Avaliação da utilização de biópsia transbrônquica em pacientes com suspeita clínica de doença pulmonar intersticial

Oliveira, Cristiano Claudino; Fabro, Alexandre Todorovic; Ribeiro, Sérgio Marrone; Defaveri, Júlio; Capelozzi, Vera Luíza; Queluz, Thais Helena Thomaz; Yoo, Hugo Hyung Bok

doi:10.1590/s1806-37132011000200006

Cited by 9 publications

(5 citation statements)

References 21 publications

(25 reference statements)

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“…In many patients with ILD, tissue sampling may be crucial to establish a diagnosis . TBB may provide diagnostic material; however, its use is limited by the small size of lung tissue samples obtained particular when expecting NSIP, IPF, LAM and PLCH . A major advantage of cryo‐TBB technique is that the sample is frozen, hence obtaining a large sample with a high percentage of alveolated tissue without no crush artefacts.…”

Section: Discussionmentioning

confidence: 99%

“…Due to these inherent limitations of forceps-TBB, there is a debate in the literature whether TBB could become the diagnostic modality of choice in patients with undiagnosed ILD. [7][8][9][10][11][12] Given the relatively small size of lung tissue samples obtained via conventional forceps-TBB, many guidelines mandate the use of open lung biopsy (OLB) to establish the histological diagnosis of ILD. [13][14][15][16] Although surgical lung biopsy is considered the gold standard, the procedure requires general anaesthesia, and mandates hospitalization with a chest tube in place.…”

Section: Introductionmentioning

confidence: 99%

“…Due to these inherent limitations of forceps‐TBB, there is a debate in the literature whether TBB could become the diagnostic modality of choice in patients with undiagnosed ILD . Given the relatively small size of lung tissue samples obtained via conventional forceps‐TBB, many guidelines mandate the use of open lung biopsy (OLB) to establish the histological diagnosis of ILD …”

Section: Introductionmentioning

confidence: 99%

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Histological diagnosis of interstitial lung diseases by cryo‐transbronchial biopsy

et al. 2014

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Background and objective: The gold standard for the histological diagnosis of interstitial lung diseases (ILD)is an open lung biopsy (OLB). Tissue samples obtained by forceps transbronchial lung biopsies (TBB) are usually too small. We aim to evaluate the efficacy and safety of cryo-TBB for the diagnosis of ILD and to explore its role as substitute for OLB. Methods: Seventy-five patients (mean age 56.2 years) with clinical and radiological features suggestive of ILD underwent cryo-TBB under moderate sedation. The diagnostic contribution on the work-up of suspected ILD was assessed. Results: No major complications occurred during cryo-TBB procedures. The mean cross-sectional area of the biopsy specimen obtained was 9 mm 2 with an average of 70% alveolated tissue. The most common pathological diagnoses were idiopathic nonspecific interstitial pneumonitis (n = 22), cryptogenic organizing pneumonia (n = 11) and usual interstitial pneumonitis (n = 7). There were three patients of pulmonary Langerhans cell histiocytosis and one patient of pulmonary lymphangioleiomyomatosis. A definite and probable clinicopathological consensus diagnosis was possible in 70% and 28% of patients, respectively. In only 2% of patients' diagnosis could not be established. Conclusions: Cryo-TBB is a safe and effective minimally invasive modality for the diagnosis of ILD. No OLB is needed in the majority of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Histological diagnosis of interstitial lung diseases by cryo‐transbronchial biopsy

et al. 2014

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“…1) has generally been accepted as a useful technique in establishing a diagnosis of pulmonary infiltrates occurring in immunosuppressed patients [1,2,3,4] and lung transplant recipients [5,6,7,8], and it is commonly employed in the diagnostic evaluation of diffuse parenchymal lung disease [9,10,11,12,13,14]. Traditionally, TBB has been performed with metal forceps under fluoroscopy.…”

Section: Introductionmentioning

confidence: 99%

Safety of Cryo-Transbronchial Biopsy in Diffuse Lung Diseases: Analysis of Three Hundred Cases

Gershman

Fruchter

Benjamin³

et al. 2015

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Background: Transbronchial biopsy (TBB) which is performed with metal forceps (forceps TBB) has been accepted as a useful technique in establishing diagnoses of diffuse lung diseases (DLDs). The use of cryoprobes to obtain alveolar tissue (cryo-TBB) is a new method which is currently used by our institute as well as others with excellent results. Objectives: To assess the safety of cryo-TBB compared with conventional forceps TBB. Methods: We performed a retrospective data evaluation of 300 consecutive patients who underwent cryo-TBB between January 2012 and April 2014 and compared them with historical cases treated with forceps TBB between 2010 and 2012. The results of both diagnostic modalities were compared based on pathological reports. The major complications (significant bleeding and pneumothorax) were compared, along with postprocedural hospitalization. Results: Pneumothorax was observed in 15 cases (4.95%) treated with cryo-TBB versus 9 cases (3.15%) treated with forceps TBB, with no significant difference (p = 0.303). The insertion of a chest tube was necessary in 6 (2%) and 4 (1.3%) of the cases having undergone cryo-TBB or forceps TBB, respectively (p = 0.8). In the cryo-TBB group, bleeding was encountered in 16 cases (5.2%), and it occurred in 13 cases (4.5%) of the forceps TBB group, with no significant difference in rates (p = 0.706). Also, there was no significant difference in hospital admission rates between the groups [cryo-TBB: 10 (3.3%); forceps TBB: 4 (1.44%); p = 0.181]. The safety profile of cryo- and forceps TBB remained the same even when stratified according to indications for TBB, i.e. immunocompromised hosts, patients after lung transplantation and those with DLDs. Conclusion: In patients with DLDs, cryo-TBB is as safe as forceps TBB.

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“…( 17 ) Even though transbronchial biopsy plays an unequivocal role in the histological classification of ILD, the limitations of transbronchial biopsy samples should be acknowledged. ( 25 )…”

Section: Discussionmentioning

confidence: 99%

Lung-dominant connective tissue disease among patients with interstitial lung disease: prevalence, functional stability, and common extrathoracic features

et al. 2015

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OBJECTIVE: To describe the characteristics of a cohort of patients with lung-dominant connective tissue disease (LD-CTD). METHODS: This was a retrospective study of patients with interstitial lung disease (ILD), positive antinuclear antibody (ANA) results (≥ 1/320), with or without specific autoantibodies, and at least one clinical feature suggestive of connective tissue disease (CTD). RESULTS: Of the 1,998 patients screened, 52 initially met the criteria for a diagnosis of LD-CTD: 37% were male; the mean age at diagnosis was 56 years; and the median follow-up period was 48 months. During follow-up, 8 patients met the criteria for a definitive diagnosis of a CTD. The remaining 44 patients comprised the LD-CTD group, in which the most prevalent extrathoracic features were arthralgia, gastroesophageal reflux disease, and Raynaud's phenomenon. The most prevalent autoantibodies in this group were ANA (89%) and anti-SSA (anti-Ro, 27%). The mean baseline and final FVC was 69.5% and 74.0% of the predicted values, respectively (p > 0.05). Nonspecific interstitial pneumonia and usual interstitial pneumonia patterns were found in 45% and 9% of HRCT scans, respectively; 36% of the scans were unclassifiable. A similar prevalence was noted in histological samples. Diffuse esophageal dilatation was identified in 52% of HRCT scans. Nailfold capillaroscopy was performed in 22 patients; 17 showed a scleroderma pattern. CONCLUSIONS: In our LD-CTD group, there was predominance of females and the patients showed mild spirometric abnormalities at diagnosis, with differing underlying ILD patterns that were mostly unclassifiable on HRCT and by histology. We found functional stability on follow-up. Esophageal dilatation on HRCT and scleroderma pattern on nailfold capillaroscopy were frequent findings and might come to serve as diagnostic criteria.

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Avaliação da utilização de biópsia transbrônquica em pacientes com suspeita clínica de doença pulmonar intersticial

Cited by 9 publications

References 21 publications

Histological diagnosis of interstitial lung diseases by cryo‐transbronchial biopsy

Histological diagnosis of interstitial lung diseases by cryo‐transbronchial biopsy

Safety of Cryo-Transbronchial Biopsy in Diffuse Lung Diseases: Analysis of Three Hundred Cases

Lung-dominant connective tissue disease among patients with interstitial lung disease: prevalence, functional stability, and common extrathoracic features

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