Cone Beam CT Guidance Improves Transbronchial Lung Cryobiopsy Safety

Benn, Bryan S.; Romero, Arthur Oliver; Bawaadam, Hasnain; Ivanick, Nathaniel; Lum, Mendy; Krishna, Ganesh

doi:10.1007/s00408-021-00473-3

Cited by 15 publications

(11 citation statements)

References 30 publications

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“…Comparable results are found when using prophylactic endobronchial blockers or balloons [ 22 , 23 ], although the severity of bleeding may decrease. Recent data using vasoconstricting medications and cone-beam computed tomography guidance, however, are promising in reducing complications [ 12 , 24 , 25 ]. Additional studies layering these different modalities together, and in comparison, will be informative to further improve patient safety.…”

Section: Discussionmentioning

confidence: 99%

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Transbronchial Lung Cryobiopsy is Safe and Effective for Diagnosing Acutely Ill Hospitalized Patients with New Diffuse Parenchymal Lung Disease

Castellani

Benn

2022

Lung

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Introduction Transbronchial lung cryobiopsy (TBLC) is an accepted alternative to surgical lung biopsy (SLB) for diagnosing diffuse parenchymal lung disease (DPLD) that is less invasive and results in comparable diagnostic yields. Performing lung biopsies on hospitalized patients, however, has increased risk due to the patient’s underlying disease severity. Data evaluating the safety and efficacy of TBLC in hospitalized patients are limited. We present a comparison of TBLC for hospitalized and outpatients and provide the safety and diagnostic yields in these populations. Methods Demographic data, pulmonary function values, chest imaging pattern, procedural information, and diagnosis were recorded from enrolled patients. Complications from the procedure were the primary outcomes and diagnostic yield was the secondary outcome. Results 77 patients ( n = 22 hospitalized vs n = 55 outpatient) underwent TBLC during the study period. Comparing adverse events between hospitalized and outpatients revealed no statistically significant differences in pneumothorax (9%, n = 2 vs 5%, n = 3), tube thoracostomy placement (5%, n = 1 vs 2%, n = 1), grade 2 bleeding (9%, n = 2 vs 0%, n = 0), escalation in level of care (5%, n = 1 vs 0%, n = 0), 30-day mortality (9%, n = 2 vs 2%, n = 1), and 60-day mortality (9%, n = 2 vs 4%, n = 2) ( p > 0.05 for all). No deaths were attributed to the procedure. 95% of cases received a multidisciplinary conference diagnosis (hospitalized 100%, n = 22 vs outpatients 93%, n = 51, p = 0.32). Conclusion Our experience supports that TBLC may be a safe and effective modality for acutely ill-hospitalized patients with DPLD. Further efforts to enhance procedural safety and to determine the impact of an expedited tissue diagnosis on patient outcomes are needed.

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Section: Discussionmentioning

confidence: 99%

“…Once biopsies were complete and airway hemostasis was confirmed, a post-procedure chest x-ray was performed immediately after the procedure to evaluate for pneumothorax. For 9 patients (8 outpatient and 1 inpatient), TBLC was performed with cone-beam CT guidance as previously described [ 12 ].…”

Section: Methodsmentioning

confidence: 99%

Transbronchial Lung Cryobiopsy is Safe and Effective for Diagnosing Acutely Ill Hospitalized Patients with New Diffuse Parenchymal Lung Disease

Castellani

Benn

2022

Lung

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“…Changes in lung anatomy between the preprocedural CT scan and the bronchoscopy are a limitation, like atelectasis, which can lead to a divergence between the expected and the actual location of the marked target [ 10 ]. Cone beam CT scan (CBCT) guidance has been shown to reduce this effect when used to guide lung cryobiopsy resulting in high diagnostic yield with no periprocedural complications [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Navigational Bronchoscopy with Cryobiopsy for Diagnosis of ILD

Rodriguez

Ghauri

Abdo

et al. 2022

Case Reports in Pulmonology

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Background Interstitial lung diseases (ILDs) are a group of parenchymal pulmonary diseases in which pathologic diagnosis is essential. Although cryobiopsy has a high diagnostic yield, the complication rate remains high. Case Presentation . We report two cases of lung cryobiopsy guided by navigational bronchoscopy (LCB) for the diagnosis of ILD. In both cases, a CT chest angiogram (CTA) using a navigational protocol was performed. Targets were premarked and reached with the navigational system. Radial ultrasound (RU) was applied in combination with fluoroscopy guidance (FG) prior to sampling. Both patients achieved a final diagnosis; they were discharged home after procedure and no complications were noted. Discussion . By using a CTA with navigational guidance, we were able to perform cryobiopsy in areas with most disease activity and least vascularization. Conclusion LCB used with navigational guidance for the diagnosis of ILD provides may be a safe and effective procedure that provides high diagnostic yield. Limitations include cost, availability, and expertise. Larger trials are needed to confirm the additional benefit.

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“…51,53,57 However, there is room for improvement in both diagnostic yield and safety. Some promising strategies include combining TBLC with more advanced imaging modalities such as radial endobronchial ultrasound and cone beam CT. [58][59][60][61][62][63] Another strategy involves combined TBLC with genomic classification for IPF. 24 Regardless of ongoing improvements, a multidisciplinary team approach of dedicated pulmonologists, radiologists, pathologists, and thoracic surgeons remains essential to a cryobiopsy program to ensure optimal management.…”

Section: Future Directionsmentioning

confidence: 99%

Transbronchial Lung Cryobiopsy for Diffuse Parenchymal Lung Disease

Ronaghi

2022

Semin Respir Crit Care Med

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Transbronchial lung cryobiopsy (TBLC) offers a minimally invasive option for the diagnosis of diffuse parenchymal lung diseases, of which interstitial lung diseases comprise the most common diagnoses. It has a high diagnostic yield with prognostic and therapeutic implications. TBLC has a favorable safety profile compared with surgical lung biopsy, but associated complications include pneumothorax and bleeding. However, TBLC techniques remain variable. Here we review the latest techniques described to maximize diagnostic yield and mitigate complications of TBLC as well as how this modality has been incorporated into guidelines.

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Cone Beam CT Guidance Improves Transbronchial Lung Cryobiopsy Safety

Cited by 15 publications

References 30 publications

Transbronchial Lung Cryobiopsy is Safe and Effective for Diagnosing Acutely Ill Hospitalized Patients with New Diffuse Parenchymal Lung Disease

Transbronchial Lung Cryobiopsy is Safe and Effective for Diagnosing Acutely Ill Hospitalized Patients with New Diffuse Parenchymal Lung Disease

Navigational Bronchoscopy with Cryobiopsy for Diagnosis of ILD

Transbronchial Lung Cryobiopsy for Diffuse Parenchymal Lung Disease

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