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Bhadra K, Setser RM, Condra W, Bader BA, David S. A Cone Beam CT Bronchoscopy Study of the Ultrathin Cryoprobe for Biopsy of Peripheral Lung Lesions. J Bronchology Interv Pulmonol 2024; 31:117-125. [PMID: 37450607 PMCID: PMC10984630 DOI: 10.1097/lbr.0000000000000936] [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: 05/28/2022] [Accepted: 05/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Compared with the standard cryoprobe, the novel ultrathin 1.1 mm cryoprobe (UTCP) has improved ergonomics, shape memory, and flexibility. The performance of UTCP has demonstrated promising results in several small trials. METHODS In this single-center, retrospective review, we examine 200 (N=200) consecutive patients referred for cone beam CT bronchoscopic biopsy of peripheral lung lesions. We utilized an extended multimodality approach, including transbronchial needle aspirate, brush, traditional forces biopsies, UTCP biopsies, and BAL. We analyzed tool in lesion, tool touch lesion, center strike rates, and diagnostic yield. We assessed for molecular adequacy and analyzed safety. RESULTS A total of 222 lesions were biopsied. We achieved a tool in lesion or tool touch lesion confirmation for all biopsy attempts (100%) and a center strike rate of 68%. AQuIRE diagnostic yield was 90%, with 60% malignant, 30% benign lung nodules, and 10% nondiagnostic. UTCP was diagnostic in 3.6 % of peripheral lung lesions biopsies when all other modalities were nondiagnostic; thus, raising our overall diagnostic yield from 86.4% to 90.1%. Our analysis demonstrates superior adequacy for molecular analysis for histologic samples (TBBX or UTCP) versus cytologic samples (FNA) ( P <0.001). Three patients (1.5%) had a pneumothorax, and 1 patient (0.5%) had moderate bleeding. CONCLUSION UTCP was diagnostic in 3.6% of peripheral lung lesions when all other modalities were nondiagnostic. In the setting of CBCT guidance, UTCP has a similar safety profile to standard biopsy tools. Future trials are warranted to assess UTCP and its impact on peripheral lung lesion biopsies.
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Affiliation(s)
- Krish Bhadra
- CHI Memorial Rees Skillern Cancer Institute, Chattanooga, TN
| | | | - William Condra
- CHI Memorial Rees Skillern Cancer Institute, Chattanooga, TN
| | | | - Stephanie David
- Diagnostic Pathology Services, CHI Memorial Hospital, Chattanooga, TN
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Sharma D, V V, Saini JK, Sethi P, Kumar L, Dubey PK. Assessing the effectiveness and safety of transbronchial lung cryobiopsy utilizing a flexible bronchoscope with an endobronchial blocker in diffuse parenchymal lung lesions. Monaldi Arch Chest Dis 2024. [PMID: 38497194 DOI: 10.4081/monaldi.2024.2887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/06/2024] [Indexed: 03/19/2024] Open
Abstract
Transbronchial lung cryobiopsy (TBLC) with flexible bronchoscope represents an encouraging modality to obtain a larger size specimen without crush artifact, and a higher diagnostic yield in patients with diffuse parenchymal lung lesions/diseases as compared to conventional transbronchial lung biopsy, and fewer complications as opposed to surgical lung biopsy. Artificial airway is preferred as it provides better airway protection in cases of severe bleeding. Although various researchers have published data on different modalities, the data is not sufficient to standardize a single technique. This study describes the procedural technique, safety, and yield of TBLC using a flexible bronchoscope with an endobronchial blocker. We performed a retrospective analysis of 100 consecutive patients who underwent TBLC using flexible bronchoscopy from May 2018 to June 2022. TBLC samples were obtained under moderate sedation without the use of artificial airway or fluoroscopy. Among the 100 patients, the majority were male (63%). The mean age of the enrolled patients was 44.43±15.92 years. The predominant diagnoses in our study were hypersensitivity pneumonitis (27%), followed by sarcoidosis (12%) and tuberculosis (10%). We obtained alveolated lung tissue in 90 out of 100 cases with a median biopsy size of 5 mm (in greatest dimension, interquartile range 5-4 mm), resulting in a specific histopathological diagnosis in 82 cases. The most frequent complications were bleeding and pneumothorax (13%). Mild bleeding occurred in 58% of the patients, and moderate bleeding occurred in 20% of the patients. There was no episode of severe/life-threatening bleeding. None of the patients required intensive care unit admission or endotracheal intubation. In conclusion, the use of TBLC through flexible bronchoscopy with an endobronchial blocker emerges as a minimally invasive, secure, time-efficient, and readily reproducible technique. Significantly, this procedure can be seamlessly executed in the bronchoscopy suite, eliminating the requirement for an artificial airway or general anesthesia.
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Affiliation(s)
- Deepak Sharma
- Department of Pulmonary and Critical Care Medicine, King George's Medical University, Lucknow.
| | - Vinay V
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Patna.
| | - Jitendra Kumar Saini
- Thoracic Oncology Clinic, National Institute of Tuberculosis and Respiratory Diseases, New Delhi.
| | - Prabhpreet Sethi
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi.
| | - Lokender Kumar
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi.
| | - Praveen Kumar Dubey
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Raipur.
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Sryma PB, Mittal S, Madan NK, Tiwari P, Hadda V, Mohan A, Guleria R, Madan K. Efficacy of Radial Endobronchial Ultrasound (R-EBUS) guided transbronchial cryobiopsy for peripheral pulmonary lesions (PPL...s): A systematic review and meta-analysis. Pulmonology 2023; 29:50-64. [PMID: 33441246 DOI: 10.1016/j.pulmoe.2020.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Transbronchial lung cryobiopsy (TBLC) is frequently described for the diagnosis of diffuse parenchymal lung diseases (DPLD). A few studies have reported transbronchial cryobiopsy for the diagnosis of peripheral pulmonary lesions (PPL...s). We aimed to study the utility and safety of transbronchial cryobiopsy for the diagnosis of PPL...s. METHODS We performed a systematic search of the PubMed and Embase databases to extract the relevant studies. We then performed a meta-analysis to calculate the diagnostic yields of transbronchial cryobiopsy and bronchoscopic forceps biopsy. RESULTS Following a systematic search, we identified nine relevant studies (300 patients undergoing cryobiopsy). All used Radial Endobronchial Ultrasound (R-EBUS) for PPL localization. The pooled diagnostic yield of transbronchial cryobiopsy was 77% (95% CI, 71%...84%) (I^2=38.72%, p=0.11). The diagnostic yield of forceps biopsy was 72% (95% CI, 60%...83%) (I^2=78.56%, p<0.01). The diagnostic yield of cryobiopsy and forceps biopsy was similar (RR 1.05, 95% CI 0.96...1.15), with a 5% risk difference for diagnostic yield (95% CI, ...6% to 15%). There was significant heterogeneity (I^2=57.2%, p=0.017), and no significant publication bias. One severe bleeding and three pneumothoraxes requiring intercostal drain (ICD) placement (major complication rate 4/122, 1.8%) were reported with transbronchial cryobiopsy. CONCLUSIONS R-EBUS guided transbronchial cryobiopsy is a safe and efficacious modality. The diagnostic yields of TBLC and forceps biopsy are similar. More extensive multicentre randomized trials are required for the further evaluation and standardization of transbronchial cryobiopsy for PPL...s.
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Affiliation(s)
- P B Sryma
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - S Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - N K Madan
- Department of Pathology, VMMC and Safdarjung Hospital, New Delhi, India
| | - P Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - V Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - A Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - R Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - K Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
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Dhooria S, Agarwal R, Sehgal IS, Aggarwal AN, Goyal R, Guleria R, Singhal P, Shah SP, Gupta KB, Koolwal S, Akkaraju J, Annapoorni S, Bal A, Bansal A, Behera D, Chhajed PN, Dhamija A, Dhar R, Garg M, Gopal B, Hibare KR, James P, Jindal A, Jindal SK, Khan A, Kishore N, Koul PA, Kumar A, Kumar R, Lall A, Madan K, Mandal A, Mehta RM, Mohan A, Nangia V, Nath A, Nayar S, Patel D, Pattabhiraman V, Raghupati N, Sarkar PK, Singh V, Sivaramakrishnan M, Srinivasan A, Swarnakar R, Talwar D, Thangakunam B. Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement. Lung India 2019; 36:48-59. [PMID: 30604705 PMCID: PMC6330795 DOI: 10.4103/lungindia.lungindia_75_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Bronchoscopic lung cryobiopsy (BLC) is a novel technique for obtaining lung tissue for the diagnosis of diffuse parenchymal lung diseases. The procedure is performed using several different variations of technique, resulting in an inconsistent diagnostic yield and a variable risk of complications. There is an unmet need for standardization of the technical aspects of BLC. METHODOLOGY This is a position statement framed by a group comprising experts from the fields of pulmonary medicine, thoracic surgery, pathology, and radiology under the aegis of the Indian Association for Bronchology. Sixteen questions on various technical aspects of BLC were framed. A literature search was conducted using PubMed and EMBASE databases. The expert group discussed the available evidence relevant to each question through e-mail and a face-to-face meeting, and arrived at a consensus. RESULTS The experts agreed that patients should be carefully selected for BLC after weighing the risks and benefits of the procedure. Where appropriate, consideration should be given to perform alternate procedures such as conventional transbronchial biopsy or subject the patient directly to a surgical lung biopsy. The procedure is best performed after placement of an artificial airway under sedation/general anesthesia. Fluoroscopic guidance and occlusion balloon should be utilized for positioning the cryoprobe to reduce the risk of pneumothorax and bleeding, respectively. At least four tissue specimens (with at least two of adequate size, i.e., ≥5 mm) should be obtained during the procedure from different lobes or different segments of a lobe. The histopathological findings of BLC should be interpreted by an experienced pulmonary pathologist. The final diagnosis should be made after a multidisciplinary discussion. Finally, there is a need for structured training for performing BLC. CONCLUSION This position statement is an attempt to provide practical recommendations for the performance of BLC in DPLDs.
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Affiliation(s)
- Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajiv Goyal
- Department of Respiratory Medicine, Jaipur Golden Hospital and Rajiv Gandhi Cancer Institute, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Pratibha Singhal
- Department of Respiratory Medicine, Bombay Hospital and Fortis Hiranandani Hospital, Mumbai, India
| | - Shirish P Shah
- Department of Respiratory Medicine, Nanavati Super Speciality Hospital, Mumbai, India
| | - Krishna B Gupta
- Department of Respiratory Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Suresh Koolwal
- Department of Chest Diseases, SMS Medical College, Jaipur, Rajasthan, India
| | - Jayachandra Akkaraju
- Department of Respiratory Medicine, Century Hospital, Hyderabad, Telangana, India
| | - Shankar Annapoorni
- Department of Respiratory Medicine, Royal Care Hospital, Coimbatore, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Avdhesh Bansal
- Department of Respiratory Medicine, Indraprastha Apollo Hospital, New Delhi, India
| | - Digambar Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prashant N Chhajed
- India and Lung Care and Sleep Centre, Institute of Pulmonology, Medical Research and Development, Mumbai, India
| | - Amit Dhamija
- Department of Respiratory Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Raja Dhar
- Department of Respiratory Medicine, Fortis Hospital Anandapur, Kolkata, West Bengal, India
| | - Mandeep Garg
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bharat Gopal
- Department of Respiratory Medicine, Maharaja Agrasen Hospital, New Delhi, India
| | - Kedar R Hibare
- Department of Respiratory Medicine, Narayana Health City, Bengaluru, Karnataka, India
| | - Prince James
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aditya Jindal
- Department of Respiratory Medicine, Jindal Chest Clinic, Chandigarh, India
| | - Surinder K Jindal
- Department of Respiratory Medicine, Jindal Chest Clinic, Chandigarh, India
| | - Ajmal Khan
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nevin Kishore
- Department of Respiratory Medicine, Max Hospital, New Delhi, India
| | - Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Arvind Kumar
- Department of Respiratory Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Raj Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, New Delhi, India
| | - Ajay Lall
- Department of Respiratory Medicine, Max Hospital, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ravindra M Mehta
- Department of Respiratory Medicine, Apollo Hospital, Bengaluru, Karnataka, India
| | - Anant Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Nangia
- Department of Respiratory Medicine, Fortis Hospital, New Delhi, India
| | - Alok Nath
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sandeep Nayar
- Department of Respiratory Medicine, BLK Super Speciality Hospital, New Delhi, India
| | - Dharmesh Patel
- Department of Respiratory Medicine, City Clinic and Bhailal Amin General Hospital, Vadodara, Gujarat, India
| | | | | | - Pralay K Sarkar
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Virendra Singh
- Department of Respiratory Medicine, Asthma Bhawan, Jaipur, Rajasthan, India
| | | | - Arjun Srinivasan
- Department of Respiratory Medicine, Royal Care Hospital, Coimbatore, India
| | - Rajesh Swarnakar
- Department of Respiratory Medicine, Getwell Hospital and Research Institute, Nagpur, Maharashtra, India
| | - Deepak Talwar
- Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh, India
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