KK, Moua T, Roden AC, Yi ES, Reisenauer JS, Decker PA, Ryu JH. Bronchoscopic Cryobiopsy and Forceps Biopsy for the Diagnostic Evaluation of Diffuse Parenchymal Lung Disease in Clinical Practice. Mayo Clin Proc Innov Qual Outcomes 2020; 4:565-574. [PMID: 33083705 PMCID: PMC7560571 DOI: 10.1016/j.mayocpiqo.2020.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective To assess the contribution and safety of bronchoscopic cryobiopsy vs traditional forceps biopsy used in clinical practice for diagnosing diffuse parenchymal lung disease (DPLD). Patients and Methods We identified 271 patients who underwent bronchoscopic biopsy for DPLD at Mayo Clinic, MN (June 1, 2013, through September 30, 2017). Medical records were reviewed including prebiopsy clinical and radiographic impressions. Diagnostic yield was assessed in terms of a specific histologic pattern resulting in a diagnosis when combined with the clinical-radiologic context. Clinical utility was defined as a biopsy result deemed useful in patient management. Results The cohort included 120 cryobiopsy and 151 forceps biopsy cases with mean age 61±14 years and 143 (53%) men. Diagnostic yield (55% vs 41%; odds ratio [OR], 1.73; 95% CI, 1.07 to 2.83; P=.026) and clinical utility (60% vs 40%; OR, 2.21; 95% CI, 1.36 to 3.63; P=.001) were higher for the cryobiopsy group, and the association remained after control for prebiopsy clinical impressions (OR, 2.21; 95% CI, 1.22 to 4.08; P=.010 and OR, 3.23; 95% CI, 1.76 to 6.10; P<.001, respectively). However, pneumothorax (5.4% vs 0.7%; P=.022) and serious bleeding (7.1% vs 0%; P=.001) rates were higher for the cryobiopsy group. Thirty-day mortality was 1.6% in the cryobiopsy group vs 0% for the forceps biopsy group (P=.20). Conclusion Bronchoscopic cryobiopsy revealed higher diagnostic yield and clinical utility than did forceps biopsy. However, procedure-related complications were higher in the cryobiopsy group. The choice of bronchoscopic biopsy procedure for patients with DPLD depends on the clinicalradiologic context.
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Key Words
- BAL, bronchoalveolar lavage
- CT, computed tomography
- CTD, connective tissue disease
- DAH, diffuse alveolar hemorrhage
- HP, hypersensitivity pneumonitis
- ILD, interstitial lung disease
- IPF, idiopathic pulmonary fibrosis
- OR, odds ratio
- SLB, surgical lung biopsy
- TBCB, transbronchial cryobiopsy
- TBFB, transbronchial forceps biopsy
- UIP, usual interstitial pneumonia
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Affiliation(s)
- Matthew Koslow
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.,Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Interstitial Lung Disease Program, National Jewish Health, Interstitial Lung Disease and Autoimmune Lung Center, Denver, CO
| | - Eric S Edell
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - David E Midthun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - John J Mullon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Ryan M Kern
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Darlene R Nelson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Kenneth K Sakata
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Anja C Roden
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Eunhee S Yi
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Janani S Reisenauer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.,Department of Thoracic Surgery, Mayo Clinic, Rochester, MN
| | - Paul A Decker
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
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Inomata M, Kuse N, Awano N, Tone M, Yoshimura H, Jo T, Minami J, Takada K, Yuan B, Kumasaka T, Yamakawa H, Sato S, Tobino K, Matsushima H, Takemura T, Izumo T. Prospective multicentre study on the safety and utility of transbronchial lung cryobiopsy with endobronchial balloon. ERJ Open Res 2020; 6:00008-2020. [PMID: 32607371 PMCID: PMC7306501 DOI: 10.1183/23120541.00008-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022] Open
Abstract
Transbronchial lung cryobiopsy (TBLC) has been increasingly utilised to diagnose diffuse parenchymal lung diseases (DPLDs) and lung cancers; however, TBLC protocols have not yet been standardised and the rate of complications associated with this procedure vary widely. Therefore, this prospective multicentre observational study investigated the safety and utility of the TBLC technique in patients with diffuse and localised respiratory diseases. This study was conducted at multiple medical centres in Japan between July 2018 and April 2019. The study's primary end-point was the rate of severe or serious adverse events associated with TBLC. Adverse events included bronchial bleeding, pneumothorax, pneumonia, respiratory failure, and an acute exacerbation of interstitial pneumonia. Adverse events were graded according to severity. During the TBLC procedure, an endobronchial balloon catheter for bronchial blockade was used in all patients. Pathological confidence and quality of specimens were categorised into three groups. A total of 112 patients were included. Neither severe nor serious adverse events were identified; therefore, the primary end-point was met. Nineteen patients (17%) experienced no bronchial bleeding. Mild or moderate bronchial bleeding was identified in 67% and 16% of patients, respectively. Mild pneumothoraces were identified in four patients (3.6%). The safety profile in patients aged ≥75 years was not significantly different from younger patients. Definite or probable pathological diagnoses were made in 84.9% of patients. This TBLC protocol with routine use of an endobronchial balloon had an acceptable safety profile and diagnostic yield in patients, including elderly ones, with diffuse and localised respiratory diseases.
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Affiliation(s)
- Minoru Inomata
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Naoyuki Kuse
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Nobuyasu Awano
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Mari Tone
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Hanako Yoshimura
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Tatsunori Jo
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Jonsu Minami
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Kohei Takada
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Bae Yuan
- Dept of Pathology, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Toshio Kumasaka
- Dept of Pathology, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Hideaki Yamakawa
- Dept of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Shintaro Sato
- Dept of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Kazunori Tobino
- Dept of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | | | - Tamiko Takemura
- Dept of Pathology, Japanese Red Cross Medical Center, Shibuya, Japan.,Dept of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Takehiro Izumo
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
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5
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Romagnoli M, Colby TV, Suehs CM, Vachier I, Molinari N, Bourdin A. Cryobiopsy Compared with Surgical Lung Biopsy in ILD: Reply to Maldonado et al., Froidure et al., Bendstrup et al., Agarwal et al., Richeldi et al., Rajchgot et al., and Quadrelli et al. Am J Respir Crit Care Med 2020; 200:944-946. [PMID: 31442081 PMCID: PMC6812448 DOI: 10.1164/rccm.201906-1252le] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Micaela Romagnoli
- AULSS2 Marca TrevigianaTreviso, Italy.,University of BolognaBologna, Italy
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6
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Wand O, Unterman A, Shochet GE, Shitrit D. Role of Transbronchial Cryobiopsy in Interstitial Lung Diseases: An Ongoing Tale. Am J Respir Crit Care Med 2020; 201:259-260. [PMID: 31535899 PMCID: PMC6961737 DOI: 10.1164/rccm.201908-1559le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ori Wand
- Meir Medical CenterKfar Saba, Israel.,Tel Aviv UniversityTel Aviv, Israeland
| | - Avraham Unterman
- Tel Aviv UniversityTel Aviv, Israeland.,Yale UniversityNew Haven, Connecticut
| | | | - David Shitrit
- Meir Medical CenterKfar Saba, Israel.,Tel Aviv UniversityTel Aviv, Israeland
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7
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Valenzuela C, Torrisi SE, Kahn N, Quaresma M, Stowasser S, Kreuter M. Ongoing challenges in pulmonary fibrosis and insights from the nintedanib clinical programme. Respir Res 2020; 21:7. [PMID: 31906942 PMCID: PMC6945404 DOI: 10.1186/s12931-019-1269-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/23/2019] [Indexed: 01/06/2023] Open
Abstract
The approvals of nintedanib and pirfenidone changed the treatment paradigm in idiopathic pulmonary fibrosis (IPF), and increased our understanding of the underlying disease mechanisms. Nonetheless, many challenges and unmet needs remain in the management of patients with IPF and other progressive fibrosing interstitial lung diseases.This review describes how the nintedanib clinical programme has helped to address some of these challenges. Data from this programme have informed changes to the IPF diagnostic guidelines, the timing of treatment initiation, and the assessment of disease progression. The use of nintedanib to treat patients with advanced lung function impairment, concomitant emphysema, patients awaiting lung transplantation and patients with IPF and lung cancer is discussed. The long-term use of nintedanib and an up-to-date summary of nintedanib in clinical practice are discussed. Directions for future research, namely emerging therapeutic options, precision medicine and other progressive fibrosing interstitial lung diseases, are described.Further developments in these areas should continue to improve patient outcomes.
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Affiliation(s)
- Claudia Valenzuela
- Hospital Universitario de La Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Sebastiano Emanuele Torrisi
- University Hospital Policlinico-Vittorio Emanuele, Catania, Italy
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Nicolas Kahn
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany
| | - Manuel Quaresma
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Susanne Stowasser
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
- Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany.
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