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Taverner J, Lucena CM, Garner JL, Orton CM, Nicholson AG, Desai SR, Wells AU, Shah PL. Low bleeding rates following transbronchial lung cryobiopsy in unclassifiable interstitial lung disease. Respirology 2024; 29:489-496. [PMID: 38355891 DOI: 10.1111/resp.14678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND OBJECTIVE Bronchoscopic transbronchial lung cryobiopsy (TBLC) is a guideline-endorsed alternative to surgical lung biopsy for tissue diagnosis in unclassifiable interstitial lung disease (ILD). The reported incidence of post-procedural bleeding has varied widely. We aimed to characterize the incidence, severity and risk factors for clinically significant bleeding following TBLC using an expert-consensus airway bleeding scale, in addition to other complications and diagnostic yield. METHODS A retrospective cohort study of consecutive adult outpatients with unclassifiable ILD who underwent TBLC following multidisciplinary discussion at a single centre in the UK between July 2016 and December 2021. TBLC was performed under general anaesthesia with fluoroscopic guidance and a prophylactic endobronchial balloon. RESULTS One hundred twenty-six patients underwent TBLC (68.3% male; mean age 62.7 years; FVC 86.2%; DLCO 54.5%). Significant bleeding requiring balloon blocker reinflation for >20 min, admission to ICU, packed red blood cell transfusion, bronchial artery embolization, resuscitation or procedural abandonment, occurred in 10 cases (7.9%). Significant bleeding was associated with traction bronchiectasis on HRCT (OR 7.1, CI 1.1-59.1, p = 0.042), a TBLC histological pattern of UIP (OR 4.0, CI 1.1-14, p = 0.046) and the presence of medium-large vessels on histology (OR 37.3, CI 6.5-212, p < 0.001). BMI ≥30 (p = 0.017) and traction bronchiectasis on HRCT (p = 0.025) were significant multivariate predictors of longer total bleeding time (p = 0.017). Pneumothorax occurred in nine cases (7.1%) and the 30-day mortality was 0%. Diagnostic yield was 80.6%. CONCLUSION TBLC has an acceptable safety profile in experienced hands. Radiological traction bronchiectasis and obesity increase the risk of significant bleeding following TBLC.
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Affiliation(s)
- John Taverner
- Royal Brompton and Harefield Hospitals, London, UK
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
- Alfred Health, Melbourne, Victoria, Australia
| | | | - Justin L Garner
- Royal Brompton and Harefield Hospitals, London, UK
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Christopher M Orton
- Royal Brompton and Harefield Hospitals, London, UK
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Andrew G Nicholson
- Royal Brompton and Harefield Hospitals, London, UK
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Sujal R Desai
- Royal Brompton and Harefield Hospitals, London, UK
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Athol U Wells
- Royal Brompton and Harefield Hospitals, London, UK
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Pallav L Shah
- Royal Brompton and Harefield Hospitals, London, UK
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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Ali SO, Castellani C, Benn BS. Transbronchial Lung Cryobiopsy Performed with Cone Beam Computed Tomography Guidance Versus Fluoroscopy: A Retrospective Cohort Review. Lung 2024; 202:73-81. [PMID: 38129333 DOI: 10.1007/s00408-023-00663-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/19/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Determining the cause of interstitial lung disease (ILD) remains challenging. While surgical lung biopsy remains the gold standard approach, risks associated with it may be prohibitive. Transbronchial lung cryobiopsy (TBLC) is a minimally invasive alternative with an improved safety profile and acceptable diagnostic accuracy. We retrospectively assessed whether the use of Cone Beam computed tomography guidance for TBLC (TBLC-CBCT) improves safety and diagnostic yield compared to performing TBLC with fluoroscopic guidance (TBLC-F). METHODS A retrospective cohort review of 120 patients presenting for evaluation of newly diagnosed ILD was performed. Demographic data, pulmonary function test values, chest imaging pattern, procedural information, and final multidisciplinary discussion (MDD) diagnosis were recorded. RESULTS 62 patients underwent TBLC-F and 58 underwent TBLC-CBCT. Patients undergoing TBLC-CBCT were older (67.86 ± 10.97 vs 61.45 ± 12.77 years, p = 0.004) and had a higher forced vital capacity percent predicted (73.80 ± 17.32% vs 66.00 ± 17.45%, p = 0.03) compared to the TBLC-F group. The average probe-to-pleura distance was 5.1 ± 2.3 mm in the TBLC-CBCT group with 4.0 ± 0.3 CBCT spins performed. Pneumothorax occurred more often in the TBLC-F group (n = 6, 9.7%) compared to the TBLC-CBCT group (n = 1, 1.7%, p = 0.06). Grade 2 bleeding only occurred in the TBLC-F group (n = 4, 6.5%). A final MDD diagnosis was obtained in 89% (n = 57) of TBLC-F patients and 95% (n = 57) of TBLC-CBCT patients. CONCLUSIONS TBLC-CBCT appears to be safer compared to TBLC-F with both approaches facilitating an MDD diagnosis. Further studies from multiple institutions randomizing patients to each modality are needed to confirm these findings.
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Affiliation(s)
- Syed O Ali
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carson Castellani
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bryan S Benn
- Division of Pulmonary and Critical Care, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Löffler C, Hellmich B. [Management of ANCA-associated vasculitides]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:93-106. [PMID: 38253699 DOI: 10.1007/s00108-023-01655-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/24/2024]
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is an autoimmune-mediated inflammation of small and medium-sized vessels that can affect virtually any organ system and bears the risk of irreversible organ damage. Without treatment the mortality rates are high, which necessitates rapid diagnosis and initiation of treatment. Histological confirmation, which is not feasible in all cases, should be strived for, especially to delineate differential diagnoses and vasculitis mimics. The new American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria are primarily designed for study purposes and show limitations in the routine application. Globally, the recently updated EULAR recommendations represent the most up to date management guidelines. Therapeutically, rituximab and cyclophosphamide in combination with glucocorticoids remain the pillars of treatment in remission induction for severe organ-threatening and life-threatening diseases. For the first time, mepolizumab and avacopan represent approved treatment options for specific entities that make a significant contribution to steroid reduction. New attention has been paid to patient-reported outcomes, for which a disease-specific outcome questionnaire is now available.
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Affiliation(s)
- Christian Löffler
- Klinik für Innere Medizin, Rheumatologie, Pneumologie, Nephrologie und Diabetologie, medius Klinik Kirchheim, Eugenstr. 3, 73230, Kirchheim unter Teck, Deutschland.
- Vaskulitis-Referenzzentrum der Europäischen Union ERN-RITA, Lehrkrankenhaus der Eberhard Karls Universität Tübingen, Kirchheim unter Teck, Deutschland.
- Klinik für Nephrologie, Endokrinologie, Hypertensiologie und Rheumatologie, Universitätsmedizin Mannheim, Medizinische Fakultät der Universität Heidelberg, Mannheim, Deutschland.
| | - Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatologie, Pneumologie, Nephrologie und Diabetologie, medius Klinik Kirchheim, Eugenstr. 3, 73230, Kirchheim unter Teck, Deutschland
- Vaskulitis-Referenzzentrum der Europäischen Union ERN-RITA, Lehrkrankenhaus der Eberhard Karls Universität Tübingen, Kirchheim unter Teck, Deutschland
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Husnain SMN, Sarkar A, Huseini T. Utility and Safety of Bronchoscopic Cryotechniques-A Comprehensive Review. Diagnostics (Basel) 2023; 13:2886. [PMID: 37761254 PMCID: PMC10530195 DOI: 10.3390/diagnostics13182886] [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: 05/31/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Cryosurgical techniques are employed for diagnostic and therapeutic bronchoscopy and serve as important tools for the management of pulmonary diseases. The diagnosis of interstitial lung disease requires multidisciplinary team discussions after a thorough assessment of history, physical exam, computed tomography, and lung-function testing. However, histological diagnosis is required in selected patients. Surgical lung biopsy has been the gold standard but this can be associated with increased morbidity and mortality. Transbronchial lung cryobiopsy is an emerging technique and multiple studies have shown that it has a high diagnostic yield with a good safety profile. There is wide procedural variability and the optimal technique for cryobiopsy is still under investigation. There is emerging data that demonstrate that cryobiopsy is safe and highly accurate in the diagnosis of thoracic malignancies. Furthermore, cryorecanalization procedures are a useful adjunct for the palliation of tumors in patients with central airway obstruction. One should keep in mind that these procedures are not free from complications and should be carried out in a specialized center by a trained and experienced bronchoscopy team. We present a review of the literature on the diagnostic and therapeutic utility of bronchoscopy-guided cryosurgical procedures and their safety profile.
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Affiliation(s)
- Shaikh M. Noor Husnain
- Department of Internal Medicine, Division of Interventional Pulmonary Medicine, Westchester Medical Center, New York, NY 10595, USA
| | - Abhishek Sarkar
- Department of Internal Medicine, Division of Interventional Pulmonary Medicine, Westchester Medical Center, New York, NY 10595, USA
| | - Taha Huseini
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA 6150, Australia
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Fortin M, Liberman M, Delage A, Dion G, Martel S, Rolland F, Soumagne T, Trahan S, Assayag D, Albert E, Kelly MM, Johannson KA, Guenther Z, Leduc C, Manganas H, Prenovault J, Provencher S. Transbronchial Lung Cryobiopsy and Surgical Lung Biopsy: A Prospective Multi-Centre Agreement Clinical Trial (CAN-ICE). Am J Respir Crit Care Med 2023; 207:1612-1619. [PMID: 36796092 DOI: 10.1164/rccm.202209-1812oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 02/16/2023] [Indexed: 02/18/2023] Open
Abstract
Rationale: Transbronchial cryobiopsy (TBCB) for the diagnosis of interstitial lung disease (ILD) has shown promising results, but prospective studies with matched surgical lung biopsy (SLB) have yielded conflicting results. Objectives: We aimed to assess within- and between-center diagnostic agreement between TBCB and SLB at both the histopathologic and multidisciplinary discussion (MDD) levels in patients with diffuse ILD. Methods: In a multicenter prospective study, we performed matched TBCB and SLB in patients referred for SLB. After a blinded review by three pulmonary pathologists, all cases were reviewed by three independent ILD teams in an MDD. MDD was performed first with TBCB, then with SLB in a second session. Within-center and between-center diagnostic agreement was evaluated using percentages and correlation coefficients. Measurements and Main Results: Twenty patients were recruited and underwent contemporaneous TBCB and SLB. Within-center diagnostic agreement between TBCB-MDD and SLB-MDD was reached in 37 of the 60 (61.7%) paired observations, resulting in a Cohen's κ value of 0.46 (95% confidence interval [CI], 0.29-0.63). Diagnostic agreement increased among high-confidence or definitive diagnoses on TBCB-MDD (21 of 29 [72.4%]), but not significantly, and was more likely among cases with SLB-MDD diagnoses of idiopathic pulmonary fibrosis than fibrotic hypersensitivity pneumonitis (13 of 16 [81.2%] vs. 16 of 31 [51.6%]; P = 0.047). Between-center agreement for cases was markedly higher for SLB-MDD (κ = 0.71 [95% CI, 0.52-0.89]) than TBCB-MDD (κ = 0.29 [95% CI, 0.09-0.49]). Conclusions: This study demonstrated moderate TBCB-MDD and SLB-MDD diagnostic agreement for ILD, while between-center agreement was fair for TBCB-MDD and substantial for SLB-MDD. Clinical trial registered with www.clinicaltrials.gov (NCT02235779).
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Affiliation(s)
- Marc Fortin
- Department of Pulmonary Medicine and Thoracic Surgery
| | | | - Antoine Delage
- Department of Medicine, Charles-Lemoyne Hospital, Sherbrooke University, Longueuil, Canada
| | | | - Simon Martel
- Department of Pulmonary Medicine and Thoracic Surgery
| | - Fabien Rolland
- Departement of Pulmonary Medicine, Cannes Medical Center, Cannes, France
| | - Thibaud Soumagne
- Departement of Pulmonary Medicine and Intensive Care, Georges Pompidou European Hospital, Paris Hospital Public Assistance, Paris, France
| | | | - Deborah Assayag
- Department of Medicine, McGill University Health Center, McGill University, Montreal, Quebec, Canada; and
| | - Elisabeth Albert
- Department of Radiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Zachary Guenther
- Department of Radiology, South Health Campus, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Julie Prenovault
- Department of Radiology, University of Montreal Health Center, University of Montreal, Montreal, Quebec, Canada
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Herath S. Using cryobiopsy with Radial EBUS in high-bleeding-risk, peripheral pulmonary lesions (PPL): description of cases and technique. Respirol Case Rep 2023; 11:e01125. [PMID: 36935897 PMCID: PMC10014523 DOI: 10.1002/rcr2.1125] [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: 12/06/2022] [Accepted: 03/03/2023] [Indexed: 03/17/2023] Open
Abstract
Cryobiopsy is an emerging tool in the diagnosis of peripheral pulmonary lesions (PPL) and becoming an important tool in the toolbox. Anecdotally the data on cryobiopsy use in the lung was extrapolated from the use of transbronchial cryobiopsy (TBCB) in Interstitial Lung disease (ILD). Similar to ILD data, cryobiopsy in PPL also provided larger tissue compared to forceps biopsies. Yet, unlike TBCB in ILD, the safety profile for cryobiopsy in PPL seems much more favourable, yet the number of publications on cryobiopsy in PPL remains sparse. Some PPL, both malignant and non-malignant are considered to be of a high bleeding risk due to vascularity of the tumour and/or inflammation of the blood vessels and surrounding tissue. The use of cryobiopsy and the risk of bleeding in this type of PPL have not been described. This paper describes four patients with PPL, undergoing cryobiopsy with radial EBUS for suspected lung cancer, and later diagnosed to have a PPL, deemed to be of a high bleeding risk. The use of cryobiopsy with radial ultrasonic examination for the vasculature of the PPL, bronchial blocker use, and airway protection as well as an expert team preserved the safety of the procedure.
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Affiliation(s)
- Samantha Herath
- Department of Respiratory MedicineNothern Beaches HospitalSydneyNew South WalesAustralia
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7
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Zayed Y, Alzghoul BN, Hyde R, Wadood Z, Banifadel M, Khasawneh M, Maharrey PB, Saker H, Harden C, Barnes G, Gomez-Manjarres D, Patel D, Faruqi I, Mehrad B, Mehta HJ. Role of Transbronchial Lung Cryobiopsy in the Diagnosis of Interstitial Lung Disease: A Meta-analysis of 68 Studies and 6300 Patients. J Bronchology Interv Pulmonol 2023; 30:99-113. [PMID: 35698283 PMCID: PMC10448786 DOI: 10.1097/lbr.0000000000000865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 04/06/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Diagnosis of interstitial lung disease (ILD) is based on multidisciplinary team discussion (MDD) with the incorporation of clinical, radiographical, and histopathologic information if available. We aim to evaluate the diagnostic yield and safety outcomes of transbronchial lung cryobiopsy (TBLC) in the diagnosis of ILD. METHODS We conducted a meta-analysis by comprehensive literature search to include all studies that evaluated the diagnostic yields and/or adverse events with TBLC in patients with ILD. We calculated the pooled event rates and their 95% confidence intervals (CIs) for the diagnostic yield by MDD, histopathologic diagnostic yield, and various clinical adverse events. RESULTS We included 68 articles (44 full texts and 24 abstracts) totaling 6386 patients with a mean age of 60.7±14.1 years and 56% men. The overall diagnostic yield of TBLC to achieve a definite or high-confidence diagnosis based on MDD was 82.3% (95% CI: 78.9%-85.2%) and histopathologic diagnosis of 72.5% (95% CI: 67.7%-76.9%). The overall rate of pneumothorax was 9.6% (95% CI: 7.9%-11%), while the rate of pneumothorax requiring drainage by a thoracostomy tube was 5.3% (95% CI: 4.1%-6.9%). The rate of moderate bleeding was 11.7% (95% CI: 9.1%-14.9%), while the rate of severe bleeding was 1.9% (95% CI: 1.4%-2.6%). The risk of mortality attributed to the procedure was 0.9% (95% CI: 0.7%-1.3%). CONCLUSION Among patients with undiagnosed or unclassified ILD requiring tissue biopsy for diagnosis, transbronchial cryobiopsy represents a reliable alternative to surgical lung biopsy with decreased incidence of various clinical adverse events.
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Affiliation(s)
- Yazan Zayed
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Bashar N. Alzghoul
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Ryan Hyde
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Zerka Wadood
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Momen Banifadel
- Division of Pulmonary and Critical Care, Case Western Reserve University, University Hospitals, Cleveland, Ohio, USA
| | - Majd Khasawneh
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - P. Brandon Maharrey
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Haneen Saker
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Christopher Harden
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Gabrielle Barnes
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Diana Gomez-Manjarres
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Divya Patel
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Ibrahim Faruqi
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Borna Mehrad
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Hiren J. Mehta
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
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8
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Proposal of a novel pipeline involving precise bronchoscopy of distal peripheral pulmonary lesions for genetic testing. Sci Rep 2022; 12:19774. [PMID: 36396864 PMCID: PMC9672070 DOI: 10.1038/s41598-022-24372-6] [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: 04/01/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Next-generation sequencing (NGS) has become increasingly more important for lung cancer management. We now expect biopsies to be sensitive, safe, and yielding sufficient samples for NGS. In this study, we propose ultraselective biopsy (USB) with sample volume adjustment (SVA) as a novel method that integrates an ultrathin bronchoscope, radial probe endobronchial ultrasound, and the direct oblique method for ultraselective navigation, and adjustment of sample volume for NGS. Our purpose was to estimate the diagnostic potential and the applicability of USB-SVA for amplicon-based NGS analysis. The diagnostic yield of bronchoscopy in forty-nine patients with malignant peripheral pulmonary lesions (PPLs) was retrospectively analyzed, and amplicon-based NGS analysis was performed on samples from some patients using USB. The diagnostic yields of distal PPLs in the USB group were significantly higher than those in the non-USB group (90.5% vs. 50%, respectively, p = 0.015). The extracted amounts of nucleic acids were at least five times the minimum requirement and the sequence quality met the criteria for the Oncomine™ Target Test. Only the tumor cell content of some samples was insufficient. The feasibility of the pipeline for USB, SVA, and amplicon-based NGS in distal PPLs was demonstrated.
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Oki M, Saka H, Kogure Y, Niwa H, Ishida A, Yamada A, Torii A, Kitagawa C. Thin bronchoscopic cryobiopsy using a nasobronchial tube. BMC Pulm Med 2022; 22:361. [PMID: 36153576 PMCID: PMC9508729 DOI: 10.1186/s12890-022-02166-w] [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: 06/06/2022] [Accepted: 09/19/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Transbronchial lung cryobiopsy is useful when diagnosing lung lesions. However, prevention of associated bleeding complications is essential. This study aimed to evaluate the safety and efficacy of our novel bronchoscopic cryobiopsy technique, which uses a long nasobronchial tube to prevent blood flooding the central airway. METHODS Patients with localized or diffuse lung lesions were prospectively enrolled and underwent cryobiopsy using a 1.9 mm diameter cryoprobe and a 4.0 mm diameter thin bronchoscope under conscious sedation. For cryobiopsy, a long silicone tube (inner diameter, 5.0 mm) was advanced through the nose to the target bronchus, then wedged to drain blood under thin-tube bronchoscopic control. The primary endpoint was the frequency of bleeding complications. RESULTS Of the 80 patients initially enrolled, 73 that underwent at least one cryobiopsy were ultimately included. Mild bleeding during cryobiopsy occurred in 58 patients (79.5%), but there was no moderate or severe bleeding. Other complications occurred in four patients (two pneumothorax, one pneumomediastinum, and one pneumonia). Tube dislocation was noted in eight patients (11%). Cryobiopsy specimens were significantly larger than forceps biopsy specimens (9.0 mm2 vs. 2.7 mm2, P < .001) and allowed specific diagnoses in 50 patients (68.5%). CONCLUSIONS Thin bronchoscopic cryobiopsy using a nasobronchial tube in consciously sedated patients is safe and effective. Trial registration Date of registration: 24/06/2019. UMIN-Clinical Trials Registry; Identifier: UMIN000037156 https://www.umin.ac.jp/ctr/index.htm.
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Affiliation(s)
- Masahide Oki
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Hideo Saka
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan ,grid.416589.70000 0004 0640 6976Department of Respiratory Medicine, Matsunami General Hospital, Gifu, Japan
| | - Yoshihito Kogure
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Hideyuki Niwa
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Akane Ishida
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Arisa Yamada
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Atsushi Torii
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Chiyoe Kitagawa
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
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Clinical Utility of Rapid On-Site Evaluation of Touch Imprint Cytology during Cryobiopsy for Peripheral Pulmonary Lesions. Cancers (Basel) 2022; 14:cancers14184493. [PMID: 36139653 PMCID: PMC9496809 DOI: 10.3390/cancers14184493] [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: 08/11/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary With increasing interest in precision medicine for lung cancer, cryobiopsy is expected to improve the success rate not only for histological diagnosis, but also for next-generation sequencing. Rapid on-site evaluation (ROSE) is an immediate cytological evaluation performed during bronchoscopy. However, little is known about its clinical utility during cryobiopsy. We retrospectively reviewed the data of 63 consecutive patients who underwent cryobiopsy with ROSE of touch imprint cytology (ROSE-TIC) for solid peripheral pulmonary lesions. When the results of ROSE-TIC of each patient were compared directly with the histological findings of the corresponding specimen, the sensitivity, specificity, and positive and negative predictive values were 69.8%, 90.0%, 93.8%, and 58.1%, respectively. The concordance rate was 76.2%. Therefore, we believe that ROSE-TIC, due to its high specificity and positive predictive value, may be a potential tool in deciding whether cryobiopsy sampling could be finished during bronchoscopy. Abstract Cryobiopsy enables us to obtain larger specimens than conventional forceps biopsy despite the caution regarding complications. This study aimed to evaluate the clinical utility of rapid on-site evaluation of touch imprint cytology (ROSE-TIC) during cryobiopsy of peripheral pulmonary lesions (PPLs). We retrospectively reviewed the data of consecutive patients who underwent cryobiopsy for solid PPLs between June 2020 and December 2021. ROSE-TIC was performed on the first specimen obtained via cryobiopsy and assessed using Diff-Quik staining. The results of ROSE-TIC for each patient were compared with the histological findings of the first cryobiopsy specimen. Sixty-three patients were enrolled in this study. Overall, 57 (90.5%) lesions were ≤30 mm in size and 37 (58.7%) had positive bronchus signs. The radial endobronchial ultrasound findings were located within and adjacent to the lesion in 46.0% and 54.0% of the cases, respectively. The sensitivity, specificity, and positive and negative predictive values of the ROSE results for histological findings of the corresponding specimens were 69.8%, 90.0%, 93.8%, and 58.1%, respectively. The concordance rate was 76.2%. In conclusion, ROSE-TIC, due to its high specificity and positive predictive value, may be a potential tool in deciding whether cryobiopsy sampling could be finished during bronchoscopy.
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DeMaio A, Thiboutot J, Yarmus L. Applications of cryobiopsy in airway, pleural, and parenchymal disease. Expert Rev Respir Med 2022; 16:875-886. [PMID: 36069255 DOI: 10.1080/17476348.2022.2122444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION :Cryobiopsy is a novel diagnostic technique for thoracic diseases which has been extensively investigated over the past 20 years. It was originally proposed for the diagnosis of endobronchial lesions and diffuse parenchymal lung disease due to limitations of conventional sampling techniques including small size and presence of artifacts. AREAS COVERED :We will review recent evidence related to the expanding use of cryobiopsy in thoracic diseases. To identify references, the MEDLINE database was searched from database inception until May 2022 for case series, cohort studies, randomized controlled trials, systematic reviews and meta-analyses related to cryobiopsy. EXPERT OPINION Cryobiopsy has expanding applications in the field of thoracic diseases. Evidence to support transbronchial cryobiopsy as an alternative to surgical lung biopsy is increasing and was recently endorsed as a conditional recommendation by the latest American Thoracic Society guideline update for Idiopathic Pulmonary Fibrosis. Developments in technology and technique, in particular the availability of a 1.1 mm flexible cryoprobe, have extended applications to pulmonary diseases, including diagnosis of interstitial lung diseases, peripheral pulmonary lesions, and lung transplant rejection.
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Affiliation(s)
- Andrew DeMaio
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Jeffrey Thiboutot
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Lonny Yarmus
- Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine.,Division of Pulmonary and Critical Care Medicine
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12
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Ribeiro Neto ML, Arrossi AV, Yadav R, Culver DA, Mukhopadhyay S, Parambil JG, Southern BD, Tolle L, Pande A, Almeida FA, Sahoo D, Glennie J, Ahmad U, Mehta AC, Gildea TR. Prospective cohort of cryobiopsy in interstitial lung diseases: a single center experience. BMC Pulm Med 2022; 22:215. [PMID: 35655191 PMCID: PMC9161499 DOI: 10.1186/s12890-022-01990-4] [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: 01/31/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022] Open
Abstract
Rationale Transbronchial cryobiopsy has been increasingly used to diagnose interstitial lung diseases. However, there is uncertainty regarding its accuracy and risks, mainly due to a paucity of prospective or randomized trials comparing cryobiopsy to surgical biopsy.
Objectives To evaluate the diagnostic yield and complications of cryobiopsy in patients selected by multidisciplinary discussion.
Methods This was a prospective cohort from 2017 to 2019. We included consecutive patients with suspected interstitial lung diseases being considered for lung biopsy presented at our multidisciplinary meeting. Measurements and main results Of 112 patients, we recommended no biopsy in 31, transbronchial forceps biopsy in 16, cryobiopsy in 54 and surgical biopsy in 11. By the end of the study, 34 patients had had cryobiopsy and 24 patients, surgical biopsy. Overall pathologic and multidisciplinary diagnostic yield of cryobiopsy was 47.1% and 61.8%, respectively. The yield increased over time for both pathologic (year 1: 28.6%, year 2: 54.5%, year 3: 66.7%, p = 0.161) and multidisciplinary (year 1: 50%, year 2: 63.6%, year 3: 77.8%, p = 0.412) diagnosis. Overall rate of grade 4 bleeding after cryobiopsy was 11.8%. Cryobiopsy required less chest tube placement (11.8% vs 100%, p < 0.001) and less hospitalizations compared to surgical biopsy (26.5% vs 95.7%, p < 0.001), but hospitalized patients had a longer median hospital stay (2 days vs 1 day, p = 0.004). Conclusions Diagnostic yield of cryobiopsy increased over time but the overall grade 4 bleeding rate was 11.8%. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01990-4.
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13
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Transbronchial Lung Cryobiopsy in Patients with Interstitial Lung Disease: A Systematic Review. Ann Am Thorac Soc 2022; 19:1193-1202. [PMID: 35499855 DOI: 10.1513/annalsats.202102-198oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE In 2018, a systematic review evaluating transbronchial lung cryobiopsy (TBLC) in patients with interstitial lung disease (ILD) was performed to inform American Thoracic Society (ATS), European Respiratory Society (ERS), Japanese Respiratory Society (JRS), and Asociación Latinoamericana del Tórax (ALAT) clinical practice guidelines on the diagnosis of idiopathic pulmonary fibrosis (IPF). OBJECTIVE To perform a new systematic review to inform updated guidelines. METHODS Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CCTR) were searched through June 2020. Studies that enrolled patients with ILD and reported the diagnostic yield or complication rates of TBLC were selected for inclusion. Data was extracted and then pooled across studies via meta-analysis. The quality of the evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS Histopathologic diagnostic yield (number of procedures that yielded a histopathologic diagnosis divided by the total number of procedures performed) of TBLC was 80% (95% CI 76-83%) in patients with ILD. TBLC was complicated by bleeding and pneumothorax in 30% (95% CI 20-41%) and 8% (95% CI 6-11%) of patients, respectively. Procedure-related mortality, severe bleeding, prolonged air leak, acute exacerbation, respiratory failure, and respiratory infection were rare. The quality of the evidence was very low due to the uncontrolled study designs, lack of consecutive enrollment, and inconsistent results. CONCLUSION Very low-quality evidence indicated that TBLC has a diagnostic yield of approximately 80% in patients with ILD, with manageable complications.
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14
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Castellani C, Castellani H, Benn BS. Transbronchial Lung Cryobiopsy is Safe and Effective for Diagnosing Acutely Ill Hospitalized Patients with New Diffuse Parenchymal Lung Disease. Lung 2022; 200:153-159. [PMID: 35103841 PMCID: PMC8805131 DOI: 10.1007/s00408-022-00513-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/08/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Transbronchial lung cryobiopsy (TBLC) is an accepted alternative to surgical lung biopsy (SLB) for diagnosing diffuse parenchymal lung disease (DPLD) that is less invasive and results in comparable diagnostic yields. Performing lung biopsies on hospitalized patients, however, has increased risk due to the patient's underlying disease severity. Data evaluating the safety and efficacy of TBLC in hospitalized patients are limited. We present a comparison of TBLC for hospitalized and outpatients and provide the safety and diagnostic yields in these populations. METHODS Demographic data, pulmonary function values, chest imaging pattern, procedural information, and diagnosis were recorded from enrolled patients. Complications from the procedure were the primary outcomes and diagnostic yield was the secondary outcome. RESULTS 77 patients (n = 22 hospitalized vs n = 55 outpatient) underwent TBLC during the study period. Comparing adverse events between hospitalized and outpatients revealed no statistically significant differences in pneumothorax (9%, n = 2 vs 5%,n = 3), tube thoracostomy placement (5%, n = 1 vs 2%, n = 1), grade 2 bleeding (9%, n = 2 vs 0%, n = 0), escalation in level of care (5%, n = 1 vs 0%, n = 0), 30-day mortality (9%, n = 2 vs 2%, n = 1), and 60-day mortality (9%, n = 2 vs 4%, n = 2) (p > 0.05 for all). No deaths were attributed to the procedure. 95% of cases received a multidisciplinary conference diagnosis (hospitalized 100%, n = 22 vs outpatients 93%, n = 51, p = 0.32). CONCLUSION Our experience supports that TBLC may be a safe and effective modality for acutely ill-hospitalized patients with DPLD. Further efforts to enhance procedural safety and to determine the impact of an expedited tissue diagnosis on patient outcomes are needed.
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Affiliation(s)
- Carson Castellani
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Bryan S Benn
- Division of Pulmonary and Critical Care, Department of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank, Milwaukee, WI, 53226, USA.
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15
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Nakai T, Watanabe T, Kaimi Y, Ogawa K, Matsumoto Y, Sawa K, Okamoto A, Sato K, Asai K, Matsumoto Y, Ohsawa M, Kawaguchi T. Safety profile and risk factors for bleeding in transbronchial cryobiopsy using a two-scope technique for peripheral pulmonary lesions. BMC Pulm Med 2022; 22:20. [PMID: 35000601 PMCID: PMC8744348 DOI: 10.1186/s12890-021-01817-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/27/2021] [Indexed: 11/24/2022] Open
Abstract
Background A balloon occlusion technique is suggested for use in cryobiopsy for interstitial lung diseases because of the bleeding risk. However, it may interfere with selection of the involved bronchus for peripheral pulmonary lesions (PPLs). A two-scope technique, in which two scopes are prepared and hemostasis is started using the second scope immediately after cryobiopsy, has also been reported. This study aimed to evaluate the safety and diagnostic utility of transbronchial cryobiopsy using the two-scope technique for PPLs. Methods Data of patients who underwent conventional biopsy followed by cryobiopsy using the two-scope technique for PPLs from November 2019 to March 2021 were collected. The incidence of complications and risk factors for clinically significant bleeding (moderate to life-threatening) were investigated. Diagnostic yields were also compared among conventional biopsy, cryobiopsy, and the combination of them. Results A total of 139 patients were analyzed. Moderate bleeding occurred in 25 (18.0%) patients without severe/life-threatening bleeding. Although five cases required transbronchial instillation of thrombin, all bleeding was completely controlled using the two-scope technique. Other complications included two pneumothoraces and one asthmatic attack. On multivariable analysis, only ground-glass features (P < 0.001, odds ratio: 9.30) were associated with clinically significant bleeding. The diagnostic yields of conventional biopsy and cryobiopsy were 76.3% and 81.3%, respectively (P = 0.28). The total diagnostic yield was 89.9%, significantly higher than conventional biopsy alone (P < 0.001). Conclusions The two-scope technique provides useful hemostasis for safe cryobiopsy for PPLs, with a careful decision needed for ground-glass lesions.
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Affiliation(s)
- Toshiyuki Nakai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yuto Kaimi
- Department of Pathology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Koichi Ogawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Atsuko Okamoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kanako Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Masahiko Ohsawa
- Department of Pathology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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16
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Hackner K, Stadler A, Schragel F, Klamminger V, Ghanim B, Varga A, Errhalt P. Transbronchial lung cryobiopsy: prospective safety evaluation and 90-day mortality after a standardized examination protocol. Ther Adv Respir Dis 2022; 16:17534666221077562. [PMID: 35238279 PMCID: PMC8902185 DOI: 10.1177/17534666221077562] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Transbronchial lung cryobiopsy (TBLC) is a new method of bronchoscopic tissue sampling in patients with unclear diffuse parenchymal lung disease (DPLD). While not the gold standard, TBLC has a good diagnostic correlation with surgical lung biopsy, and retrospective analyses of peri-interventional complications and mortality are promising. However, prospective reports on 90-day mortality are lacking. OBJECTIVES This study addresses morbidity and 30- and 90-day mortality in TBLC after a standardized protocol. METHODS In this prospective study, 75 patients with DPLD requiring tissue sampling were included. A standardized protocol (including prophylactic use of an endobronchial balloon, postinterventional observation, and minimum sampling requirements) was used in all patients. Adverse events (pneumothorax, bronchial bleeding, premature discontinuation, prolonged monitoring at ICU, and fatal outcome) and 30- and 90-day mortality rates were recorded. RESULTS A total of 308 cryobiopsies were performed in 75 patients. Peri- and postinterventional pneumothorax were observed in 20% (9.3% mild and 10.7% moderate with the necessity of chest drainage), and bronchial bleeding was found in 29.3% (22.7% moderate and 6.7% severe). Total lung capacity below normal value was associated with the risk of pneumothorax (p = 0.009), and diffusion limitation for carbon monoxide below normal value was associated with the risk of bronchial bleeding (p = 0.044). No fatal events were observed within 30 days, and the 90-day mortality rate was 1.3%, but not related to the procedure itself. CONCLUSION As it gradually becomes the invasive procedure of choice in unclear DPLD, TBLC is a safe procedure with a low 30- and 90-day mortality.Trial registration ID: DRKS00026746 (German Clinical Trial Register).
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Affiliation(s)
- Klaus Hackner
- Department of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Mitterweg 10, 3500 Krems, Austria
| | - Antonia Stadler
- Department of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Felix Schragel
- Department of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Valerie Klamminger
- Department of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Bahil Ghanim
- Department of General and Thoracic Surgery, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria
| | | | - Peter Errhalt
- Department of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria
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17
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Benn BS, Romero AO, Bawaadam H, Ivanick N, Lum M, Krishna G. Cone Beam CT Guidance Improves Transbronchial Lung Cryobiopsy Safety. Lung 2021; 199:485-492. [PMID: 34495390 DOI: 10.1007/s00408-021-00473-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/29/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Determining the cause of diffuse parenchymal lung disease (DPLD) is challenging. While surgical lung biopsy has been the standard approach, transbronchial lung cryobiopsy (TBLC) represents a minimally invasive alternative with an acceptable safety profile and reasonable accuracy. In this study, we prospectively assessed whether the use of cone beam CT (CBCT) coupled with a novel bronchoscope holder and prophylactic administration of vasoconstricting medications decreases potential complications and improves diagnostic accuracy when performing TBLC. METHODS 33 patients presenting for evaluation of newly diagnosed DPLD were enrolled. Demographic data, pulmonary function values, chest imaging pattern, procedural information, and diagnosis were recorded. RESULTS Mean patient age was 67, with the majority Caucasian (n = 26, 79%) and male (n = 20, 61%). Mean pulmonary function values revealed restrictive lung disease (76 ± 14% predicted) and diffusing capacity impairment (52 ± 16%). A non-usual interstitial pneumonia imaging pattern was commonly seen (n = 20, 61%). CBCT guided TBLC was performed in one lobe (n = 29, 88%) or two lobes (n = 4, 12%) with mean probe-to-pleura distance of 4.2 ± 1.3 mm. No peri or post procedural complications occurred. 32 patients (97%) received a histological diagnosis with a final multidisciplinary conference diagnosis possible for 32 (97%). CONCLUSION CBCT guided TBLC coupled with a novel articulating scope holder and prophylactic phenylephrine administration has the potential to increase safety and diagnostic yield for patients with newly identified DPLD. Future studies comparing different aspects of this approach in isolation and with other modalities have the potential to refine this procedure to improve patient care.
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Affiliation(s)
- Bryan S Benn
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank, Milwaukee, WI, 53226, USA.
| | - Arthur Oliver Romero
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Hasnain Bawaadam
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Nathaniel Ivanick
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, CA, USA.,Department of Pulmonary Medicine, Roswell Park Cancer Center, Buffalo, NY, USA
| | - Mendy Lum
- Respiratory Care Services, El Camino Health, Mountain View, CA, USA
| | - Ganesh Krishna
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, CA, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Palo Alto Medical Foundation, Palo Alto, CA, USA
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18
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Menezes V, Molina JC, Pollock C, Romeo P, Morisset J, Ferraro P, Lafontaine E, Martin J, Nasir B, Leduc C, Liberman M. Lung Cryobiopsy Outside of the Operating Room: A Safe Alternative to Surgical Biopsy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:463-469. [PMID: 34338070 PMCID: PMC8637350 DOI: 10.1177/15569845211034506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
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 occurred in 25% and 16.7% of patients,
respectively. Sixty-seven percent of complications occurred with use of the
2.4 mm cryoprobe (P = 0.036). Concordance between the
histologic diagnosis and final clinical diagnosis was observed in 62.5% of
patients and the pathology guided the final treatment in 71%
(P = 0.027) with Kappa-concordance of 0.60
(P < 0.001). Conclusions Cryobiopsy is becoming part of the diagnostic evaluation in patients with
indeterminate DPLD or hypoxemic respiratory failure. TBLC is easy to perform
and has a favorable safety profile. Thoracic specialists should consider
adding TBLC to their procedural armamentarium as a first option for patients
with indeterminate PLD.
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Affiliation(s)
- Vanessa Menezes
- 5622 Division of Thoracic Surgery, CHUM Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Juan Carlos Molina
- 5622 Division of Thoracic Surgery, CHUM Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Clare Pollock
- 5622 Division of Thoracic Surgery, CHUM Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Philippe Romeo
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Julie Morisset
- Division of Pulmonology, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Pasquale Ferraro
- 5622 Division of Thoracic Surgery, CHUM Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Edwin Lafontaine
- 5622 Division of Thoracic Surgery, CHUM Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Jocelyne Martin
- 5622 Division of Thoracic Surgery, CHUM Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Basil Nasir
- 5622 Division of Thoracic Surgery, CHUM Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Charles Leduc
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Moishe Liberman
- 5622 Division of Thoracic Surgery, CHUM Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Québec, Canada
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Turan D, Uğur Chousein EG, Koç AS, Çörtük M, Yıldırım Z, Demirkol B, Özgül MA, Çınarka H, Akalın N, Yardımcı AH, Çetinkaya E. Transbronchial cryobiopsy for diagnosing parenchymal lung diseases: real-life experience from a tertiary referral center. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2021; 38:e2021004. [PMID: 33867791 PMCID: PMC8050620 DOI: 10.36141/svdld.v38i1.11029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/23/2021] [Indexed: 11/21/2022]
Abstract
Background and Objectives: Transbronchial cryobiopsy (cryo-TBB) is increasingly being used in the diagnosis of diffuse parenchymal lung diseases (DPLD). Varying diagnostic success and complication rates have been reported. Herein we report our experience with cryo-TBB, focusing on diagnostic yield, factors affecting diagnosis, and safety. Methods: This retrospective study was conducted in a tertiary referral chest diseases hospital. Data regarding the patients, procedures, complication rates, diagnostic yield, and the final diagnosis made by a multidisciplinary committee at all diagnosis stages were evaluated. Results: We recruited 147 patients with suspected DPLD. The definitive diagnosis was made pathologically in 98 of 147 patients (66.6%) and using a multidisciplinary approach in 109 of 147 (74.1%) cases. The number of samples had a significant effect on diagnostic success. Histopathologic diagnostic yield and diagnostic yield with a multidisciplinary committee after a single biopsy were 50%, and histopathological diagnostic yield and diagnostic yield with multidisciplinary committee increased to 71.4% and 85.7%, respectively, with a second biopsy (p = 0.034). The incidence of mild-to-moderate hemorrhage was 31.9%; no severe hemorrhage occurred. Pneumothorax rate was 15.6%, and the mortality rate was 0.68%. Conclusions: Cryo-TBB has sufficient diagnostic yield in the context of a multidisciplinary diagnosis with acceptable complication rates. Performing at least 2 biopsies and from at least 2 segments increases diagnostic success.
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Affiliation(s)
- Demet Turan
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Efsun Gonca Uğur Chousein
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Aysu Sinem Koç
- Ministry of Health, Dr. Yaşar Eryilmaz Dogubayazit State Hospital, Clinic of Chest Diseases, Agri, Turkey
| | - Mustafa Çörtük
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Zeynep Yıldırım
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Bariş Demirkol
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Mehmet Akif Özgül
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Halit Çınarka
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Neslihan Akalın
- University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Department of Pathology, Istanbul, Turkey
| | - Aytül Hande Yardımcı
- University of Health Sciences Turkey, Basaksehir Cam and Sakura City Hospital, Department of Radiology, Istanbul, Turkey
| | - Erdoğan Çetinkaya
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
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Endobronchial Balloon Blockers: A Retrospective Analysis of Their Implementation for Use in Transbronchial Cryobiopsy Under Conscious Sedation. Lung 2021; 199:187-193. [PMID: 33595686 DOI: 10.1007/s00408-021-00424-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Transbronchial lung cryobiopsy (TBLC) is a promising technique that is evolving as a standard diagnostic procedure in the diagnosis of interstitial lung disease. However, there are a variety of non-standardised techniques adopted for this procedure. We aim to describe our approach to TBLC with balloon blockade under conscious sedation (CS). METHODS We performed a retrospective analysis of patients undergoing TBLC using flexible bronchoscopy under CS in our institution over the calendar years 2017-2018; before and after a transition to the use of endobronchial balloon blockers (EBB) in 2017. RESULTS 25 patients underwent transbronchial cryobiopsy during the study period. Of these; 12 procedures used EBB. EBB subjects had significantly less moderate or severe airway bleeding (8.3% vs 38.5%) despite higher biopsy rates in the EBB group, 2.9 (2-4) vs 2.4 (1-4) in the non-EBB group. No severe airway bleeding occurred in the EBB group. A multidisciplinary meeting (MDM) confirmed diagnosis was achieved in 88% of patients. 10/12 subjects (83%) in the EBB group and 12/13 subjects (92%) in the non-EBB group (p = 0.5). CONCLUSION Our institution is novel in using EBB as standard during TBLC specifically under CS with flexible bronchoscopy in the bronchoscopy suite. This retrospective analysis demonstrates that EBB enhances the safety profile of performing TBLC under CS and did not appear to impact diagnostic yield or patient safety.
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21
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Goel MK, Kumar A, Maitra G, Singh B, Ahlawat S, Jain P, Garg N, Verma RK. Safety and diagnostic yield of transbronchial lung cryobiopsy by flexible bronchoscopy using laryngeal mask airway in diffuse and localized peripheral lung diseases: A single-center retrospective analysis of 326 cases. Lung India 2021; 38:109-116. [PMID: 33687002 PMCID: PMC8098897 DOI: 10.4103/lungindia.lungindia_220_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Intubation with either an endotracheal tube or a rigid bronchoscope is generally preferred to provide airway protection as well as to manage unpredictable complications during transbronchial lung cryobiopsy (TBLC). The laryngeal mask airway has been described as a safe and convenient tool for airway control during bronchoscopy. Aims and Objectives In this study, we evaluated the safety and outcome of using a laryngeal mask airway (LMA) as a conduit for performing TBLC by flexible video bronchoscopy (FB). Methods We retrospectively analyzed the database of the patients who underwent TBLC between November 2015 and September 2019. The procedure was performed using FB through LMA under general anesthesia. Prophylactic occlusion balloon was routinely used starting January 2017 onwards. Radial endobronchial ultrasound (R-EBUS) guidance was used for TBLC in the localized lung lesions when deemed necessary. Multidisciplinary consensus diagnostic yield was determined and periprocedural complications were recorded. Results A total of 326 patients were analysed. The overall diagnostic yield was 81.60% (266/326) which included a positive yield of 82.98% (161/194) in patients with diffuse lung disease and 79.54% (105/132) in patients with localized disease. Serious bleeding complication occurred in 3 (0.92%) cases. Pneumothorax was encountered in 8 (2.45%) cases. A total of 9 (2.76%) cases had at least 1 major complication. Conclusion This study demonstrates that the use of LMA during TBLC by flexible bronchoscopy allows for a convenient port of entry, adequate airway support and effective endoscopic management of intrabronchial haemorrhage especially with the use of occlusion balloon.
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Affiliation(s)
- Manoj Kumar Goel
- Department of Pulmonology, Critical Care and Sleep Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Ajay Kumar
- Department of Pulmonology, Critical Care and Sleep Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Gargi Maitra
- Department of Pulmonology, Critical Care and Sleep Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Balkar Singh
- Department of Anesthesiology, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Sunita Ahlawat
- Department of Pathology, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Priti Jain
- Department of Pathology, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Neeraj Garg
- Department of Pathology, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - R K Verma
- Department of Radiology, Fortis Memorial Research Institute, Gurugram, Haryana, India
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22
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Avasarala SK, Wells AU, Colby TV, Maldonado F. Transbronchial Cryobiopsy in Interstitial Lung Diseases: State-of-the-Art Review for the Interventional Pulmonologist. J Bronchology Interv Pulmonol 2021; 28:81-92. [PMID: 32960830 DOI: 10.1097/lbr.0000000000000716] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
Interstitial lung diseases are a heterogenous group of disorders that are often difficult to diagnose precisely. Clinical, laboratory, radiographic, and histologic information may be needed to arrive at the correct diagnosis. The multidisciplinary discussion has been proven to be useful in this patient group. Transbronchial cryobiopsy has become a popular method for obtaining tissue samples. Over the course of the last decade, there has been a significant amount of research assessing the feasibility, safety, and diagnostic endpoints of transbronchial cryobiopsy in patients with interstitial lung disease. Data continues to mount to support its use, which has been reflected in guidelines and expert panel reports. Patient selection, procedural performance, and appropriate specimen handling are critical factors for success. A coordinated approach by pulmonologists with expertise in interstitial lung diseases, interventional pulmonologists, and thoracic pathologists is essential. In this evidence-based narrative review, we address transbronchial cryobiopsies from these three distinct perspectives. In addition, the current literature was used to address nine common procedural questions.
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Affiliation(s)
- Sameer K Avasarala
- Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, TN
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College London, London, UK
| | | | - Fabien Maldonado
- Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, TN
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23
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Torky M, Elshimy WS, Ragab MA, Attia GA, Lopez R, Mate JL, Centeno C, Serra P, Tazi Mezalek R, Pérez EN, Manzano JR, Rosell A, Andreo F. Endobronchial ultrasound guided transbronchial cryobiopsy versus forceps biopsy in peripheral lung lesions. CLINICAL RESPIRATORY JOURNAL 2020; 15:320-328. [PMID: 33112480 DOI: 10.1111/crj.13301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/24/2020] [Accepted: 10/23/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Radial probe endobronchial ultrasound (RP-EBUS) is a modern technique for diagnosis of peripheral lung lesions. It is assumed that the addition of transbronchial cryobiopsy (TBCB) could increase the diagnostic value for RP-EBUS. OBJECTIVES The main objectives were to evaluate the efficacy and safety of RP-EBUS-guided TBCB for diagnosis of peripheral lung lesions and comparing it with RP-EBUS-guided transbronchial forceps biopsy. METHODS Sixty patients with peripheral lung diseases were divided into two groups. Group I included 45 patients who were eligible for TBCB and they subjected to forceps transbronchial biopsy (forceps TBB) and TBCB guided by RP-EBUS. Fifteen patients who were not eligible for TBCB were included in group II and they were subjected to forceps TBB and/or cytology retrieval procedures guided by RP-EBUS. RESULTS In group I, forceps TBB had sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of; 67.5%, 100%, 100%, 18.8%, and 69.8%, respectively, while TBCB had sensitivity, specificity, PPV, NPV, and accuracy of 75%, 100%, 100%, 23.1%, and 76.7%, respectively. The sensitivity in group II was 80% and the overall results including both groups were sensitivity, specificity, PPV, NPV, and accuracy of 85.2%, 100%, 100%, 42.8%, and 86.7%, respectively. Regarding the complications, only one patient (1.7%) had significant bleeding. One patient (1.7%) had pneumothorax and another patient (1.7%) suffered from hypoxemia. CONCLUSIONS RP-EBUS-guided TBCB is a safe and effective technique for diagnosis of peripheral lung lesions. TBCB has achieved higher diagnostic values and better quality of samples.
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Affiliation(s)
- Mohamed Torky
- Chest Department, Tanta University, Tanta, Egypt.,Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Bronchoscopy Unit, Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | | | - Raquel Lopez
- Pathology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jose Luis Mate
- Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Pathology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Carmen Centeno
- Bronchoscopy Unit, Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Pere Serra
- Bronchoscopy Unit, Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Rachid Tazi Mezalek
- Bronchoscopy Unit, Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Eli Nancy Pérez
- Pulmonology Department, Hospital Dos de Maig, Barcelona, Spain
| | - Juan Ruiz Manzano
- Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Bronchoscopy Unit, Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Pathology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Antonio Rosell
- Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Bronchoscopy Unit, Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Felipe Andreo
- Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Bronchoscopy Unit, Pulmonology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
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24
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Negative Results: We Shouldn't Leave them Out in the Cold. J Bronchology Interv Pulmonol 2020; 28:8-9. [PMID: 33332845 DOI: 10.1097/lbr.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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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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26
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Jiang S, Liu X, Chen J, Ma H, Xie F, Sun J. A pilot study of the ultrathin cryoprobe in the diagnosis of peripheral pulmonary ground-glass opacity lesions. Transl Lung Cancer Res 2020; 9:1963-1973. [PMID: 33209616 PMCID: PMC7653104 DOI: 10.21037/tlcr-20-957] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background It is very difficult to obtain samples of peripheral pulmonary ground-glass opacity lesions (GGOs) by traditional transbronchial biopsy. This study was conducted to evaluate the diagnostic efficacy and safety of transbronchial cryobiopsy (TBCB) of GGOs using a newly developed ultrathin cryoprobe with an outer diameter of 1.1 mm. Methods We retrospectively analyzed 20 patients with 23 GGOs who underwent TBCB using the ultrathin cryoprobe from October 2018 to November 2019 in the Shanghai Chest Hospital. The TBCB procedure was performed under the guidance of virtual bronchoscopic navigation (VBN), electromagnetic navigation bronchoscopy (ENB), endobronchial ultrasound, and fluoroscopy. We collected the baseline information of participants, reported diagnostic yield and complications, and analyzed factors may have affected the diagnostic yield. Results A total of 23 GGOs (12 pure GGOs, 11 mixed GGOs), with an average diameter of 21.58±11.88 mm, underwent TBCB, and the diagnostic yield was 82.61% (19/23). Of the 19 GGOs diagnosed by TBCB, 12 were adenocarcinomas, 5 were inflammation, 1 was occupational interstitial lung disease, and 1 was a pulmonary meningothelial-like nodule. The remaining 4 undiagnosed lesions were confirmed to be adenocarcinomas by further analysis. The diagnostic yield was unchanged by factors including size (GGOs ≥20 mm, GGOs <20 mm), navigation (VBN, ENB), fluoroscopic visibility (visible, invisible), GGO-component (pure GGOs, mixed GGOs), and guide sheath (K-201, K203). There was no presentation of pneumothorax or severe hemorrhage. Conclusions The ultrathin cryoprobe is feasible, safe, and has a high diagnostic yield in the diagnosis of pulmonary GGOs. There is vast potential for the ultrathin cryoprobe as a tool for the diagnosis of GGOs, especially for cases suspicious of early-stage lung cancer. Trial registration ClinicalTrials.gov. No: NCT03716284. Registered: 20 October, 2018. URL: ClinicalTrials.gov.
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Affiliation(s)
- Simin Jiang
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Xiaojun Liu
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Respiratory and Critical Care Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Junxiang Chen
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Haifeng Ma
- Institute of Respiratory Disease, First Hospital of China Medical University, Shenyang, China
| | - Fangfang Xie
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
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Pajares V, Núñez-Delgado M, Bonet G, Pérez-Pallarés J, Martínez R, Cubero N, Zabala T, Cordovilla R, Flandes J, Disdier C, Torrego A. Transbronchial biopsy results according to diffuse interstitial lung disease classification. Cryobiopsy versus forceps: MULTICRIO study. PLoS One 2020; 15:e0239114. [PMID: 32956379 PMCID: PMC7505587 DOI: 10.1371/journal.pone.0239114] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In recent years, transbronchial cryobiopsy (TBCB) has come to be increasingly used in interventional pulmonology units as it obtains larger and better-quality samples than conventional transbronchial lung biopsy (TBLB) with forceps. No multicenter studies have been performed, however, that analyse and compare TBCB and TBLB safety and yield according to the interstitial lung disease (ILD) classification. OBJECTIVES We compared the diagnostic yield and safety of TBCB with cryoprobe sampling versus conventional TBLB forceps sampling in the same patient. METHOD Prospective multicenter clinical study of patients with ILD indicated for lung biopsy. Airway management with orotracheal tube, laryngeal mask and rigid bronchoscope was according to the protocol of each centre. All procedures were performed using fluoroscopy and an occlusion balloon. TBLB was followed by TBCB. Complications were recorded after both TBLB and TBCB. RESULTS Included were 124 patients from 10 hospitals. Airway management was orotracheal intubation in 74% of cases. Diagnostic yield according to multidisciplinary committee results for TBCB was 47.6% and for TBLB was 19.4% (p<0.0001). Diagnostic yield was higher for TBCB compared to TBLB for two groups: idiopathic interstitial pneumonias (IIPs) and ILD of known cause or association (OR 2.5; 95% CI: 1.4-4.2 and OR 5.8; 95% CI: 2.3-14.3, respectively). Grade 3 (moderate) bleeding after TBCB occurred in 6.5% of patients compared to 0.8% after conventional TBLB. CONCLUSIONS Diagnostic yield for TBCB was higher than for TBLB, especially for two disease groups: IIPs and ILD of known cause or association. The increased risk of bleeding associated with TBCB confirms the need for safe airway management and prophylactic occlusion-balloon use. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT02464592.
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Affiliation(s)
- Virginia Pajares
- Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | | | - Gloria Bonet
- Respiratory Medicine, Hospital Universitario de Germans Trias i Pujol, Barcelona, Spain
| | - Javier Pérez-Pallarés
- Respiratory Medicine, Hospital Universitario de Santa Lucía, Cartagena, Murcia, Spain
| | - Raquel Martínez
- Respiratory Medicine, Hospital Universitario La Fé, Valencia, Spain
| | - Noelia Cubero
- Respiratory Medicine, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Txomin Zabala
- Respiratory Medicine, Hospital Galdakao-Usansolo, Vizcaya, Bizkaia, Spain
| | - Rosa Cordovilla
- Respiratory Medicine, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Javier Flandes
- Respiratory Medicine, Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos Disdier
- Respiratory Medicine, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Alfons Torrego
- Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
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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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Bourdin A, Romagnoli M, Gamez AS, Hireche K, Berthet JP, Mallet JP, Vachier I, Nava S, Reynaud P, Molinari N, Suehs C. Careful consideration of the bleeding caused by transbronchial lung cryobiopsies. Eur Respir J 2020; 55:55/5/1902415. [PMID: 32439734 DOI: 10.1183/13993003.02415-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/07/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Arnaud Bourdin
- Dept of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France.,PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Micaela Romagnoli
- Pulmonology Unit, Ospedale Ca' Foncello, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Anne Sophie Gamez
- Dept of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Kheira Hireche
- Dept of Cardiac, Thoracic and Vascular Surgery, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Jean Philippe Berthet
- Dept of Cardiac, Thoracic and Vascular Surgery, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Jean Pierre Mallet
- Dept of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Isabelle Vachier
- Dept of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Stefano Nava
- Dept of Pulmonology, Univ Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Paul Reynaud
- Dept of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Nicolas Molinari
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France.,Dept of Medical Information, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Carey Suehs
- Dept of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France .,Dept of Medical Information, Univ Montpellier, CHU Montpellier, Montpellier, France
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30
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Maldonado F, Danoff SK, Wells AU, Colby TV, Ryu JH, Liberman M, Wahidi MM, Frazer L, Hetzel J, Rickman OB, Herth FJ, Poletti V, Yarmus LB. Transbronchial Cryobiopsy for the Diagnosis of Interstitial Lung Diseases. Chest 2020; 157:1030-1042. [DOI: 10.1016/j.chest.2019.10.048] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/03/2019] [Accepted: 10/28/2019] [Indexed: 11/26/2022] Open
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Maldonado F, Wells A, Danoff S, Colby T, Ryu J, Poletti V, Rickman O, Herth F, Wahidi M, Hetzel J, Liberman M, Yarmus L. Before Freezing Out Cryobiopsy, We Need to Thaw Out Flaws in the Diagnosis of Interstitial Lung Disease. Am J Respir Crit Care Med 2020; 200:937-938. [PMID: 31442071 PMCID: PMC6812452 DOI: 10.1164/rccm.201903-0699le] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Athol Wells
- Royal Brompton HospitalLondon, United Kingdom
| | - Sonye Danoff
- Johns Hopkins School of MedicineBaltimore, Maryland
| | | | - Jay Ryu
- Mayo ClinicRochester, Minnesota
| | | | - Otis Rickman
- Vanderbilt University Medical CenterNashville, Tennessee
| | - Felix Herth
- University Hospital HeidelbergHeidelberg, Germany
| | - Momen Wahidi
- Duke University School of MedicineDurham, North Carolina
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32
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Greer M, Werlein C, Jonigk D. Surveillance for acute cellular rejection after lung transplantation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:410. [PMID: 32355854 PMCID: PMC7186718 DOI: 10.21037/atm.2020.02.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Acute cellular rejection (ACR) is a common complication following lung transplantation (LTx), affecting almost a third of recipients in the first year. Established, comprehensive diagnostic criteria exist but they necessitate allograft biopsies which in turn increases clinical risk and can pose certain logistical and economic problems in service delivery. Undermining these challenges further, are known problems with inter-observer interpretation of biopsies and uncertainty as to the long-term implications of milder or indeed asymptomatic episodes. Increased risk of chronic lung allograft dysfunction (CLAD) has long been considered the most significant consequence of ACR. Consensus is lacking as to whether this applies to mild ACR, with contradictory evidence available. Given these issues, research into alternative, minimal or non-invasive biomarkers represents the main focus of research in ACR. A number of potential markers have been proposed, but none to date have demonstrated adequate sensitivity and specificity to allow translation from bench to bedside.
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Affiliation(s)
- Mark Greer
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany
| | | | - Danny Jonigk
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Centre for Lung Research (DZL), Hannover, Germany.,Institute for Pathology, Hannover Medical School, Hannover, Germany
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Maldonado F, Kropski JA. POINT: Should Transbronchial Cryobiopsies Be Considered the Initial Biopsy of Choice in Patients With a Possible Interstitial Lung Disease? Yes. Chest 2020; 155:893-895. [PMID: 31060702 DOI: 10.1016/j.chest.2019.02.331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
| | - Jonathan A Kropski
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Veterans Affairs Medical Center, Nashville, TN
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Troy LK, Grainge C, Corte TJ, Williamson JP, Vallely MP, Cooper WA, Mahar A, Myers JL, Lai S, Mulyadi E, Torzillo PJ, Phillips MJ, Jo HE, Webster SE, Lin QT, Rhodes JE, Salamonsen M, Wrobel JP, Harris B, Don G, Wu PJC, Ng BJ, Oldmeadow C, Raghu G, Lau EMT, Arnold D, Cao C, Cashmore A, Cleary S, Evans TJ, French B, Geis M, Glenn L, Hibbert M, Ing A, James A, Meredith G, Merry C, Pudipeddi A, Saghaie T, Thomas R, Thomson C, Twaddell S. Diagnostic accuracy of transbronchial lung cryobiopsy for interstitial lung disease diagnosis (COLDICE): a prospective, comparative study. THE LANCET RESPIRATORY MEDICINE 2020; 8:171-181. [DOI: 10.1016/s2213-2600(19)30342-x] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 10/25/2022]
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Protocolized Thoracic Ultrasonography in Transbronchial Lung Cryobiopsies: A Potential Role as an Exclusion Study for Pneumothorax. J Bronchology Interv Pulmonol 2020; 26:172-178. [PMID: 30124515 DOI: 10.1097/lbr.0000000000000541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Widespread implementation of transbronchial lung cryobiopsy (TBLCB) in the diagnostic approach to diffuse parenchymal lung disease has prompted a call for standardization of technique to optimize safety and diagnostic yield. Thoracic ultrasound (TUS) is proving effective in detecting postconventional transbronchial biopsy pneumothorax (PTX). However, TUS does not obviate the need for chest radiography (CXR) which quantifies and guides treatment of PTX. To our knowledge, this is the first experience evaluating TUS's reliability to rule-out PTX post-TBLCB in diffuse parenchymal lung disease. METHODS Retrospective analysis of patients undergoing TBLCB. A standardized pre-TBLCB/post-TBLCB TUS was performed to detect the presence or absence of sliding lung (SL). TUS' findings were then compared with CXR performed at 1 hour after TBLCB. RESULTS A total of 24 patients' records reviewed. In total, 21 of 24 patients had SL in all lung zones on TUS before and after TBLCB, with a negative CXR for PTX in all 21 patients. The negative predictive value was 100% (95% confidence interval, 84%-100%). Three patients did not have SL in all lung zones on TUS, of which 2 showed the absence of SL in all lung zones on both pre-TBLCB and post-TBLCB TUS, with negative CXR for PTX. 1 of the 3 showed SL in all zones pre-TBLCB and in only 2 zones post-TBLCB. CXR confirmed PTX in this 1 patient. CONCLUSION Our study demonstrates a 100% negative predictive value for the exclusion of PTX via TUS' verification of SL. The practical value of TUS post-TBLCB may lie in its application as a rule-out study, thereby avoiding CXR.
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Guo S, Li Q, Jiang J, Luo F, Li Y, Jin F, Liu X, Wang H, Chen P, Bai C, Dai H, Huang H, Ye X, Yi X, Zhang J, Wang C, Ke M, Sun J, Feng J, Zhou H, Wu Y, Wang Z, Ma Y, Li J, Lv L, Xie B, Hohenforst-Schmidt W, Ding W, Wang X, Yang J, Cai Q, Sun P, Luo Z, Giri M. Chinese expert consensus on the standardized procedure and technique of transbronchial cryobiopsy. J Thorac Dis 2019; 11:4909-4917. [PMID: 32030207 DOI: 10.21037/jtd.2019.12.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Shuliang Guo
- The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qiang Li
- Shanghai East Hospital, Tong Ji University, Shanghai 200120, China
| | - Jinyue Jiang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Fengming Luo
- West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yishi Li
- The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Faguang Jin
- Tangdu Hospital Affiliated to Air Force Medical University, Xi'an 710038, China
| | - Xinzhu Liu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Hongwu Wang
- Emergency General Hospital, Beijing 100028, China
| | - Ping Chen
- The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Chong Bai
- Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Haiyun Dai
- The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Haidong Huang
- Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Xianwei Ye
- Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Xianghua Yi
- Tongji Hospital of Tongji University, Shanghai 200065, China
| | - Jie Zhang
- Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Changhui Wang
- Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Mingyao Ke
- The Second Affiliated Hospital of Xiamen Medical College, Xiamen 361021, China
| | - Jiayuan Sun
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jing Feng
- General Hospital, Tianjin Medical University, Tianjin 300052, China
| | - Hongmei Zhou
- Zhongshan Hospital Affiliated to Guangdong Medical University, Zhongshan 528415, China
| | - Youru Wu
- Mianyang Central Hospital, Mianyang 621000, China
| | - Zhen Wang
- Beijing Chao-yang Hospital, Capital Medical University, Beijing 100069, China
| | - Yun Ma
- Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Jing Li
- Guangdong Provincial People's Hospital, Guangzhou 510030, China
| | - Liping Lv
- Anhui Chest Hospital, Hefei 230022, China
| | - Baosong Xie
- Fujian Provincial Hospital, Fuzhou 350001, China
| | | | - Weimin Ding
- Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Xiaoping Wang
- Shandong Provincial Chest Hospital, Jinan 250000, China
| | | | - Qingshan Cai
- Hangzhou Red Cross Hospital, Hangzhou 310003, China
| | - Peng Sun
- Jilin Tuberculosis Hospital, Changchun 212006, China
| | - Zhuang Luo
- First Affiliated Hospital of Kunming Medical University, Kunming 650031, China
| | - Mohan Giri
- The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Wahidi MM, Herth FJF, Chen A, Cheng G, Yarmus L. State of the Art: Interventional Pulmonology. Chest 2019; 157:724-736. [PMID: 31678309 DOI: 10.1016/j.chest.2019.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/13/2019] [Accepted: 10/09/2019] [Indexed: 12/17/2022] Open
Abstract
Interventional pulmonology (IP) has evolved over the past decade from an obscure subspecialty in pulmonary medicine to a recognized discipline offering advanced consultative and procedural services to patients with thoracic malignancy, anatomic airway disease, and pleural disease. Innovative interventions are now also available for diseases not traditionally treated procedurally, such as asthma and emphysema. The IP field has established certification examinations and training standards for IP training programs in an effort to enhance training quality and ensure competency. Validating new technology and proving its cost-effectiveness and effect on patient outcomes present the biggest challenge to IP as the health-care environment marches toward value-based health care. High-quality research is now thriving in IP and promises to elevate its practice into patient-centric evidence-based care.
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Affiliation(s)
- Momen M Wahidi
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, Durham, NC.
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center, University of Heidelberg, Heidelberg, Germany
| | - Alexander Chen
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO
| | - George Cheng
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, Durham, NC
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
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39
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Heterogeneity in Unclassifiable Interstitial Lung Disease. A Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2019; 15:854-863. [PMID: 29779392 DOI: 10.1513/annalsats.201801-067oc] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
RATIONALE Accurate diagnosis of interstitial lung disease is necessary to identify the most appropriate management strategy and to inform prognosis. Many patients cannot be provided a confident diagnosis, despite an exhaustive search for potential etiologies and review in a multidisciplinary conference, and are consequently labeled with unclassifiable interstitial lung disease. OBJECTIVES To systematically review and meta-analyze previous studies reporting on the diagnostic criteria, prevalence, clinical features, and outcome of unclassifiable interstitial lung disease. METHODS MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials databases were systematically searched for all studies related to unclassifiable interstitial lung disease published before September 1, 2017. Two authors independently screened each citation for eligibility criteria, serially reviewing the title, abstract, and full-text manuscript, and then abstracted data pertaining to the study objectives from eligible studies. Articles were stratified by risk of selection bias, whether the publication stated that patients were reviewed in a multidisciplinary discussion, and by the frequency of surgical lung biopsy. Meta-analyses and meta-regression were performed to calculate the pooled prevalence of unclassifiable interstitial lung disease within an interstitial lung disease population and within specific subgroups to identify reasons for across-study heterogeneity. RESULTS The search identified 10,130 unique citations, 313 articles underwent full-text review, and eligibility criteria were met in 88 articles. Twenty-two studies were deemed low risk of selection bias, including 1,060 patients with unclassifiable interstitial lung disease from a total of 10,174 patients with interstitial lung disease. The terminology and definition of unclassifiable interstitial lung disease varied substantially across publications, with inconsistent diagnostic criteria and evaluation processes. The prevalence of unclassifiable interstitial lung disease was 11.9% (95% confidence interval, 8.5-15.6%), with lower prevalence in centers that reported use of a formal multidisciplinary discussion of cases (9.5% vs. 14.5%). Four articles reported survival of unclassifiable interstitial lung disease, with 1-year, 2-year, and 5-year survival of 84% to 89%, 70% to 76%, and 46% to 70%, respectively. CONCLUSIONS This systematic review and meta-analysis shows that unclassifiable interstitial lung disease is common but has substantial heterogeneity and inconsistent definitions across interstitial lung disease cohorts. These findings highlight important limitations in multicenter studies of fibrotic interstitial lung disease and the need for a standardized approach to interstitial lung disease diagnostic classification.
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40
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Oki M, Saka H. Novel technique to prevent central airway blood flooding during transbronchial cryobiopsy. J Thorac Dis 2019; 11:4085-4089. [PMID: 31656684 DOI: 10.21037/jtd.2019.04.59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Masahide Oki
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan
| | - Hideo Saka
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan
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Pannu J, Roller LJ, Maldonado F, Lentz RJ, Chen H, Rickman OB. Transbronchial cryobiopsy for diffuse parenchymal lung disease: 30- and 90-day mortality. Eur Respir J 2019; 54:13993003.00337-2019. [PMID: 31285307 DOI: 10.1183/13993003.00337-2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/25/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Jasleen Pannu
- Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University Medical Center, Columbus, OH, USA
| | - Lance J Roller
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert J Lentz
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Dept of Veterans Affairs Medical Center, Nashville, TN, USA
| | - Heidi Chen
- Dept of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Otis B Rickman
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Harari S, Cereda F, Pane F, Cavazza A, Papanikolaou N, Pelosi G, Scarioni M, Uslenghi E, Zompatori M, Caminati A. Lung Cryobiopsy for the Diagnosis of Interstitial Lung Diseases: A Series Contribution to a Debated Procedure. ACTA ACUST UNITED AC 2019; 55:medicina55090606. [PMID: 31546869 PMCID: PMC6780159 DOI: 10.3390/medicina55090606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 12/31/2022]
Abstract
Introduction: Transbronchial cryobiopsy is an alternative to surgical biopsy for the diagnosis of fibrosing interstitial lung diseases, although the role of this relatively new method is rather controversial. Aim of this study is to evaluate the diagnostic performance and the safety of transbronchial cryobiopsy in patients with fibrosing interstitial lung disease. Materials and methods: The population in this study included patients with interstitial lung diseases who underwent cryobiopsy from May 2015 to May 2018 at the Division of Pneumology of San Giuseppe Hospital in Milan and who were retrospectively studied. All cryobiopsy procedures were performed under fluoroscopic guidance using a flexible video bronchoscope and an endobronchial blocking system in the operating room with patients under general anaesthesia. The diagnostic performance and safety of the procedure were assessed. The main complications evaluated were endobronchial bleeding and pneumothorax. All cases were studied with a multidisciplinary approach, before and after cryobiopsy. Results: Seventy-three patients were admitted to this study. A specific diagnosis was reached in 64 cases, with a diagnostic sensitivity of 88%; 5 cases (7%) were considered inadequate, 4 cases (5%) were found to be non-diagnostic. Only one major bleeding event occurred (1.4%), while 14 patients (19%) experienced mild/moderate bleeding events while undergoing bronchoscopy; 8 cases of pneumothorax (10.9%) were reported, of which 2 (2.7%) required surgical drainage. Conclusions: When performed under safe conditions and in an experienced center, cryobiopsy is a procedure with limited complications having a high diagnostic yield in fibrotic interstitial lung disease.
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Affiliation(s)
- Sergio Harari
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria-Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, via San Vittore 12, 20123 Milan, Italy.
- U.O. di Medicina Generale, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy.
| | - Francesca Cereda
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria-Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, via San Vittore 12, 20123 Milan, Italy.
| | - Federico Pane
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria-Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, via San Vittore 12, 20123 Milan, Italy.
| | - Alberto Cavazza
- U.O. di Anatomia Patologica Azienda USL/IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy.
| | - Nikolaos Papanikolaou
- Servizio Interaziendale di Anatomia Patologica, Polo Scientifico e Tecnologico, IRCCS MultiMedica, Via Gaudenzio Fantoli 16/15, 20138 Milan, Italy.
| | - Giuseppe Pelosi
- Servizio Interaziendale di Anatomia Patologica, Polo Scientifico e Tecnologico, IRCCS MultiMedica, Via Gaudenzio Fantoli 16/15, 20138 Milan, Italy.
- Dipartimento di Oncologia ed Onco-ematologia, Università degli Studi di Milano, 20122 Milan, Italy.
| | - Monica Scarioni
- U.O. di Anestesia e Rianimazione, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy.
| | - Elisabetta Uslenghi
- Dipartimento di Diagnostica per Immagini e U.O. di Radiologia MultiMedica IRCCS, 20123 Milan, Italy.
| | - Maurizio Zompatori
- Dipartimento di Diagnostica per Immagini e U.O. di Radiologia MultiMedica IRCCS, 20123 Milan, Italy.
- Dipartimento Universitario DIMES, Università di Bologna, 40126 Bologna, Italy.
| | - Antonella Caminati
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria-Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, via San Vittore 12, 20123 Milan, Italy.
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Lodhi T, Hughes G, Stanel S, Chaudhuri N, Hayton C. Transbronchial Lung Cryobiopsy in Idiopathic Pulmonary Fibrosis: A State of the Art Review. Adv Ther 2019; 36:2193-2204. [PMID: 31363997 PMCID: PMC6822843 DOI: 10.1007/s12325-019-01036-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Indexed: 12/17/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease associated with significant morbidity and mortality. The diagnosis of IPF involves a combination of clinical history, radiological imaging and examination of histopathological samples in appropriate cases. Historically, transbronchial biopsy (TBB) has been used to obtain histological samples; however this lacks diagnostic accuracy. At present, surgical lung biopsy (SLB) is the gold standard technique for obtaining specimen samples; however this carries a significant mortality risk. Transbronchial lung cryobiopsy (TBLC) is a new technique that has been pioneered in the management of lung malignancy and offers a potential alternative to SLB. The technique employs a freezing probe, which is used to obtain lung tissue samples that are larger and better quality than traditional TBB samples. This affords TBLC an estimated diagnostic yield of 80% in interstitial lung disease. However, with limited evidence directly comparing TBLC to SLB, the diagnostic accuracy of the procedure has been uncertain. Common complications of TBLC include pneumothorax and bleeding. Mortality in TBLC is low compared with SLB, with exacerbation of IPF frequently reported as the cause. TBLC represents an exciting potential option in the diagnostic pathway in IPF; however its true value has yet to be determined.
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Affiliation(s)
- Taha Lodhi
- North West Interstitial Lung Disease Unit, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Gareth Hughes
- Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Department of Thoracic Medicine, Royal Bolton Hospital, Minerva Road, Farnworth, Bolton, BL4 0JR, UK
| | - Stefan Stanel
- North West Interstitial Lung Disease Unit, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
- Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Nazia Chaudhuri
- North West Interstitial Lung Disease Unit, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
- Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Conal Hayton
- North West Interstitial Lung Disease Unit, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.
- Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
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Hetzel J, Eberhardt R, Petermann C, Gesierich W, Darwiche K, Hagmeyer L, Muche R, Kreuter M, Lewis R, Ehab A, Boeckeler M, Haentschel M. Bleeding risk of transbronchial cryobiopsy compared to transbronchial forceps biopsy in interstitial lung disease - a prospective, randomized, multicentre cross-over trial. Respir Res 2019; 20:140. [PMID: 31277659 PMCID: PMC6612220 DOI: 10.1186/s12931-019-1091-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/03/2019] [Indexed: 01/01/2023] Open
Abstract
Background Bronchoscopic cryobiopsy is a new method of bronchoscopic tissue sampling in interstitial lung disease. In case of transbronchial biopsies, the resultant tissue samples are of high quality, and the lung parenchyma seen in the samples is adequate for a histological diagnosis in most cases. Bleeding after transbronchial biopsy is the most important procedure- associated complication and may be life threatening. This study addresses the risk of bleeding of transbronchial cryobiopsy. Methods In this prospective, randomized, controlled multicentre study 359 patients with interstitial lung disease requiring diagnostic bronchoscopic tissue sampling were included. Both conventional transbronchial forceps biopsy and transbronchial cryobiopsy were undertaken in each patient. The sequence of the procedures was randomized. Bleeding severity was evaluated semi-quantitatively as “no bleeding”, “mild” (suction alone), “moderate” (additional intervention) or “severe” (prolonged monitoring necessary or fatal outcome), for each intervention. Results In 359 patients atotal of 1160 cryobiopsies and 1302 forceps biopsies were performed. Bleeding was observed after forceps biopsy in 173 patients (48.2%) and after cryobiopsy in 261 patients (72.7%). Bleeding was significantly greater in the cryobiopsy group (cryobiopsy/forceps biopsy: no bleeding 27.3%/51.8%; mild 56.5%/44.0%; moderate 15.0%/4.2%; severe 1.2%/0%; p < 0.001). The rate of clinically relevant bleeding (moderate or severe) was higher after the cryobiopsy procedures compared to the forceps biopsies (16.2% vs. 4.2%, p < 0.05). No fatal bleeding complications occurred. Conclusions Compared to transbronchial forceps biopsy, transbronchial cryobiopsy was associated with an increased risk of bleeding which is of clinical relevance. Therefore training and additional precautions for bleeding control should be considered. Trial registration The study was registered with clinicaltrials.gov (NCT01894113).
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Affiliation(s)
- Juergen Hetzel
- Department of Haematology, Oncology, Rheumatology, Immunology and Pulmology, Eberhard Karls University, Otfried-Mueller-Str. 10, 70771, Tübingen, Germany.
| | - Ralf Eberhardt
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg (TLRCH, German Center for Lung Research (DZL), Heidelberg, Germany
| | - Christoph Petermann
- Department for Pulmonary Diseases, Asklepios-Klinik Harburg, Hamburg, Germany
| | | | - Kaid Darwiche
- Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Lars Hagmeyer
- Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany
| | - Rainer Muche
- Institute of Epidemiology and Medical Biometry, Ulm University Ulm, Ulm, Germany
| | - Michael Kreuter
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg (TLRCH, German Center for Lung Research (DZL), Heidelberg, Germany
| | | | - Ahmed Ehab
- Department of Haematology, Oncology, Rheumatology, Immunology and Pulmology, Eberhard Karls University, Otfried-Mueller-Str. 10, 70771, Tübingen, Germany
| | - Michael Boeckeler
- Department of Haematology, Oncology, Rheumatology, Immunology and Pulmology, Eberhard Karls University, Otfried-Mueller-Str. 10, 70771, Tübingen, Germany
| | - Maik Haentschel
- Department of Haematology, Oncology, Rheumatology, Immunology and Pulmology, Eberhard Karls University, Otfried-Mueller-Str. 10, 70771, Tübingen, Germany
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45
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Maldonado F, Shafiq M, Batra H, Pannu J, Yarmus L. Interventional Pulmonology-Bridging the Gaps through Standardization: Malignant Pleural Effusion, Mediastinal Staging, and Cryobiopsy. Am J Respir Crit Care Med 2019; 197:1478-1480. [PMID: 29583020 DOI: 10.1164/rccm.201711-2274rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Fabien Maldonado
- 1 Interventional Pulmonology Fellowship, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Majid Shafiq
- 2 Interventional Pulmonology Fellowship, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Hitesh Batra
- 2 Interventional Pulmonology Fellowship, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jasleen Pannu
- 1 Interventional Pulmonology Fellowship, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Lonny Yarmus
- 2 Interventional Pulmonology Fellowship, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
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Raghu G, Lederer DJ, Rabe KF. Cryobiopsy for Interstitial Lung Disease: The Heat Is On. Am J Respir Crit Care Med 2019; 199:1183-1184. [PMID: 30917297 PMCID: PMC6519865 DOI: 10.1164/rccm.201903-0682ed] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ganesh Raghu
- 1 Center for Interstitial Lung Disease University of Washington Seattle, Washington
| | - David J Lederer
- 2 Department of Medicine.,3 Department of Epidemiology Columbia University Irving Medical Center New York, New York
| | - Klaus F Rabe
- 4 LungenClinic Grosshansdorf, Member of the German Center for Lung Research (DZL) Grosshansdorf, Germany and.,5 Christian Albrechts University, Member of the German Center for Lung Research (DZL) Kiel, Germany
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Galway U, Zura A, Khanna S, Wang M, Turan A, Ruetzler K. Anesthetic considerations for bronchoscopic procedures: a narrative review based on the Cleveland Clinic experience. J Thorac Dis 2019; 11:3156-3170. [PMID: 31463144 DOI: 10.21037/jtd.2019.07.29] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The advent of advanced diagnostic bronchoscopy has shown an increased demand for anesthesiologists to administer anesthesia in the bronchoscopy suite. Procedures such as navigational bronchoscopy, airway stenting and advanced therapeutic procedures often require the presence of an anesthesiologist to manage these more complex patients and procedures. In this review we describe the various bronchoscopic procedures and anesthetic management and complications of these procedures at our institution The Cleveland Clinic, Cleveland Ohio.
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Affiliation(s)
- Ursula Galway
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew Zura
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sandeep Khanna
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mi Wang
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alparslan Turan
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kurt Ruetzler
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
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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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Diagnostic yield and risk/benefit analysis of trans-bronchial lung cryobiopsy in diffuse parenchymal lung diseases: a large cohort of 699 patients. BMC Pulm Med 2019; 19:16. [PMID: 30651103 PMCID: PMC6335717 DOI: 10.1186/s12890-019-0780-3] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/07/2019] [Indexed: 12/02/2022] Open
Abstract
Background Standardization of trans-bronchial lung cryobiopsy in diffuse parenchymal lung diseases is imminent; however, the majority of published series on cryobiopsy include a limited number of patients and are characterized by several differences in procedural technical details. Methods This is an observational, retrospective cohort study. Aim of the study was to suggest some sampling strategies related to transbronchial cryobiopsy in the diagnostic work-up of patients with diffuse parenchymal lung diseases. Results Six hundred ninety-nine patients with suspected diffuse parenchymal lung disease were recruited. A specific pathological diagnosis was achieved in 614/699 cases (87.8%) and a multidisciplinary diagnosis was obtained in 630/699 cases (90.1%). Diagnostic yield was significantly influenced by the number of samples taken (1 vs ≥ 2 biopsies, p < 0.005). In 60.4% of patients, biopsies were taken from one site and in 39.6% from different sites (in the same lobe or in two different lobes), with a significant increase in diagnostic yield, specifically in patients with fibrotic lung diseases (65.5% vs 93.4%, p < 0.0001). The 2.4 mm or 1.9 mm probes were used, with no differences in terms of diagnostic yield. Regarding safety, pneumothorax occurred in 19.2% and was influenced by baseline lung function; in all patients Fogarty balloon has been used and severe haemorrhage occurred in 0.7% of cases. Three patients (0.4% of cases) died within 30 days after the procedure. Conclusions We propose some sampling strategies of cryobiopsy which seem to be associated with a higher diagnostic yield and a favorable risk/benefit ratio: sampling at least two samples in different sites, using either the 2.4 mm or the 1.9 mm probe, intubating the patients and using bronchial blockers/catheters.
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