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Hara Y, Ohkubo H, Fujita K, Niimi A. Pulmonary Artery Pseudoaneurysm after Transbronchial Lung Cryobiopsy. Intern Med 2024; 63:1325-1326. [PMID: 37722891 DOI: 10.2169/internalmedicine.2652-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Affiliation(s)
- Yumi Hara
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Hirotsugu Ohkubo
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Kohei Fujita
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
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Takigawa Y, Watanabe H, Sato K, Goda M, Inoue T, Fujiwara M, Matsuoka S, Kudo K, Sato A, Fujiwara K, Shibayama T. Successful ultrathin bronchoscopy with cryobiopsy for diagnosing and removing mucus plugs in allergic bronchopulmonary mycosis mimicking lung cancer. Respirol Case Rep 2024; 12:e01359. [PMID: 38660339 PMCID: PMC11040176 DOI: 10.1002/rcr2.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
In patients presenting with abnormal pulmonary nodules, especially those with a history of asthma, allergic bronchopulmonary mycosis should be considered. Eosinophil counts and IgE levels should be checked in such patients.
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Affiliation(s)
- Yuki Takigawa
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Hiromi Watanabe
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Ken Sato
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Mayu Goda
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Tomoyoshi Inoue
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Miho Fujiwara
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Suzuka Matsuoka
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Kenichiro Kudo
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Akiko Sato
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Keiichi Fujiwara
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Takuo Shibayama
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
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3
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Al Sona M, Esivue O, Benzaquen S. Endobronchial ultrasound (EBUS)-guided transbronchial miniforceps biopsy an urban center experience. J Thorac Dis 2024; 16:183-190. [PMID: 38410576 PMCID: PMC10894409 DOI: 10.21037/jtd-23-884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 11/17/2023] [Indexed: 02/28/2024]
Abstract
Background The role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in staging mediastinal and hilar lymph nodes in non-small cell lung cancer (NSCLC) is well established. However, evidence of its diagnostic utility in other pathologies-such as lymphoma-remains inadequate. This retrospective observational study aims to determine the diagnostic yield of EBUS-guided miniforceps biopsy (EBUS-MFB) compared to EBUS-TBNA in both malignant and nonmalignant conditions. Methods We conducted a retrospective cross-sectional chart review of all adult patients referred for EBUS at our institution between January 2019 and December 2022. All patients who underwent both EBUS-TBNA and EBUS-MFB were included, with some patients also undergoing transbronchial cryobiopsy. Patients without pathology reports available were excluded. Results The combination of EBUS-MFB and EBUS-TBNA had the highest percentage of diagnostic results both in the overall cohort (34.4%) and in patients who did not undergo transbronchial cryobiopsy (46.2%). EBUS-MFB alone yielded more diagnostic results compared to EBUS-TBNA. Transbronchial cryobiopsy was the sampling method with the highest percentage of diagnostic results in the cryobiopsy group (64.5%). Statistical analysis revealed a significant difference in diagnostic yield between EBUS-MFB and EBUS-TBNA (P<0.001), with EBUS-MFB showing a higher diagnostic yield overall. EBUS-MFB had a significantly higher diagnostic yield than EBUS-TBNA in benign cases, in patients diagnosed with sarcoidosis, but not in malignant disease. Conclusions Our study suggests that combining EBUS-MFB with EBUS-TBNA can improve the diagnostic yield, particularly in benign cases and sarcoidosis. These findings support the potential superiority of adding EBUS-MFB over EBUS-TBNA alone and highlight the need for further randomized control trials to validate these results. The retrospective nature of this study and certain limitations, such as the lack of adequate longer-term follow-up, selection and operator biases, and the absence of rapid on-site evaluation (ROSE) in some cases, should be considered when interpreting the results. Nonetheless, this study contributes to the growing evidence for the utility of EBUS-MFB in improving the diagnostic yield of EBUS procedures in specific clinical scenarios.
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Affiliation(s)
| | - Oshioke Esivue
- Department of Pulmonary and Critical Care, Albert Einstein Medical Center, Philadelphia, PA, USA
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Ramarmuty HY, Huan NC, Nyanti LE, Khoo TS, Renganathan T, Manoh AZ, Azman N, Sivaraman Kannan KK. Early experience of endobronchial ultrasound-guided transbronchial nodal cryobiopsy: a case series from Sabah, Malaysia. Ther Adv Respir Dis 2024; 18:17534666241231122. [PMID: 38357899 PMCID: PMC10870810 DOI: 10.1177/17534666241231122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established minimally invasive method for the diagnosis of benign and malignant conditions. Continuous efforts are underway to improve the material adequacy of EBUS-TBNA, including the introduction of a new technique called EBUS-guided transbronchial nodal cryobiopsy (EBUS-TBNC). This method allows for the retrieval of larger and well-preserved histologic samples from the mediastinum. We present a case series of four patients who underwent combined EBUS-TBNA and EBUS-TBNC procedures in our centre. All procedures were performed under general anaesthesia using a convex probe EBUS scope (Pentax EB-1970UK). Two patients were diagnosed with malignancy and two with benign disorders (silicosis and tuberculosis). In the malignant cases, both EBUS-TBNA/cell block and cryobiopsy provided a diagnosis but cryobiopsy yielded more material for ancillary tests in one patient. However, in the benign cases, there was discordance between EBUS-TBNA/cell block and cryobiopsy. Only cryobiopsy detected granuloma in the patient with TB (tuberculosis), and in the patient with silicosis, TBNC provided a better overall histological evaluation, leading to a definitive diagnosis. No complications were observed. This case series supports the potential diagnostic value of combining EBUS-TBNA and EBUS-TBNC, particularly in benign mediastinal lesions (granulomatous diseases), and in cases requiring additional molecular tests in cancer diagnosis.
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Affiliation(s)
- Hema Yamini Ramarmuty
- Respiratory Department, Queen Elizabeth Hospital, 13a, Jalan Penampang, Kota Kinabalu, Sabah 88200, Malaysia
| | - Nai-Chien Huan
- Respiratory Department, Queen Elizabeth Hospital, Sabah, Malaysia
| | - Larry Ellee Nyanti
- Medical Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Teng Shin Khoo
- Medical Department, Queen Elizabeth Hospital, Sabah, Malaysia
| | | | - Ahmad Zaki Manoh
- Department of Pathology, Queen Elizabeth Hospital, Sabah, Malaysia
| | - Nusaibah Azman
- Department of Pathology, Queen Elizabeth Hospital, Sabah, Malaysia
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Ramarmuty HY, Oki M. Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy: a narrative review. Mediastinum 2023; 8:2. [PMID: 38322189 PMCID: PMC10839513 DOI: 10.21037/med-23-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/07/2023] [Indexed: 02/08/2024]
Abstract
Background and Objective Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, safe, and well-established method for diagnosing and staging lung cancer and other conditions associated with mediastinal lymphadenopathy. Efforts have been made to enhance the material adequacy of EBUS-TBNA, including the recent introduction of EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TMC). This advancement facilitates the acquisition of larger and better-preserved tissue samples from the mediastinum. We evaluated the diagnostic accuracy and safety of EBUS-TMC in the diagnosis of malignant lesions and its effectiveness in relation to benign conditions, such as tuberculosis and sarcoidosis. Methods We searched the PubMed® database for relevant English articles published up to July 1, 2023. Subsequently, we conducted a comprehensive bibliographic analysis with a particular emphasis on diagnostic yield, safety profile, and procedural technicalities. Key Content and Findings Our narrative review, comprising seven publications, emphasizes the significance of EBUS-TMC as an effective technique for obtaining diagnostic tissue in malignant and benign conditions while maintaining an excellent safety profile. Furthermore, its capability for obtaining larger tissue samples facilitates molecular and immunological analysis in non-small cell lung cancer. Conclusions EBUS-TMC exhibits significant efficacy with regard to obtaining diagnostic tissue in malignant and benign conditions. However, further studies are needed to evaluate uncertainties regarding the selection of suitable cases and technical intricacies.
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Affiliation(s)
| | - Masahide Oki
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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Velasco-Albendea FJ, Cruz-Rueda JJ, Gil-Belmonte MJ, Pérez-Rodríguez Á, López-Pardo A, Agredano-Ávila B, Lozano-Paniagua D, Nievas-Soriano BJ. The Contribution of Mediastinal Transbronchial Nodal Cryobiopsy to Morpho-Histological and Molecular Diagnosis. Diagnostics (Basel) 2023; 13:3476. [PMID: 37998611 PMCID: PMC10670691 DOI: 10.3390/diagnostics13223476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
(1) Background: endobronchial ultrasound-guided mediastinal transbronchial cryo-node biopsy, previously assisted by fine-needle aspiration, is a novel technique of particular interest in the field of lung cancer diagnosis and is of great utility for extrathoracic tumor metastases, lymphomas, and granulomatous diseases. An integrated histological and molecular diagnosis of small samples implies additional difficulty for the pathologist. Additionally, emerging tumor biomarkers create the need to search for new approaches to better manage the tissue sample; (2) Methods: An analytical observational study of 32 mediastinal node cryobiopsies is carried out in 27 patients (n = 27). Statistical analysis using the t-student and Wilcoxon signed-rank tests for paired data is performed with SPSS 26 and R Statistical software. The significance level is established at p < 0.05; (3) Results: cryobiopsies were valid for diagnosis in 25 of 27 patients, with a maximum average size of 3.5 ± 0.7 mm. A total of 18 samples (66.67%) were positive for malignancy and 9 (33.33%) were benign. The tumor percentage measured in all neoplastic samples was greater than 30%. The average DNA and RNA extracted in nine non-small cell lung cancer cases was 97.2 ± 22.4 ng/µL and 26.6 ± 4.9 ng/µL, respectively; (4) Conclusions: the sample size obtained from an endobronchial ultrasound-guided mediastinal transbronchial cryo-node biopsy facilitates the morphological and histo-architectural assessment of inflammatory and neoplastic pathology. It optimizes molecular tests in the latter due to more tumor cells, DNA, and RNA.
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Affiliation(s)
| | - Juan José Cruz-Rueda
- Clinical Management Unit of Pneumology, Torrecárdenas University Hospital, 04009 Almeria, Spain; (J.J.C.-R.); (A.L.-P.)
| | - María Jesús Gil-Belmonte
- Clinical Management Unit of Pathological Anatomy, Torrecárdenas University Hospital, 04009 Almeria, Spain; (F.J.V.-A.); (B.A.-Á.)
| | - Álvaro Pérez-Rodríguez
- Department of Pathological Anatomy, Hospital Clínico Universitario, 47003 Valladolid, Spain;
| | - Andrés López-Pardo
- Clinical Management Unit of Pneumology, Torrecárdenas University Hospital, 04009 Almeria, Spain; (J.J.C.-R.); (A.L.-P.)
| | - Beatriz Agredano-Ávila
- Clinical Management Unit of Pathological Anatomy, Torrecárdenas University Hospital, 04009 Almeria, Spain; (F.J.V.-A.); (B.A.-Á.)
| | - David Lozano-Paniagua
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain;
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Farshchian M, Kimyai-Asadi A, Daveluy S. Cryosnip for skin tag removal. J Am Acad Dermatol 2023; 89:e113-e114. [PMID: 34062213 DOI: 10.1016/j.jaad.2021.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/12/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Mehdi Farshchian
- Department of Dermatology, Wayne State University, Detroit, Michigan.
| | - Arash Kimyai-Asadi
- Department of Dermatology, Weill Cornell Medical College, Houston, Texas; Division of Dermatology, Houston Methodist Hospital, Houston, Texas; DermSurgery Associates, Houston, Texas
| | - Steven Daveluy
- Department of Dermatology, Wayne State University, Detroit, Michigan
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Park D, Lee D, Kim Y, Park Y, Lee YJ, Lee JE, Yeo MK, Kang MW, Chong Y, Han SJ, Choi J, Park JE, Koh Y, Lee J, Park Y, Kim R, Lee JS, Choi J, Lee SH, Ku B, Kang DH, Chung C. Cryobiopsy: A Breakthrough Strategy for Clinical Utilization of Lung Cancer Organoids. Cells 2023; 12:1854. [PMID: 37508518 PMCID: PMC10377875 DOI: 10.3390/cells12141854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
One major challenge associated with lung cancer organoids (LCOs) is their predominant derivation from surgical specimens of patients with early-stage lung cancer. However, patients with advanced lung cancer, who are in need of chemotherapy, often cannot undergo surgery. Therefore, there is an urgent need to successfully generate LCOs from biopsy specimens. Conventional lung biopsy techniques, such as transthoracic needle biopsy and forceps biopsy, only yield small amounts of lung tissue, resulting in a low success rate for culturing LCOs from biopsy samples. Furthermore, potential complications, like bleeding and pneumothorax, make it difficult to obtain sufficient tissue. Another critical issue is the overgrowth of normal lung cells in later passages of LCO culture, and the optimal culture conditions for LCOs are yet to be determined. To address these limitations, we attempted to create LCOs from cryobiopsy specimens obtained from patients with lung cancer (n = 113). Overall, the initial success rate of establishing LCOs from cryobiopsy samples was 40.7% (n = 46). Transbronchial cryobiopsy enables the retrieval of significantly larger amounts of lung tissue than bronchoscopic forceps biopsy. Additionally, cryobiopsy can be employed for peripheral lesions, and it is aided via radial endobronchial ultrasonography. This study significantly improved the success rate of LCO culture and demonstrated that the LCOs retained characteristics that resembled the primary tumors. Single-cell RNA sequencing confirmed high cancer cell purity in early passages of LCOs derived from patients with advanced lung cancer. Furthermore, the three-dimensional structure and intracellular components of LCOs were characterized using three-dimensional holotomography. Finally, drug screening was performed using a specialized micropillar culture system with cryobiopsy-derived LCOs. LCOs derived from cryobiopsy specimens offer a promising solution to the critical limitations of conventional LCOs. Cryobiopsy can be applied to patients with lung cancer at all stages, including those with peripheral lesions, and can provide sufficient cells for LCO generation. Therefore, we anticipate that cryobiopsy will serve as a breakthrough strategy for the clinical application of LCOs in all stages of lung cancer.
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Affiliation(s)
- Dongil Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Dahye Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Yoonjoo Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Yeonhee Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 34943, Republic of Korea
| | - Yeon-Jae Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Jeong Eun Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Min-Kyung Yeo
- Department of Pathology, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Min-Woong Kang
- Thoracic and Cardiovascular Surgery, School of Medicine, Chungnam National University, Munhwa-ro 282, Jung-Gu, Daejeon 35015, Republic of Korea
| | - Yooyoung Chong
- Thoracic and Cardiovascular Surgery, School of Medicine, Chungnam National University, Munhwa-ro 282, Jung-Gu, Daejeon 35015, Republic of Korea
| | - Sung Joon Han
- Thoracic and Cardiovascular Surgery, School of Medicine, Chungnam National University, Munhwa-ro 282, Jung-Gu, Daejeon 35015, Republic of Korea
| | - Jinwook Choi
- School of Life Science, Gwangju Institute of Science and Technology, Gwangju 61005, Republic of Korea
| | - Jong-Eun Park
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Republic of Korea
| | - Yongjun Koh
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Republic of Korea
| | | | - YongKeun Park
- Tomocube Inc., Daejeon 34141, Republic of Korea
- Department of Physics, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Republic of Korea
| | - Ryul Kim
- GENOME INSIGHT Inc., Daejeon 34051, Republic of Korea
| | - Jeong Seok Lee
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Republic of Korea
- GENOME INSIGHT Inc., Daejeon 34051, Republic of Korea
| | - Jimin Choi
- Central R&D Center, Medical & Bio Decision Co., Ltd., Suwon 16229, Republic of Korea
| | - Sang-Hyun Lee
- Central R&D Center, Medical & Bio Decision Co., Ltd., Suwon 16229, Republic of Korea
| | - Bosung Ku
- Central R&D Center, Medical & Bio Decision Co., Ltd., Suwon 16229, Republic of Korea
| | - Da Hyun Kang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
| | - Chaeuk Chung
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon 34134, Republic of Korea
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Tomassetti S, Ravaglia C, Piciucchi S, Ryu J, Wells A, Donati L, Dubini A, Klersy C, Luzzi V, Gori L, Rosi E, Lavorini F, Poletti V. Historical eye on IPF: a cohort study redefining the mortality scenario. Front Med (Lausanne) 2023; 10:1151922. [PMID: 37332746 PMCID: PMC10273674 DOI: 10.3389/fmed.2023.1151922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/26/2023] [Indexed: 06/20/2023] Open
Abstract
Rationale Therapies that slow idiopathic pulmonary fibrosis (IPF) progression are now available and recent studies suggest that the use of antifibrotic therapy may reduce IPF mortality. Objectives The aim of the study was to evaluate whether, to what extent, and for which factors the survival of IPF in a real-life setting has changed in the last 15 years. Methods Historical eye is an observational study of a large cohort of consecutive IPF patients diagnosed and treated in a referral center for ILDs with prospective intention. We recruited all consecutive IPF patients seen at GB Morgagni Hospital, Forlì, Italy between January 2002 and December 2016 (15 years). We used survival analysis methods to describe and model the time to death or lung transplant and Cox regression to model prevalent and incident patient characteristics (time-dependent Cox models were fitted). Measurements and main results The study comprised 634 patients. The year 2012 identifies the time point of mortality shift (HR 0.58, CI 0.46-0.63, p < 0.001). In the more recent cohort, more patients had better preserved lung function, underwent cryobiopsy instead of surgery, and were treated with antifibrotics. Highly significant negative prognostic factors were lung cancer (HR 4.46, 95% CI 3.3-6, p < 0.001), hospitalizations (HR 8.37, 95% CI 6.5-10.7, p < 0.001), and acute exacerbations (HR 8.37, 95% CI 6.52-10.7, p < 0.001). The average antifibrotic treatment effect estimated using propensity score matching showed a significant effect in the reduction of all-cause mortality (ATE coeff -0.23, SE 0.04, p < 0.001), acute exacerbations (ATE coeff -0.15, SE 0.04, p < 0.001), and hospitalizations (ATE coeff -0.15, SE 0.04, p < 0.001) but no effect on lung cancer risk (ATE coeff -0.03, SE 0.03, p = 0.4). Conclusion Antifibrotic drugs significantly impact hospitalizations, acute exacerbations, and IPF survival. After the introduction of cryobiopsy and antifibrotic drugs, the prognosis of IPF patients has significantly improved together with our ability to detect IPF at an earlier stage.
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Affiliation(s)
- Sara Tomassetti
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Claudia Ravaglia
- Pulmonary Unit, Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Sara Piciucchi
- Radiology Department, Ospedale GB Morgagni, Forlì, Italy
| | - Jay Ryu
- Respiratory and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Athol Wells
- ILD Unit, Pulmonary Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Luca Donati
- Pulmonary Unit, Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | | | - Catherine Klersy
- Servizio di Biometria ed Epidemiologia Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Luzzi
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Leonardo Gori
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Elisabetta Rosi
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Federico Lavorini
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Venerino Poletti
- Pulmonary Unit, Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
- Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
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12
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Zarogoulidis P, Matthaios D, Huang H, Bai C, Hohenforst-Schmidt W, Porpodis K, Petridis D, Pigakis K, Kougkas N, Oikonomou P, Nikolaou C, Hatzibougias D, Sardeli C. Positron Emission-Computed Tomography, Cryobiopsy versus Bronchoalveolar Lavage and Computed Tomography Findings for Interstitial Lung Disease: A Long-Term Follow-Up. Medicina (Kaunas) 2023; 59:medicina59040787. [PMID: 37109746 PMCID: PMC10144839 DOI: 10.3390/medicina59040787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Interstitial lung diseases have always been an issue for pulmonary and rheumatology physicians. Computed tomography scans with a high-resolution protocol and bronchoalveolar lavage have been used along with biochemical blood tests to reach a diagnosis. Materials and Methods: We included 80 patients in total. First, all patients had their diagnosis with computed tomography of the thorax, serological/ immunological blood tests and bronchoalveolar lavage. However; after 3 months, all were divided into 2 groups: those who had bronchoalveolar lavage again and those who had cryobiopsy instead of bronchoalveolar lavage (40/40). Positron emission-computed tomography was also performed upon the first and second diagnosis. The patients' follow-up was 4 years from diagnosis. Results: Patients suffered most from chronic obstructive pulmonary disease (56, 70%), while lung cancer was rarely encountered in the sample (7, 9.75%). Age distribution ranged between 53 and 68 years with a mean value of 60 years. The computed tomography findings revealed 25 patients with typical diagnosis (35.2%), 17 with interstitial pulmonary fibrosis (23.9%) and 11 with probable diagnosis (11%). The cryobiopsy technique led to a new diagnosis in 28 patients (35% of the total sample). Patients who had a new diagnosis with cryobiopsy had a mean survival time of 710 days (<1460). Positron emission-computed tomography SUV uptake was positively associated with the cryobiopsy technique/new disease diagnosis and improved all respiratory functions. Discussion: Positron emission-computed tomography is a tool that can be used along with respiratory functions for disease evaluation. Conclusions: Cryobiopsy is a safe tool for patients with interstitial lung disease and can assist in the diagnosis of interstitial lung diseases. The survival of patients was increased in the cryobiopsy group versus only bronchoalveolar lavage for disease diagnosis.
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Affiliation(s)
- Paul Zarogoulidis
- Pulmonary Department, General Clinic Euromedica, 54454 Thessaloniki, Greece
- 3rd Surgery Department, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | | | - Haidong Huang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China
| | - Chong Bai
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China
| | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology/Pulmonology/Intensive Care/Nephrology, "Hof" Clinics, University of Erlangen, 91052 Hof, Germany
| | - Konstantinos Porpodis
- Pulmonary Department, "George Papanikolaou" General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece
| | - Dimitris Petridis
- Department of Food Technology, School of Food Technology and Nutrition, Alexander Technological Educational Institute, 57400 Thessaloniki, Greece
| | | | - Nikolaos Kougkas
- Rheumatology Department, Ippokrateio University General Hospital, 54642 Thessaloniki, Greece
| | - Panagoula Oikonomou
- Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Christina Nikolaou
- Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | | | - Chrysanthi Sardeli
- Department of Pharmacology & Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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13
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Prasad KT, Dhooria S, Muthu V, Sehgal IS, Aggarwal AN, Agarwal R. Advantages and drawbacks associated with the use of endosonography in sarcoidosis. Expert Rev Respir Med 2023; 17:267-277. [PMID: 37026845 DOI: 10.1080/17476348.2023.2201439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
INTRODUCTION Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a real-time, minimally invasive procedure for sampling intrathoracic lymph nodes. Herein, we discuss EBUS-guided procedures, their benefits, and drawbacks in diagnosing sarcoidosis. AREAS COVERED We first describe the utility of various endosonographic imaging techniques like B-mode, elastography, and doppler imaging. We then review the diagnostic yield and safety of EBUS-TBNA and compare it with the other available diagnostic modalities. Subsequently, we discuss the technical aspects of EBUS-TBNA influencing the diagnostic yield. Recent advances in EBUS-guided diagnostics like EBUS-guided intranodal forceps biopsy (EBUS-IFB) and EBUS-guided transbronchial mediastinal cryobiopsy (EBMC) are reviewed. Finally, we summarize the advantages and disadvantages associated with EBUS-TBNA in sarcoidosis and provide an expert opinion on the optimal use of this procedure in patients with suspected sarcoidosis. EXPERT OPINION EBUS-TBNA is a minimally invasive, safe procedure with a good diagnostic yield, and should be the preferred diagnostic modality for sampling intrathoracic lymph nodes in patients with suspected sarcoidosis. For optimal diagnostic yield, EBUS-TBNA should be combined with endobronchial biopsy (EBB) and transbronchial lung biopsy (TBLB). Newer endosonographic techniques like EBUS-IFB and EBMC might obviate the need for EBB and TBLB due to their superior diagnostic yield.
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Affiliation(s)
- Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valliappan Muthu
- 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
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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14
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Takemura C, Imabayashi T, Furuse H, Uchimura K, Matsumoto Y, Tsuchida T, Watanabe SI. Thoracic SMARCA4-deficient undifferentiated tumor diagnosed by transbronchial mediastinal cryobiopsy: A case report. Thorac Cancer 2023; 14:953-957. [PMID: 36828806 PMCID: PMC10067353 DOI: 10.1111/1759-7714.14830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/26/2023] Open
Abstract
Thoracic SMARCA4-deficient undifferentiated tumors (SMARCA4-UT) have a poor prognosis and are often diagnosed at an inoperable advanced stage. Herein, we report a case of SMARCA4-UT diagnosed by endobronchial ultrasound-guided transbronchial cryobiopsy (EBUS-cryo). The patient was a 42-year-old man with a history of smoking. Chest computed tomography revealed a right upper lobe nodule and an enlarged #11s lymph node. Core tissues could not be obtained by EBUS-guided transbronchial needle aspiration (EBUS-TBNA) for diagnosis and mediastinal staging; hence, EBUS-guided intranodal forceps biopsy (EBUS-IFB) was performed. However, a detailed diagnosis beyond poorly differentiated carcinoma could not be obtained. Subsequent EBUS-cryo provided sufficient specimens for immunohistochemical and molecular evaluation and SMARCA4-UT was definitively diagnosed. Thus, EBUS-cryo could be of additional diagnostic value for uncommon tumors, such as SMARCA4-UT, conjointly with EBUS-IFB as well as EBUS-TBNA.
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Affiliation(s)
- Chihiro Takemura
- National Cancer Center Japan, Respiratory Endoscopy Division, Chuo-ku, Japan
| | - Tatsuya Imabayashi
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Hideaki Furuse
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Japan, Chuo-ku, Tokyo, Japan
| | - Keigo Uchimura
- Respiratory Endoscopy Division, National Cancer Center Japan, Chuo-ku, Tokyo, Japan
| | - Yuji Matsumoto
- Department of Thoracic Oncology, National Cancer Center Japan, Chuo-ku, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Division of Thoracic Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
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15
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Oki M, Saka H, Kogure Y, Niwa H, Yamada A, Torii A, Kitagawa C. Ultrathin bronchoscopic cryobiopsy of peripheral pulmonary lesions. Respirology 2023; 28:143-151. [PMID: 36066209 DOI: 10.1111/resp.14360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/22/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Ultrathin bronchoscopy aids in the diagnosis of peripheral pulmonary lesions. However, both the working channel and the specimens are small. A 1.1-mm ultrathin cryoprobe that can enter the working channel of the ultrathin bronchoscope is now available, which may overcome the limitations of small specimen size. The aim of this study was to evaluate the feasibility, efficacy and safety of ultrathin bronchoscopic cryobiopsy using an ultrathin cryoprobe for diagnosing peripheral pulmonary lesions. METHODS Patients with peripheral pulmonary lesions ≤30 mm in diameter were prospectively enrolled in the study. All patients underwent forceps biopsy followed by cryobiopsy using a 3.0-mm ultrathin bronchoscope under radial probe endobronchial ultrasound guidance, virtual bronchoscopic navigation and fluoroscopic guidance. The primary endpoint was the feasibility of cryobiopsy. RESULTS In total, 50 patients with peripheral pulmonary lesions were enrolled in the study; the median longest diameter on computed tomography was 17.9 mm. Cryobiopsy was performed successfully in 49 patients (98%). Forceps biopsy, cryobiopsy and the combination of these two methods provided a specific diagnosis in 54% (27/50), 62% (31/50) and 74% (37/50) of patients, respectively. The median size of specimens obtained via cryobiopsy was significantly larger than the median size obtained via forceps biopsy (7.0 vs. 1.3 mm2 , respectively, p < 0.001). Mild bleeding during cryobiopsy occurred in 47 patients (94%). No moderate/severe bleeding or pneumothorax occurred. CONCLUSION Ultrathin bronchoscopic cryobiopsy is feasible, effective and sufficiently safe for the diagnosis of peripheral pulmonary lesions.
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Affiliation(s)
- Masahide Oki
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Hideo Saka
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.,Department of Respiratory Medicine, Matsunami General Hospital, Gifu, Japan
| | - Yoshihito Kogure
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Hideyuki Niwa
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Arisa Yamada
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Atsushi Torii
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Chiyoe Kitagawa
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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16
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Ing AJ, Saghaie T. Ultrathin bronchoscopy and cryobiopsy in diagnosing peripheral pulmonary lesions: Another tool in the toolbox. Respirology 2023; 28:90-92. [PMID: 36319029 DOI: 10.1111/resp.14402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 10/24/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Alvin J Ing
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Tajalli Saghaie
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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17
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Ishiguro Y, Uchimura K, Furuse H, Imabayashi T, Matsumoto Y, Watanabe S, Tsuchida T. Esophageal submucosal tumor diagnosed with EBUS-guided transbronchial mediastinal cryobiopsy: A case report. Thorac Cancer 2022; 13:3068-3072. [PMID: 36100954 PMCID: PMC9626318 DOI: 10.1111/1759-7714.14650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 01/07/2023] Open
Abstract
Cryobiopsy is advantageous for collecting larger specimens with minimum crushing compared to forceps biopsy and transbronchial needle aspiration (TBNA), but it has not been widely used for mediastinal tumors. In this report, a leiomyoma of the thoracic esophagus was diagnosed with endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-cryo). An asymptomatic 49-year-old woman had a 2.6-cm sized submucosal tumor (SMT) of the esophagus adjacent to the trachea and left main bronchus. EBUS-TBNA and EBUS-guided intranodal forceps biopsy were performed, followed by EBUS-cryo. The biopsy forceps could not be inserted into the tumor, but the cryoprobe was smoothly inserted. EBUS-TBNA could not obtain enough spindle-shaped tumor cells for immunohistochemical staining, but EBUS-cryo provided sufficient specimens for diagnosing the leiomyoma. Adding EBUS-cryo to EBUS-TBNA has recently been reported to achieve high diagnostic yields for lymphomas, uncommon tumors, and benign diseases. EBUS-cryo seems a valid diagnostic option for esophageal SMTs that are difficult to diagnose with needles and forceps.
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Affiliation(s)
- Yuki Ishiguro
- Department of Endoscopy, Respiratory Endoscopy DivisionNational Cancer Center HospitalTokyoJapan,Department of Thoracic SurgeryNational Cancer Center HospitalTokyoJapan
| | - Keigo Uchimura
- Department of Endoscopy, Respiratory Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Hideaki Furuse
- Department of Endoscopy, Respiratory Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Tatsuya Imabayashi
- Department of Endoscopy, Respiratory Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy DivisionNational Cancer Center HospitalTokyoJapan,Department of Thoracic OncologyNational Cancer Center HospitalTokyoJapan
| | | | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
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18
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Morita C, Kitamura A, Kinoshita K, Sueyoshi K, Murakami M, Ro S, Imai R, Okafuji K, Kojima F, Tomishima Y, Jinta T, Bando T, Nishimura N. A case of a thoracic mass negative on thoracentesis diagnosed by cryobiopsy from the visceral pleura. Respirol Case Rep 2022; 10:e01050. [PMID: 36268501 PMCID: PMC9577260 DOI: 10.1002/rcr2.1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Thoracoscopy under local anaesthesia is recommended for malignant tumours with negative pleural effusion cytology. Cryobiopsy from the visceral pleura by thoracoscopy under local anaesthesia can provide more diagnostic options for patients with thoracentesis‐negative malignant effusions. Here we present the first case in which this technique was used. The patient had a pleural metastasis that could not be diagnosed even with rapid cytology of the parietal pleura biopsy. Indications, technical pitfalls, and safety tips are discussed.
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Affiliation(s)
- Chie Morita
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan,Department of Respiratory MedicineNational Center for Global Health and MedicineTokyoJapan
| | - Atsushi Kitamura
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Katsuhito Kinoshita
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Kuniyo Sueyoshi
- Department of Thoracic Surgery, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Manabu Murakami
- Department of Anesthesia and Intensive Care UnitSt. Luke's International HospitalTokyoJapan
| | - Shosei Ro
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Ryosuke Imai
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Kohei Okafuji
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Fumitsugu Kojima
- Department of Thoracic Surgery, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Yutaka Tomishima
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Torahiko Jinta
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Toru Bando
- Department of Thoracic Surgery, Thoracic CenterSt. Luke's International HospitalTokyoJapan
| | - Naoki Nishimura
- Department of Respiratory Medicine, Thoracic CenterSt. Luke's International HospitalTokyoJapan
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19
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Muto Y, Uchimura K, Imabayashi T, Matsumoto Y, Furuse H, Tsuchida T. Clinical Utility of Rapid On-Site Evaluation of Touch Imprint Cytology during Cryobiopsy for Peripheral Pulmonary Lesions. Cancers (Basel) 2022; 14:4493. [PMID: 36139653 DOI: 10.3390/cancers14184493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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20
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Schramm D, Freitag N, Kötz K, Iglesias-Serrano I, Culebras-Amigo M, Koblizek V, Pérez-Tarazona S, Cases Viedma E, Srikanta JT, Durdik P, Darwiche K, Rubak S, Stafler P. Cryotherapy in the paediatric airway: Indications, success and safety. Respirology 2022; 27:966-974. [PMID: 36054726 DOI: 10.1111/resp.14353] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 08/15/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Cryotherapy in interventional bronchoscopy is a new treatment modality, which has recently been made available for the paediatric airway. Lack of experience and safety concerns have led to hesitant adaptation. The aim of this study was to assess indications, success rates and complications of airway cryotherapy in children. METHODS Bronchoscopists from medical centre performing cryotherapy in patients between 0 and 18 years were invited to participate in a prospective study based on an online questionnaire. Patient and participant data were collected between June 2020 and June 2021. RESULTS A total of 69 cryotherapy procedures were performed in 57 patients a for three main indications: Biopsy (30), restoration of airway patency (23) and foreign body aspiration (16). The overall success rate was 93%, the remaining 7% were performed for foreign body removal and required a switch of technique. Restoration of airway patency was successfully applied in various pathologies, including mucus plugs, bronchial casts and post traumatic stenosis. The diagnostic yield of transbronchial biopsies was 96%. No severe complications were encountered; one pneumothorax following a cryobiopsy required a chest drain for 48 h. No child was admitted to intensive care or died from a procedural complication. CONCLUSION In this largest paediatric case collection to date, cryotherapy was safe and carried a high success rate. Cryobiopsy compares favourably to the widely used forceps biopsy and could replace it in the future. Paediatric bronchoscopists are encouraged to add cryotherapy to their armamentarium of airway interventions.
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Affiliation(s)
- Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Nadine Freitag
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Karsten Kötz
- Queen Silvias Children Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ignacio Iglesias-Serrano
- Unitat de Pneumologia Pediàtrica i Fibrosi Quística, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Vladimir Koblizek
- Department of Pneumology, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czechia
| | | | - Enrique Cases Viedma
- Respiratory Endoscopy Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - J T Srikanta
- Pediatric Interventional Pulmonology, Allergy and Sleep Medicine, Aster CMI and RV Hospitals, Bengaluru, India
| | - Peter Durdik
- Pediatric Department, University Hospital Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Kaid Darwiche
- Department for Interventional Pneumology, Ruhrlandklinik-West German Lung Center, University Medicine Essen, Essen, Germany
| | - Sune Rubak
- Department of Pediatrics and Adolescents Medicine, Danish Center of Pediatric Pulmonology and Allergology, University Hospital of Aarhus, Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Patrick Stafler
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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22
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Mizumori Y, Hirano K, Hirata N, Hiraoka R, Takahashi S, Kominami R, Miyake K, Takenouchi M, Kato T, Kume S, Higashino S, Nakahara Y, Kawamura T. Precut technique using an injection needle: A retrospective study on a new ancillary procedure for pleural biopsy. Medicine (Baltimore) 2022; 101:e29377. [PMID: 35945762 PMCID: PMC9351845 DOI: 10.1097/md.0000000000029377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The effectiveness of thoracoscopic biopsy as a diagnostic method for pleural diseases has been reported; however, obtaining a sufficient specimen size is sometimes difficult. Therefore, an ancillary technique, the precut technique using an injection needle, was devised to address this problem. This study aimed to evaluate the effectiveness and safety of the novel precut technique in patients with undiagnosed pleural effusion. This retrospective study included 22 patients who underwent pleural biopsy using the precut technique to examine exudative pleural effusion of unknown etiology. Thoracoscopy was performed under local anesthesia. The biopsy procedure was performed as follows: a needle was inserted into the pleura around the lesion using a semiflexible thoracoscope; the needle was positioned to make an incision in the pleura while injecting 1% lidocaine with epinephrine and lifting the pleura from the fascia; 2 or 3 precut incision lines were arranged in a triangle; and the specimen was obtained from the parietal pleura using forceps or a cryoprobe. Patient data including age, number of biopsies, biopsy specimen size, pathological and final diagnosis, and postoperative complications were examined. All patients were male with an average age of 74 years. Pleural effusion was found on the right and left sides in 16 and 6 patients, respectively. The average major axis of the biopsy specimens was 18 mm (range, 10-30 mm), which was sufficient to establish a pathological diagnosis. Only 1 patient experienced minor temporal bleeding as a complication. The precut technique enabled the procurement of specimens sufficient in size for pleural biopsy.
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Affiliation(s)
- Yasuyuki Mizumori
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
- *Correspondence: Yasuyuki Mizumori, Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, 68 Honmachi, Himeji-shi, Hyogo 670-8520, Japan (e-mail: )
| | - Katsuya Hirano
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Nobuya Hirata
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Ryota Hiraoka
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Sayaka Takahashi
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Ryota Kominami
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Kohei Miyake
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Masaki Takenouchi
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Tomohiro Kato
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Sachie Kume
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Sachiko Higashino
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Yasuharu Nakahara
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
| | - Tetsuji Kawamura
- Department of Respiratory Medicine, National Hospital Organization Himeji Medical Center, Himeji-shi, Hyogo, Japan
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23
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Steinack C, Gaspert A, Gautschi F, Hage R, Vrugt B, Soltermann A, Schuurmans MM, Franzen D. Transbronchial Cryobiopsy Compared to Forceps Biopsy for Diagnosis of Acute Cellular Rejection in Lung Transplants: Analysis of 63 Consecutive Procedures. Life (Basel) 2022; 12:life12060898. [PMID: 35743931 PMCID: PMC9225122 DOI: 10.3390/life12060898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/25/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
Abstract
Background: Acute cellular rejection (ACR) is a complication after lung transplantation (LTx). The diagnosis of ACR is based on histologic findings using transbronchial forceps biopsy (FB). However, its diagnostic accuracy is limited because of the small biopsy size and crush artifacts. Transbronchial cryobiopsy (CB) provides a larger tissue size compared with FB. Methods: FB and CB were obtained consecutively during the same bronchoscopy (February 2020–April 2021). All biopsies were scored according to the ISHLT criteria by three pathologists. Interobserver agreement was scored by the kappa index. We assessed the severity of bleeding and the presence of pneumothorax. Results: In total, 35 lung transplant recipients were included, and 126 CBs and 315 FBs were performed in 63 consecutive bronchoscopies. ACR (A1–A3, minimal–moderate) was detected in 18 cases (28.6%) by CB, whereas ACR was detected in 3 cases (4.8%) by FB. Moderate and severe bleeding complicated FB and CB procedures in 23 cases (36.5%) and 1 case (1.6%), respectively. Pneumothorax occurred in 6.3% of patients. The interobserver agreement was comparable for both CB and FB. Conclusions: CB provided an improved diagnostic yield for ACR diagnosis, leading to reclassification and changes in treatment strategies in 28.6% of cases. Prospective studies should better define the role of CB after LTx.
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Affiliation(s)
- Carolin Steinack
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.G.); (R.H.); (M.M.S.); (D.F.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
- Correspondence:
| | - Ariana Gaspert
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
- Department of Pathology and Molecular Pathology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Fiorenza Gautschi
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.G.); (R.H.); (M.M.S.); (D.F.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
| | - René Hage
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.G.); (R.H.); (M.M.S.); (D.F.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
| | - Bart Vrugt
- Department of Pathology, Cantonal Hospital Münsterlingen, 8596 Münsterlingen, Switzerland;
| | | | - Macé Matthew Schuurmans
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.G.); (R.H.); (M.M.S.); (D.F.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
| | - Daniel Franzen
- Department of Pulmonology, Center of Lung Transplantation, Center of Adult Cystic Fibrosis, Interventional Lung Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.G.); (R.H.); (M.M.S.); (D.F.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
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24
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Zarogoulidis P, Kosmidis CS, Hohenforst-Schmidt W, Matthaios D, Sapalidis K, Petridis D, Perdikouri EI, Courcoutsakis N, Hatzibougias D, Arnaoutoglou C, Freitag L, Ioannidis A, Huang H, Tolis C, Bai C, Turner JF. Radial-EBUS: CryoBiopsy Versus Conventional Biopsy: Time-Sample and C-Arm. Int J Environ Res Public Health 2022; 19:ijerph19063569. [PMID: 35329255 PMCID: PMC8955438 DOI: 10.3390/ijerph19063569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/14/2022] [Accepted: 03/10/2022] [Indexed: 12/21/2022]
Abstract
Introduction: Diagnosis of lung nodules is still under investigation. We use computed tomography scans and positron emission tomography in order to identify their origin. Patients and Methods: In our retrospective study, we included 248 patients with a single lung nodule or multiple lung nodules of size ≥1 cm. We used a radial-endobronchial ultrasound and a C-Arm. We used a 1.1 mm cryoprobe versus a 22G needle vs. forceps/brush. We compared the sample size of each biopsy method with the number of cell-block slices. Results: Central lesions indifferent to the method provided the same mean number of cell-block slices (0.04933–0.02410). Cryobiopsies provide less sample size for peripheral lesions due to the higher incidence of pneumothorax (0.04700–0.02296). Conclusion: The larger the lesion ≥2 cm, and central, more cell-blocks are produced indifferent to the biopsy method (0.13386–0.02939). The time of the procedure was observed to be less when the C-Arm was used as an additional navigation tool (0.14854–0.00089).
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Affiliation(s)
- Paul Zarogoulidis
- Pulmonary-Oncology Department, General Clinic Euromedica, Private Hospital, 54645 Thessaloniki, Greece
- Correspondence:
| | - Christoforos S. Kosmidis
- Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki (AUTH), 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece; (C.S.K.); (K.S.)
| | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology/Pulmonology/Intensive Care/Nephrology, “Hof” Clinics, University of Erlangen, 91052 Hof, Germany;
| | - Dimitrios Matthaios
- Department of Medical Oncology, Rhodes General Hospital, 85133 Rhodes, Greece;
| | - Konstantinos Sapalidis
- Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki (AUTH), 1st St. Kiriakidi Street, 54621 Thessaloniki, Greece; (C.S.K.); (K.S.)
| | - Dimitrios Petridis
- Department of Food Science and Technology, International Hellenic University, 54621 Thessaloniki, Greece;
| | | | - Nikos Courcoutsakis
- Department of Radiology and Medical Imaging, University Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | | | - Christos Arnaoutoglou
- Department of Obstetrics & Gynecology, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece;
| | - Lutz Freitag
- Pulmonary Department, University Hospital of Zurich, 8004 Zurich, Switzerland;
| | - Aristeidis Ioannidis
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai 200001, China; (A.I.); (H.H.); (C.B.)
| | - Haidong Huang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai 200001, China; (A.I.); (H.H.); (C.B.)
| | - Christos Tolis
- Oncoderm Private Oncology Clinic, 45221 Ioannina, Greece;
| | - Chong Bai
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai 200001, China; (A.I.); (H.H.); (C.B.)
| | - J. Francis Turner
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN 37001, USA;
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25
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Uchimura K, Imabayashi T, Matsumoto Y, Tsuchida T. Intravascular Lymphoma Diagnosed by "Hot Lung" Sign. Intern Med 2022; 61:761-762. [PMID: 34393173 PMCID: PMC8943363 DOI: 10.2169/internalmedicine.8087-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Keigo Uchimura
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Japan
| | - Tatsuya Imabayashi
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Japan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Japan
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26
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Zhu D, Shen Y, Huang J, Zhao L. Intravascular large B-cell lymphoma with diffuse ground glass lesion on chest computed tomography diagnosed using transbronchial lung cryobiopsy: a case report. Transl Cancer Res 2022; 10:4571-4576. [PMID: 35116313 PMCID: PMC8798442 DOI: 10.21037/tcr-21-769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022]
Abstract
A 68-year-old man was presented with high fever of unknown origin for 3 weeks and non-productive cough for 1 week. A chest computed tomography (CT) scan revealed multiple nodules and ground glass opacities (GGO) in both lungs. The patient was initially diagnosed with hypersensitivity pneumonitis based on the result of bronchoalveolar lavage fluids (BALF). After treatment with methylprednisolone for 2 weeks, the patient’s fever recurred, with no resolution of lesions on chest CT. The patient consented to positron emission tomography (PET)/CT. It showed that fluorodeoxyglucose (FDG) metabolism was significantly increased in the spleen, whole skeleton, and both lungs, suggesting a malignant hematological disease. Large B-cell lymphoma was diagnosed by bone marrow puncture and flow cytometry. Transbronchial lung cryobiopsy was performed to evaluate the diffuse lung lesion. Hematoxylin-eosin (HE) staining showed diffuse infiltration of heterotypic cells in the pulmonary interstitial capillaries. Furthermore, immunohistochemical examination results suggested lung infiltration of B lymphohematopoietic system tumors. The patient was finally diagnosed as intravascular large B-cell lymphoma (IVLBCL). IVLBCL with diffuse lung ground glass lesions is very rare and difficult to diagnose. Transbronchial lung cryobiopsy, as an emerging procedure, plays an important role in the diagnosis of interstitial lung disease and has gained popularity for a lower complication rate and acquisition of more tissue samples.
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Affiliation(s)
- Dongyi Zhu
- Department of Respiratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan Shen
- Department of Emergency Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianhao Huang
- Department of Respiratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liming Zhao
- Department of Respiratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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27
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Kobe H, Saito K, Arita M, Ishida T. Cryobiopsy for Pneumocystis jirovecii pneumonia secondary to adult T-cell lymphoma/leukaemia. Respirol Case Rep 2022; 10:e0893. [PMID: 34976400 PMCID: PMC8689570 DOI: 10.1002/rcr2.893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/08/2022] Open
Abstract
A 79-year-old woman presented to the emergency department with a 1-week history of progressively worsening dyspnoea on exertion. Chest computed tomography (CT) showed bilateral consolidation. On laboratory findings, the line blot assay for human T-cell leukaemia virus type 1 was positive, the white blood cell count was 33,000/μl (atypical lymphocytes 8500/μl, 26% of the total white blood cell count) and β-d-glucan was increased to 391.1 pg/ml. In bronchoalveolar lavage fluid, there was a small number of atypical lymphocytes, and the polymerase chain reaction for Pneumocystis jirovecii was positive. Sulfamethoxazole-trimethoprim and corticosteroid were administered, but the lung shadows remained. Adult T-cell lymphoma/leukaemia (ATLL) cell infiltration was suspected, and transbronchial lung cryobiopsy was performed, which showed no infiltration of lymphoma cells into the lung. The lung shadow showed an improving trend on chest CT. She was diagnosed with chronic type ATLL and discharged without chemotherapy.
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Affiliation(s)
- Hiroshi Kobe
- Department of Respiratory MedicineOhara Healthcare Foundation, Kurashiki Central HospitalOkayamaJapan
| | - Kenki Saito
- Department of Hematology/OncologyOhara Healthcare Foundation, Kurashiki Central HospitalOkayamaJapan
| | - Machiko Arita
- Department of Respiratory MedicineOhara Healthcare Foundation, Kurashiki Central HospitalOkayamaJapan
| | - Tadashi Ishida
- Department of Respiratory MedicineOhara Healthcare Foundation, Kurashiki Central HospitalOkayamaJapan
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28
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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29
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Häntschel M, Eberhardt R, Petermann C, Gesierich W, Darwiche K, Hagmeyer L, Colby TV, Fend F, Theegarten D, Wintzer HO, Kreuter M, Spengler W, Behrens-Zemek AF, Lewis RA, Evrard HC, Ehab A, Böckeler M, Hetzel J. Diagnostic Yield of Transbronchial Lung Cryobiopsy Compared to Transbronchial Forceps Biopsy in Patients with Sarcoidosis in a Prospective, Randomized, Multicentre Cross-Over Trial. J Clin Med 2021; 10:jcm10235686. [PMID: 34884387 PMCID: PMC8658102 DOI: 10.3390/jcm10235686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Transbronchial lung forceps biopsy (TBLF) is of limited value for the diagnosis of interstitial lung disease (ILD). However, in cases with predominantly peribronchial pathology, such as sarcoidosis, TBLF is considered to be diagnostic in most cases. The present study examines whether transbronchial lung cryobiopsy (TBLC) is superior to TBLF in terms of diagnostic yield in cases of sarcoidosis. Methods: In this post hoc analysis of a prospective, randomized, controlled, multicentre study, 359 patients with ILD requiring diagnostic bronchoscopic tissue sampling were included. TBLF and TBLC were both used for each patient in a randomized order. Histological assessment was undertaken on each biopsy and determined whether sarcoid was a consideration. Results: A histological diagnosis of sarcoidosis was established in 17 of 272 cases for which histopathology was available. In 6 out of 17 patients, compatible findings were seen with both TBLC and TBLF. In 10 patients, where the diagnosis of sarcoidosis was confirmed by TBLC, TBLF did not provide a diagnosis. In one patient, TBLF but not TBLC confirmed the diagnosis of sarcoidosis. Conclusions: In this post hoc analysis, the histological diagnosis of sarcoidosis was made significantly more often by TBLC than by TBLF. As in other idiopathic interstitial pneumonias (IIPs), the use of TBLC should be considered when sarcoidosis is suspected.
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Affiliation(s)
- Maik Häntschel
- Department of Medical Oncology and Pneumology, Eberhard Karls University of Tübingen, 72074 Tübingen, Germany; (W.S.); (A.F.B.-Z.); (A.E.); (M.B.); (J.H.)
- Department of Internal Medicine—Pneumology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
- Correspondence: or ; Tel.:+49-7071-29-82711
| | - Ralf Eberhardt
- Department of Pneumology and Critical Care Medicine, Asklepios-Klinik Barmbek, 22307 Hamburg, Germany;
| | - Christoph Petermann
- Department for Pulmonary Diseases, Asklepios-Klinik Hamburg, 22307 Hamburg, Germany;
| | - Wolfgang Gesierich
- Comprehensive Pneumology Center Munich, Asklepios-Fachkliniken Munich-Gauting, 81377 Munich, Germany;
| | - Kaid Darwiche
- Department of Interventional Pneumology, Ruhrlandklinik—University Medicine Essen, University of Duisburg-Essen, 47057 Duisburg, Germany;
| | - Lars Hagmeyer
- Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, 42699 Solingen, Germany;
| | - Thomas V. Colby
- Department of Pathology (Emeritus), Mayo Clinic, Scottsdale, AZ 13400, USA;
| | - Falko Fend
- Institute of Pathology and Neuropathology, Reference Center for Hematopathology University Hospital, Eberhard Karls University of Tübingen, 72074 Tübingen, Germany;
| | - Dirk Theegarten
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, 7057 Essen, Germany;
| | - Hanns-Olof Wintzer
- Institute for Pathology, MVZ Hanse Histologikum, 22547 Hamburg, Germany;
- Department of Pathology/Hematopathology, Institute for Hematopathology, 22547 Hamburg, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik, University of Heidelberg and German Center for Lung Research (DZL), 69117 Heidelberg, Germany;
| | - Werner Spengler
- Department of Medical Oncology and Pneumology, Eberhard Karls University of Tübingen, 72074 Tübingen, Germany; (W.S.); (A.F.B.-Z.); (A.E.); (M.B.); (J.H.)
| | - Annika Felicitas Behrens-Zemek
- Department of Medical Oncology and Pneumology, Eberhard Karls University of Tübingen, 72074 Tübingen, Germany; (W.S.); (A.F.B.-Z.); (A.E.); (M.B.); (J.H.)
| | | | - Henry C. Evrard
- Department Physiology of Cognitive Processes, Max Planck Institute for Biological Cybernetics, 72076 Tübingen, Germany;
- Center for Integrative Neuroscience, Eberhard Karls University of Tübingen, 72074 Tübingen, Germany
- Center for Biomedical Imaging & Neurostimulation, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA
| | - Ahmed Ehab
- Department of Medical Oncology and Pneumology, Eberhard Karls University of Tübingen, 72074 Tübingen, Germany; (W.S.); (A.F.B.-Z.); (A.E.); (M.B.); (J.H.)
- Department of Pneumology, Klinik Loewenstein, 74245 Loewenstein, Germany
- Chest Medicine Department, Mansoura University, Mansoura 35516, Egypt
| | - Michael Böckeler
- Department of Medical Oncology and Pneumology, Eberhard Karls University of Tübingen, 72074 Tübingen, Germany; (W.S.); (A.F.B.-Z.); (A.E.); (M.B.); (J.H.)
- Department of Internal Medicine, Gastroenterology and Tumor Medicine, 73760 Ostfildern-Ruit, Germany
| | - Jürgen Hetzel
- Department of Medical Oncology and Pneumology, Eberhard Karls University of Tübingen, 72074 Tübingen, Germany; (W.S.); (A.F.B.-Z.); (A.E.); (M.B.); (J.H.)
- Department of Internal Medicine—Pneumology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
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Kronborg-White S, Madsen LB, Bendstrup E, Poletti V. PD-L1 Expression in Patients with Idiopathic Pulmonary Fibrosis. J Clin Med 2021; 10:jcm10235562. [PMID: 34884264 PMCID: PMC8658518 DOI: 10.3390/jcm10235562] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) is the most common and severe form within the group of idiopathic interstitial pneumonias. It is characterized by repetitive alveolar injury in genetically susceptible individuals and abnormal wound healing, leading to dysregulated bronchiolar proliferation and excessive deposition of extracellular matrix, causing complete architectural distortion and fibrosis. Epithelial-to-mesenchymal transition is considered an important pathogenic event, a phenomenon also observed in various malignant neoplasms, in which tumor cells express programmed death-ligand one (PD-L1). The aim of this study was to assess the presence of PD-L1 in patients with IPF and other interstitial lung diseases (ILDs). Method: Patients with a clinically and radiologically suspected idiopathic interstitial pneumonia or other ILDs undergoing transbronchial cryobiopsy to confirm the diagnosis at the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, were included in this prospective observational study. Cellular membrane PD-L1 expression in epithelial cells was determined using the DAKO PD-L1 IHC 22C3 PharmDx Kit. Results: Membrane-bound PD-L1 (mPD-L1) was found in twelve (28%) of the forty-three patients with IPF and in five (9%) of the fifty-five patients with other ILDs (p = 0.015). When adjusting for age, gender and smoking status, the odds ratio of having IPF when expressing mPD-L1 in alveolar and/or bronchiolar epithelial cells was 4.3 (CI: 1.3–14.3). Conclusion: Expression of mPD-L1 in epithelial cells in the lung parenchymal zones was detected in a consistent subgroup of patients with IPF compared to other interstitial pneumonias. Larger studies are needed to explore the role of mPD-L1 in patients with IPF.
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Affiliation(s)
- Sissel Kronborg-White
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (E.B.); (V.P.)
- Correspondence:
| | - Line Bille Madsen
- Department of Pathology, Aarhus University Hospital, 8200 Aarhus, Denmark;
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (E.B.); (V.P.)
| | - Venerino Poletti
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, 8200 Aarhus, Denmark; (E.B.); (V.P.)
- Department of the Diseases of the Thorax, Ospedale Morgagni, University of Bologna, 47121 Forli, Italy
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Ishihara H, Kataoka K, Takei R, Yamano Y, Yokoyama T, Matsuda T, Kimura T, Fukuoka J, Johkoh T, Kondoh Y. Anti-MDA5 antibody-positive clinically amyopathic dermatomyositis with diffuse alveolar damage diagnosed by transbronchial lung cryobiopsy: A case report. Respirol Case Rep 2021; 9:e0865. [PMID: 34707877 PMCID: PMC8524674 DOI: 10.1002/rcr2.865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/11/2022] Open
Abstract
Diffuse alveolar damage (DAD) is known to be a pathological hallmark of acute respiratory distress syndrome or acute interstitial pneumonia, and to have a poor prognosis. We report a case of anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive clinically amyopathic dermatomyositis (CADM) with rapidly progressive interstitial lung disease (RP-ILD), in which DAD was confirmed by transbronchial lung cryobiopsy at an early stage without respiratory failure. Although this patient initially did not show respiratory failure, his respiratory condition gradually worsened despite intensive immunosuppression therapy and he died 3 months later. Therefore, the early pathological findings of DAD did not match the clinical picture, which showed no respiratory failure. However, these findings were consistent with the subsequent course and poor outcome. Histological DAD, even in the absence of respiratory failure, may indicate a subsequent poor prognosis and explain the refractory course of RP-ILD with anti-MDA5 antibody-positive CADM.
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Affiliation(s)
- Hiroyuki Ishihara
- Department of Respiratory Medicine and AllergyTosei General HospitalSetoJapan
| | - Kensuke Kataoka
- Department of Respiratory Medicine and AllergyTosei General HospitalSetoJapan
| | - Reoto Takei
- Department of Respiratory Medicine and AllergyTosei General HospitalSetoJapan
| | - Yasuhiko Yamano
- Department of Respiratory Medicine and AllergyTosei General HospitalSetoJapan
| | - Toshiki Yokoyama
- Department of Respiratory Medicine and AllergyTosei General HospitalSetoJapan
| | - Toshiaki Matsuda
- Department of Respiratory Medicine and AllergyTosei General HospitalSetoJapan
| | - Tomoki Kimura
- Department of Respiratory Medicine and AllergyTosei General HospitalSetoJapan
| | - Junya Fukuoka
- Department of Laboratory of PathologyNagasaki University HospitalNagasakiJapan
| | - Takeshi Johkoh
- Department of RadiologyKansai Rosai HospitalAmagasakiJapan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and AllergyTosei General HospitalSetoJapan
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Abstract
BACKGROUND Transbronchial Lung Cryobiopsy (TBLC) is a novel technique, available globally only in a limited number of centers. Since the data on the role of TBLCs amongst pediatric patients is limited, the aim was to evaluate its efficacy in diagnosing lung diseases amongst children. METHODS The records of 28 pediatric patients were retrospectively reviewed from October 2016 till September 2018. The participants' demographic information, procedural indications, sample adequacy, diagnostic utility, and the complications associated with this type of bronchoscopy apparatus were further assessed. RESULTS Twenty-eight pediatric patients aged 22 months to 17 years underwent TBLC. From the 73 obtained biopsies, 97% had an adequate sampling size. The diagnostic yield of this method was 92.8%. The most common complication was mild bleeding. Transient hypoxemia and bronchospasm were observed in eleven and eight patients, respectively. Furthermore, most of them (78.6%) had uneventful post-procedure and recovery. CONCLUSIONS TBLC was a relatively safe and effective method with high accuracy and fewer complications in diagnosing and monitoring lung diseases in the selected children. However, more extensive multicentre trials are warranted to corroborate the potential benefits of this novel technique.
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Affiliation(s)
- Mohammad Ashkan Moslehi
- Director of Pediatric Interventional Pulmonology Division, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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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 (Phila) 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chami HA, Diaz-Mendoza J, Chua A, Duggal A, Jenkins AR, Knight SL, Patolia S, Tamae-Kakazu M, Raghu G, Wilson KC. Transbronchial Biopsy and Cryobiopsy in the Diagnosis of Hypersensitivity Pneumonitis among Patients with Interstitial Lung Disease. Ann Am Thorac Soc 2021; 18:148-61. [PMID: 32810411 DOI: 10.1513/AnnalsATS.202005-421OC] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Rationale: Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) with a diagnosis based on clinical, radiological, and pathological findings. The evidence supporting transbronchial forceps lung biopsy (TBBx) and transbronchial lung cryobiopsy (TBLC) as sampling techniques to diagnose HP in patients with newly detected ILD has not been reviewed systematically.Objectives: A systematic review was performed to assess the diagnostic yield and complication rates of TBBx or TBLC in patients with newly detected ILD whose differential diagnosis includes HP and to inform the development of the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax clinical practice guidelines on the diagnosis of HP.Methods: Medline, Excerpta Medica Database, and the Cochrane Library were searched through October 2019. Studies that enrolled patients with ILD and reported the diagnostic yield of TBBx or TBLC were selected for inclusion. Data related to diagnostic yield and safety outcomes were 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: The histopathologic diagnostic yields (number of procedures that yielded a histopathologic diagnosis divided by the total number of procedures performed) of TBBx and TBLC were 37% (95% confidence interval [CI], 32-42%) and 82% (95% CI, 78-86%), respectively, among patients with ILD. Among those diagnosed by TBBx, the proportion with HP could not be determined. However, among those diagnosed by TBLC, 13.4% had HP. TBBx was complicated by moderate to severe bleeding, severe bleeding, and pneumothorax in 4% (95% CI, 0-8%), 0% (95% CI, 0-1%), and 7% (95% CI, 2-13%) of patients, respectively. TBLC was complicated by any bleeding, severe bleeding, and pneumothorax in 11% (95% CI, 7-15%), 0% (95% CI, 0-1%), and 11% (95% CI, 9-14%) of patients, respectively. The quality of the evidence was very low because of the uncontrolled study designs, lack of consecutive enrollment, and inconsistent results.Conclusions: Very low-quality evidence indicated that TBLC had a higher diagnostic yield than TBBx among patients with ILD, although complications were similar.
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Zhang Q, Li H, An Y, Cheng D, Sun G, Qi Y, Xuan W, Wang Z, Zhang X. Combination of the Archimedes Navigation System and cryobiopsy in diagnosis of diffuse lung disease. J Int Med Res 2021; 49:3000605211016665. [PMID: 34275377 PMCID: PMC8293853 DOI: 10.1177/03000605211016665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of the Archimedes Navigation System (Broncus Medical, San Jose, CA, USA) for guidance during transbronchial cryobiopsy and the incidence of complications in patients with diffuse lung disease. METHODS High-resolution computed tomography and transbronchial cryobiopsy were used to evaluate eight patients with diffuse lung disease. The Archimedes Navigation System was used before cryobiopsy to obtain the best path with which to avoid large vessels. Three to five cryobiopsy specimens were taken from each sampled segment. RESULTS Preoperative planning using the Archimedes Navigation System was successfully performed on all eight patients. The probe-to-pleura distance was approximately 10 mm. No cases of pneumothorax occurred, one patient developed moderate bleeding, two developed minor bleeding, and five developed minimal bleeding that stopped spontaneously. A final diagnosis was obtained for seven patients, and ongoing follow-up was being conducted for the last patient at the time of this writing. CONCLUSIONS This is the first report of combining navigation technology with cryobiopsy to diagnose diffuse lung disease. The Archimedes Navigation System, which provides real-time guidance, is helpful in pre-cryobiopsy planning and diagnosis of diffuse lung disease. Moreover, this system can reduce the pneumothorax rate and bleeding risk by avoiding large vessels.
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Affiliation(s)
- Quncheng Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Huili Li
- Department of Medical Equipment, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Yunxia An
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Dongjun Cheng
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Guannan Sun
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Yong Qi
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Weixia Xuan
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Zheng Wang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
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Otsuka R, Kushima H, Fujita M, Ishii H. Aspergillus Niger-pulmonary Aspergillosis in an Immunocompetent Woman. Intern Med 2021; 60:2341-2342. [PMID: 33583889 PMCID: PMC8355378 DOI: 10.2169/internalmedicine.6057-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Rikako Otsuka
- Department of Respiratory Medicine, Fukuoka University Hospital, Japan
| | - Hisako Kushima
- Department of Respiratory Medicine, Fukuoka University Hospital, Japan
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Japan
| | - Masaki Fujita
- Department of Respiratory Medicine, Fukuoka University Hospital, Japan
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Japan
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Balasubramanian V, Gonuguntla HK, Gupta N. Antidiarrheal pill in the airway. Adv Respir Med 2021; 88:278-279. [PMID: 32706111 DOI: 10.5603/arm.2020.0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/14/2020] [Accepted: 03/18/2020] [Indexed: 11/25/2022]
Abstract
Pill aspiration depicts an unusual type of foreign body aspiration necessitating a discrete diagnostic and therapeutic approach.1 Some pills may remain intact in the endobronchial tree for many years without causing much harm, whereas others may dissolve2 The clinical outcomes may also vary, from an asymptomatic granuloma to severe, life-threatening airway complications, depending upon the chemical properties of the pill. We report a compelling case of pill aspiration in a healthy patient.
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Affiliation(s)
| | - Hari Kishan Gonuguntla
- Division of Interventional Pulmonology, Yashoda Hospitals, Secunderabad, Hyderabad, India
| | - Nitesh Gupta
- Department of Pulmonary, Critical Care & Sleep Medicine, VMMC & Safdarjung Hospital, New Delhi, India.
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38
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Han Q, Chen X, Xu X, Qian W, Zhao G, Mao M, Guo B, Xia S, Peng G, He J, Gu Y, Li S, Luo Q. The Application of Transbronchial Lung Cryobiopsy and Uniportal and Tubeless Video-Assisted Thoracic Surgery in the Multidisciplinary Diagnosis of Interstitial Lung disease-A Real-World Prospective Study. Front Mol Biosci 2021; 8:681669. [PMID: 34222336 PMCID: PMC8241905 DOI: 10.3389/fmolb.2021.681669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
The application of transbronchial lung cryobiopsy (TBLC) and uniportal and tubeless video-assisted thoracic surgery (UT-VATS) in the multidisciplinary diagnosis of interstitial lung disease (ILD) has not been demonstrated in real-world clinical practice. This prospective study included 137 patients with no definitive diagnosis who were the subject of two multidisciplinary discussion (MDD) sessions. As indicated in the first MDD, 67 patients underwent UT-VATS and 70 underwent TBLC. The specificity of biopsy information and its contribution to final MDD diagnosis were evaluated in the second MDD. The post-operative complications and hospitalization costs associated with the two biopsy methods were compared. UT-VATS was favored for patients initially diagnosed with idiopathic pulmonary fibrosis (IPF), bronchiolitis-associated interstitial lung disease (RB-ILD)/desquamative interstitial pneumonia (DIP) and undefined idiopathic interstitial pneumonia (UIIP), while TBLC was preferred for pulmonary lymphangioleiomyomatosis (PLAM) and pulmonary alveolar proteinosis (PAP). The spirometry parameters were better in patients who underwent UT-VATS than those who underwent TBLC. UT-VATS provided more specific pathological results than TBLC (85.7 vs 73.7%, p = 0.06). In patients initially diagnosed with UIIP, pathological information from UT-VATS was more clinically useful than that obtained from TBLC, although both tests contributed similarly to cases initially diagnosed as interstitial pneumonia with auto-immune features (IPAF)/connective tissue disease-related ILD (CTD-ILD). The safety of UT-VATS was comparable with TBLC although TBLC was cheaper during hospitalization (US$4,855.7 vs US$3,590.9, p < 0.001). multidisciplinary discussion decisions about biopsies were driven by current knowledge of sampling and diagnosis capacity as well as potential risks of different biopsy methods. The current MDD considered UT-VATS more informative than TBLC in cases initially diagnosed as UIIP although they were equally valuable in patients initially diagnosed with IPAF/CTD-ILD.
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Affiliation(s)
- Qian Han
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Xiaobo Chen
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Xin Xu
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.,Department of Cardio-thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weiping Qian
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Gui Zhao
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Mengmeng Mao
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Bingpeng Guo
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Shu Xia
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Guilin Peng
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.,Department of Cardio-thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianxing He
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.,Department of Cardio-thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yingying Gu
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.,Department of Pathology, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Shiyue Li
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Qun Luo
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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Pertzov B, Gershman E, Izhakian S, Heching M, Amor SM, Rosengarten D, Kramer MR. The LungVision navigational platform for peripheral lung nodule biopsy and the added value of cryobiopsy. Thorac Cancer 2021; 12:2007-2012. [PMID: 34096182 PMCID: PMC8258356 DOI: 10.1111/1759-7714.14003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The LungVision system is a novel augmented-fluoroscopy-based real-time navigation and guidance technology for bronchoscopy that can be integrated with any standard biopsy tool, including the cryoprobe, to enable real-time visualization and localization of pulmonary nodules. OBJECTIVES To evaluate the diagnostic yield and safety among patients undergoing peripheral pulmonary nodule biopsy with the LungVision system. METHODS This prospective, single-center study was conducted at Rabin Medical Center in Israel. All patients that underwent peripheral pulmonary nodule biopsy with the LungVision system from January 2016 to August 2020 were included. All procedures were performed under moderate sedation. The primary outcome was tissue diagnosis by either identification of malignant cells or benign diagnosis. Secondary outcomes were safety and the added value of cryobiopsy. RESULTS Sixty-three procedures were performed during the study period. Median lesion size (interquartile range) was 25.0 mm (18-28 mm). The diagnostic yield overall was 27/33 (81.8%) and for lesions smaller than 20 mm was 13/18 (72.2%). In nine cases the transbronchial cryobiopsy showed tissue with malignant cells that were not found in any other biopsy material taken with other sampling tools. One patient was treated with a chest tube for a pneumothorax. No other major complications were reported. CONCLUSIONS The LungVision system showed good feasibility and safety for peripheral pulmonary nodule biopsy. The system is compatible with all biopsy tools, including the cryoprobe. Randomized controlled trials are needed to accurately ascertain its diagnostic yield.
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Affiliation(s)
- Barak Pertzov
- Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Evgeni Gershman
- Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimon Izhakian
- Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Heching
- Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Moshe Amor
- Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Reuven Kramer
- Pulmonary Division, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kurman JS, Benn BS. Equal Pay for Unequal Work: The Undervaluation of Transbronchial Cryobiopsy. Chest 2020; 158:2288-9. [PMID: 33280748 DOI: 10.1016/j.chest.2020.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 07/29/2020] [Indexed: 11/24/2022] Open
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Matsumoto Y, Nakai T, Tanaka M, Imabayashi T, Tsuchida T, Ohe Y. Diagnostic Outcomes and Safety of Cryobiopsy Added to Conventional Sampling Methods: An Observational Study. Chest 2021; 160:1890-1901. [PMID: 34022184 DOI: 10.1016/j.chest.2021.05.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 04/04/2021] [Accepted: 05/10/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Cryobiopsy enables specialists to perform high-quality, large, entirely circumferential biopsies; therefore, it may improve the diagnostic yield of peripheral pulmonary lesions (PPLs), as has been previously observed regarding endobronchial tumors and interstitial lung diseases. RESEARCH QUESTION How do the diagnostic accuracy and safety change by cryobiopsy when performed alongside conventional biopsy for PPLs? STUDY DESIGN AND METHODS Consecutive patients who underwent cryobiopsy in addition to conventional biopsies for PPL diagnosis at our institution between June 2017 and May 2018 were reviewed retrospectively. The target location was estimated and sampling was performed using conventional devices (ie, forceps, brush, aspiration needle), and cryobiopsy was performed at the same location. Diagnostic outcomes and cryobiopsy safety when performed in addition to conventional sampling methods were analyzed in this observational study. RESULTS In total, 257 patients were analyzed, and the overall diagnostic yield was 89.9%. Among them, 22 lesions were diagnosable by cryobiopsy exclusively, which improved the rate of diagnosis by 8.6%. Advantages of the use of cryobiopsy were the most apparent when lesions were adjacent to areas assessed via radial endobronchial ultrasound (69.4% vs 84.3%). Multivariable analysis identified bronchus sign (positive/negative, P = .001), lobe (other lobes/right upper lobe and left upper segment, P = .028), and visibility on radiograph (visible/invisible, P = .047) as factors that significantly affected diagnostic yield. On the other hand, three instances of severe hemorrhage (1.2%) and two of pneumothorax (0.8%) occurred. Although most complications were minor, two patients required hospitalization because of cerebral infarction and lung abscess. INTERPRETATION Cryobiopsy improves the diagnostic yield of PPLs when combined with other conventional sampling methods; however, caution is required because of the possibility of complications.
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Affiliation(s)
- Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.
| | - Toshiyuki Nakai
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Midori Tanaka
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsuya Imabayashi
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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Herth FJ, Mayer M, Thiboutot J, Kapp CM, Sun J, Zhang X, Herth J, Kontogianni K, Yarmus L. Safety and Performance of Transbronchial Cryobiopsy for Parenchymal Lung Lesions. Chest 2021:S0012-3692(21)00885-0. [PMID: 33971147 DOI: 10.1016/j.chest.2021.04.063] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite advances in technology, the bronchoscopic diagnosis of parenchymal pulmonary lesions (PPLs) remains difficult to achieve. Transbronchial lung cryobiopsy (TLCB) offers the potential for larger samples with improved diagnostic yield; however, a paucity of data exists describing its safety and usefulness for the diagnosis of PPL. RESEARCH QUESTION What is the safety profile of TLCB for PPL? STUDY DESIGN AND METHODS An observational, retrospective, multicenter cohort study enrolled patients without endobronchial disease undergoing TLCB of PPL from 2015 through 2019. All procedures were performed using both rigid and flexible bronchoscopy with a flexible cryoprobe. Complication rates, including bleeding and pneumothorax rates, were collected. Bleeding was graded on a scale from 0 (trace) to 4 (requiring surgical intervention) with a grade of ≥ 3 considered clinically significant. Pneumothorax, tube thoracostomy placement, diagnostic yield, and need for subsequent interventions were recorded. RESULTS One thousand twenty-four patients underwent TLCB. One hundred eighty-eight patients (18%) experienced bleeding; in 36 patients (3.5%), the bleeding was clinically significant. Sixty-eight patients (6.6%) demonstrated a pneumothorax and 64 patients (6.3%) required drainage with tube thoracostomy. All chest drains were removed within 4 days, and no cases of prolonged air leak occurred. A definitive diagnosis was achieved in 932 patients (91%). Adenocarcinoma (46%) and metastatic disease (21%) were the most common diagnoses. INTERPRETATION TLCB showed an acceptable safety profile and diagnostic yield for the evaluation of PPL in this large retrospective cohort. Prospective clinical trials are underway to validate these findings further.
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Kronborg-White S, Sritharan SS, Madsen LB, Folkersen B, Voldby N, Poletti V, Rasmussen TR, Bendstrup E. Integration of cryobiopsies for interstitial lung disease diagnosis is a valid and safe diagnostic strategy-experiences based on 250 biopsy procedures. J Thorac Dis 2021; 13:1455-1465. [PMID: 33841938 PMCID: PMC8024861 DOI: 10.21037/jtd-20-2431] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transbronchial cryobiopsies has become increasingly used in the diagnostic workup in patients suspected of having interstitial lung disease. The procedure is associated with less complications, morbidity and mortality compared to surgical lung biopsies although with a diagnostic yield that is not as high, but close to that of surgical lung biopsies. The aim of the present study was to describe the complications and diagnostic yield and their prognostic factors. Methods All patients undergoing transbronchial cryobiopsies at the Department of Respiratory Diseases and Allergy, Aarhus University Hospital, were included in this prospective observational cohort study. Results A total of 250 patients were included [61% male, mean age 66 years (range, 22–81 years)]. Pneumothorax was detected in 70 (28%) of the patients, moderate hemorrhage in 53 (21%) and severe hemorrhage in 2 (1%) of the patients. Hemorrhage was associated with central biopsies, but not with anticoagulant therapy. None of the complications were related to lung function, exercise capacity, biopsy or probe size. Only one patient experienced an acute exacerbation. Three-month mortality was 0.4% (1 patient), caused by cancer and unrelated to the procedure. Cryobiopsies contributed to the final diagnosis in 72% of the patients and after multidisciplinary team discussion, a consensus diagnosis was obtained in 82% of the patients. The gender, the total sum of biopsy sizes, number of biopsies and presence of more than 50% alveolar tissue in biopsies increased the diagnostic yield. Conclusions Our study confirms that using cryobiopsies in the diagnostic setup for interstitial lung diseases is safe with a limited risk of acute exacerbations and mortality. Cryobiopsies contribute to the diagnosis in the majority of patients.
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Affiliation(s)
- Sissel Kronborg-White
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.,Department of Internal Medicine, Viborg Regional Hospital, Viborg, Denmark
| | | | - Line Bille Madsen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Birgitte Folkersen
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Nina Voldby
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Venerino Poletti
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.,Department of the Diseases of the Thorax, Ospedale Morgagni, Forli, Italy
| | - Torben Riis Rasmussen
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Nishida T, Matsumoto Y, Sasada S, Tanaka M, Nakai T, Fukai R, Ohe Y, Watanabe SI, Motoi N. Feasibility study of cryobiopsy for practical pathological diagnosis of primary lung cancer including immunohistochemical assessment. Jpn J Clin Oncol 2021; 51:271-278. [PMID: 32964232 DOI: 10.1093/jjco/hyaa174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Precision medicine in non-small cell lung cancer requires attainment of a sufficient amount of high-quality tumor tissue. Transbronchial cryobiopsy has emerged as a new diagnostic method for non-neoplastic lung disease with a better potential to assess morphology compared with conventional methods. However, the influence of cryobiopsy on specimen quality, particularly detection of protein expression, is unknown. We performed a comparative immunohistochemical study in specimens obtained by cryobiopsy versus conventional sampling to evaluate the feasibility of cryobiopsy for lung cancer diagnosis. METHODS Pairs of artificial biopsy specimens, collected using a cryoprobe or conventional scalpel, were obtained from 43 surgically resected primary lung tumors. Formalin-fixed, paraffin-embedded blocks were prepared in an ISO15189-certified laboratory. Immunohistochemical staining of thyroid transcription factor-1, p40, Ki67 and programmed death-ligand 1 (22C3) was performed. The H-scores for thyroid transcription factor-1 and p40, labeling index for Ki67 and tumor proportion score for programmed death-ligand 1 were assessed. Pearson's correlation coefficients between two sampling types were calculated. RESULTS The thyroid transcription factor-1 and p40 H-scores showed perfect correlations between the cryobiopsy and conventional scalpel-obtained specimens (R2 = 0.977 and 0.996, respectively). Ki67 labeling index and PD-L1 tumor proportion score also showed strong correlations between the two sample types (R2 = 0.896 and 0.851, respectively). Five cases (11.6%) exhibited differences in tumor proportion score category between sample types, potentially because of intratumoral heterogeneity. CONCLUSIONS Immunohistochemical expression of certain tumor markers showed a high concordance between cryobiopsy and conventional scalpel sampling. Cryobiopsy is feasible for pathological diagnostics including PD-L1 evaluation.
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Affiliation(s)
- Tomoki Nishida
- Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.,Department of Thoracic Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yuji Matsumoto
- Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.,Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shinji Sasada
- Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.,Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Midori Tanaka
- Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
| | - Toshiyuki Nakai
- Respiratory Endoscopy Division, Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.,Department of Respiratory Medicine, Osaka City University Hospital, Osaka, Japan
| | - Ryuta Fukai
- Department of Thoracic Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Noriko Motoi
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan.,Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
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Gnass M, Filarecka A, Bartczak A, Szołkowska M, Knapczyk A, Lis M, Skrobot M, Soja J, Misiaszek M, Barszczok Ł, Czyżewski D, Szlubowski A. Transbronchial lung cryobiopsy guided by radial mini-probe endobronchial ultrasound in interstitial lung diseases - a multicenter prospective study. Adv Respir Med 2021; 88:123-128. [PMID: 32383463 DOI: 10.5603/arm.2020.0086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). Ageneral anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing it's safety could result in wider use. Prospective, observational study was conducted in three Polish pulmonology centers to evaluate safety and diagnostic yield of TBLC under conscious sedation, without intubation and bronchial blockers and with radial-EBUS guidance instead of fluoroscopy. MATERIAL AND METHODS In patients suspected of ILD, in accordance with high resolution computer tomography (HRCT) selected lung segments were examined with radial-EBUS mini probe without aguide sheath. If the lung infiltrations were visible this locations were preferred. If not, specimens were taken from two different segments of the same lobe. Two to five biopsies with freezing time 5-8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels. RESULTS From March 2017 to September 2019 - 114 patients (M: 59, F: 55) of mean (SD) age 54 (14) years were included to the study on the basis of medical history and HRCT. Histopathology was conclusive in 90 (79%) patients and included 16 different diagnoses (sarcoidosis, EAA, COP predominantly). 24 inconclusive biopsies of unclassifiable pulmonary fibrosis were followed up. Complications included five cases (4.4%) of pneumothorax requiring achest tube drainage and aminor and moderate bleeding in few cases. There was no need for use of balloon bronchial blockers. CONCLUSIONS TBLC under conscious sedation guided by radial EBUS mini-probe is novel, reasonable and safe technique for histological diagnosis of ILDs.
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Affiliation(s)
- Maciej Gnass
- Endoscopy Unit, Pulmonary Hospital, Zakopane, Polan.
| | - Anna Filarecka
- Department of Pulmonology, Pulmonary Hospital, Zakopane, Poland
| | - Artur Bartczak
- Department of Pathology, Pulmonary Hospital, Zakopane, Poland
| | - Małgorzata Szołkowska
- Department of Pathology, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | | | - Monika Lis
- Department of Pathology, Pulmonary Hospital, Zakopane, Poland
| | - Monika Skrobot
- Department of Pathology, Pulmonary Hospital, Zakopane, Poland
| | - Jerzy Soja
- Department of Medicine, Jagiellonian University, Cracow, Poland
| | | | - Łukasz Barszczok
- Chair and Department of Thoracic Surgery of Silesian Medical University, Katowice, Poland
| | - Damian Czyżewski
- Chair and Department of Thoracic Surgery of Silesian Medical University, Katowice, Poland
| | - Artur Szlubowski
- Endoscopy Unit, Pulmonary Hospital, Zakopane, Polan.,Endoscopy Unit, John Paul II Hospital, Cracow, Poland
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Nasu S, Kawahara K, Han Y, Okamoto N, Tamura Y, Suzuki H, Shiroyama T, Samejima Y, Kanai T, Noda Y, Tanaka A, Morishita N, Ueda K, Hashimoto S, Hirashima T, Nagai T. Transbronchial Cryobiopsy for Miliary Tuberculosis Mimicking Hypersensitivity Pneumonitis. Intern Med 2021; 60:445-448. [PMID: 32963150 PMCID: PMC7925263 DOI: 10.2169/internalmedicine.4511-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Miliary tuberculosis is a potentially lethal type of tuberculosis that results from the hematogenous dissemination of Mycobacterium tuberculosis bacilli. We herein describe the case of a 34-year-old man that presented with a one-month history of cough and fever, while his sputum smear results were negative. Chest computed tomography revealed bilateral centrilobular ground-glass opacification (GGO), suggestive of hypersensitivity pneumonitis; thus, bronchoscopy was performed. Cryobiopsy specimens revealed necrotic granulomas. A re-examination of sputum after bronchoscopy identified Mycobacterium tuberculosis, and miliary tuberculosis was diagnosed. A cryobiopsy might be useful for diagnosing miliary tuberculosis pathologically, particularly when miliary nodules may be masked by GGO.
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Affiliation(s)
- Shingo Nasu
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Kunimitsu Kawahara
- Department of Pathology Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Japan
| | - Yuki Han
- Department of Infectious Diseases, Osaka Habikino Medical Center, Japan
| | - Norio Okamoto
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Yoshitaka Tamura
- Department of Infectious Diseases, Osaka Habikino Medical Center, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | | | - Yumiko Samejima
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Tomohiro Kanai
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Yoshimi Noda
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Ayako Tanaka
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Naoko Morishita
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Japan
| | - Kayo Ueda
- Department of Pathology Osaka Prefectural Hospital Organization, Osaka Habikino Medical Center, Japan
| | - Shoji Hashimoto
- Department of Infectious Diseases, Osaka Habikino Medical Center, Japan
| | | | - Takayuki Nagai
- Department of Infectious Diseases, Osaka Habikino Medical Center, Japan
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Tone M, Inomata M, Awano N, Kuse N, Takada K, Minami J, Muto Y, Fujimoto K, Kumasaka T, Izumo T. Comparison of adequacy between transbronchial lung cryobiopsy samples and endobronchial ultrasound-guided transbronchial needle aspiration samples for next-generation sequencing analysis. Thorac Cancer 2020; 12:251-258. [PMID: 33270369 PMCID: PMC7812063 DOI: 10.1111/1759-7714.13770] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/26/2022] Open
Abstract
Background Most lung cancer patients present with lesions in both lung fields and lymphadenopathy. Thus, transbronchial lung cryobiopsy (TBLC) and endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) are commonly performed for diagnosing lung cancer. However, the adequacy of these samples for next‐generation sequencing (NGS) analysis remains unclear. This study aimed to compare the adequacy between TBLC and EBUS‐TBNA samples for NGS analysis. Methods This retrospective cohort study included patients whose lung samples were collected via TBLC or EBUS‐TBNA and analyzed using NGS. Out of 46 genes, the number of genes in TBNA and TBLC samples that could not be assessed via NGS analysis was mainly evaluated. Results A total of 37 patients were included and classified into two groups (TBLC group, n = 18 and TBNA group, n = 19). The mean number of genes that could not be evaluated via NGS analysis was significantly lower in the TBLC group than in the TBNA group (0.9 vs. 10.3, P = 0.024). The median total area of tumor cells in TBLC samples was significantly greater than that in TBNA samples (6.3 [1.6–4.2] vs. 2.6 [0.2–17.3] mm2, P < 0.01). In the TBNA group, there were two fully inadequate samples for NGS analysis with a high degree of cell crush or low tumor content, while there was no fully inadequate sample in the TBLC group. Conclusions TBLC is more effective in obtaining adequate samples for NGS analysis than EBUS‐TBNA. TBLC should be performed to obtain adequate samples for NGS analysis in lung cancer patients with target lesions in lung fields, even if they have lymphadenopathy. Key points Significant findings of the studyThe mean number of genes that could not be evaluated was significantly lower in TBLC samples than in EBUS‐TBNA samples (0.9 vs. 10.3, P = 0.024). TBLC could obtain adequate samples with a high concentration of uncrushed tumor cells for NGS.
What this study addsTo obtain samples for NGS analysis, the use of TBLC should be aggressively considered in lung‐cancer patients with target lesions located in lung fields, even if they have lymphadenopathy.
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Affiliation(s)
- Mari Tone
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Minoru Inomata
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Nobuyasu Awano
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Naoyuki Kuse
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Kohei Takada
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Jonsu Minami
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Yutaka Muto
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Kazushi Fujimoto
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Takehiro Izumo
- Department of Pathology, Japanese Red Cross Medical Center, Shibuya, Japan
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Arya R, Boujaoude Z, Rafferty WJ, Abouzgheib W. Usefulness and safety of transbronchial biopsy with large forceps during flexible bronchoscopy. Proc (Bayl Univ Med Cent) 2020; 34:232-236. [PMID: 33678954 DOI: 10.1080/08998280.2020.1835123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Transbronchial lung biopsy (TBLB) using forceps is one of the most common procedures used to obtain lung tissue. The procedure's usefulness remains limited when diagnosing interstitial lung diseases. This retrospective descriptive study analyzed the feasibility and safety of using large forceps for TBLB in all patients who underwent TBLB from 2014 to 2018 for diffuse lung disease where the diagnosis could not be made by high-resolution chest computed tomography. We excluded patients with radiographic features of usual interstitial pneumonia. Among the 35 study patients, 7 were men and 28 were women. Diagnoses included respiratory associated bronchiolitis (7), diffuse alveolar damage (4), organizing pneumonia (4), nonspecific interstitial pneumonitis (3), acute fibrinous organizing pneumonia (3), sarcoidosis (2), hypersensitivity pneumonitis (2), IgG4 interstitial lung disease (1), eosinophilic pneumonia (1), pulmonary alveolar proteinosis (1), pulmonary fibrosis (1), pneumocystis (1), plasma-rich bronchiolitis (1), and diffuse alveolar hemorrhage (1). In three cases, the biopsies were nondiagnostic. Two patients developed a pneumothorax, and one required chest tube placement. There was one episode of minor bleeding. No escalation of care or hospitalization was required. Large-forceps TBLB is a feasible and safe method for obtaining parenchymal lung biopsies.
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Affiliation(s)
- Rohan Arya
- Division of Pulmonary, Critical Care, and Sleep Medicine, Prisma Health, Columbia, South Carolina
| | - Ziad Boujaoude
- Division of Pulmonary and Critical Care, Cooper Medical School at Rowan University, Camden, New Jersey
| | - William J Rafferty
- Division of Pulmonary and Critical Care, Cooper Medical School at Rowan University, Camden, New Jersey
| | - Wissam Abouzgheib
- Division of Pulmonary and Critical Care, Cooper Medical School at Rowan University, Camden, New Jersey
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49
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Asaoka M, Baba T, Ogura T. Pleural Emphysema after Transbronchial Lung Cryobiopsy. Intern Med 2020; 59:2331-2332. [PMID: 32536649 PMCID: PMC7578616 DOI: 10.2169/internalmedicine.4698-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Masato Asaoka
- Division of Pulmonary Medicine, Department of Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tomohisa Baba
- Division of Pulmonary Medicine, Department of Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Takashi Ogura
- Division of Pulmonary Medicine, Department of Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
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50
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Doan J, Rao N, Kurman JS, Routes JM, Benn BS. Granulomatous and lymphocytic interstitial lung disease diagnosed by transbronchial lung cryobiopsy. Cryobiology 2020; 97:231-234. [PMID: 32810518 DOI: 10.1016/j.cryobiol.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 01/18/2023]
Abstract
Granulomatous and lymphocytic interstitial lung disease is a pulmonary complication of common variable immune deficiency with significant morbidity and increased mortality. Diagnosis has historically been obtained by surgical lung biopsy as transbronchial biopsy typically yields insufficient tissue for definitive diagnosis from a disease process with a patchy distribution. However, the potential for significant morbidity and mortality with surgical lung biopsy exists, necessitating the development of alternative diagnostic approaches. We present a case of granulomatous and lymphocytic interstitial lung disease confirmed through minimally invasive transbronchial lung cryobiopsy and discuss the role of this modality in diagnosing interstitial lung disease.
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Affiliation(s)
- John Doan
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nagarjun Rao
- Department of Pathology, Aurora Clinical Laboratories/Great Lakes Pathologists, Aurora West Allis Medical Center, West Allis, WI, USA
| | - Jonathan S Kurman
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John M Routes
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bryan S Benn
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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