How might transbronchial cryobiopsy improve diagnosis and treatment of diffuse parenchymal lung disease patients?

Poletti, Venerino; Ravaglia, Claudia; Dubini, Alessandra; Piciucchi, Sara; Rossi, Giulio; Kronborg-White, Sissel; Tomassetti, Sara

doi:10.1080/17476348.2017.1395283

Cited by 13 publications

(27 citation statements)

References 33 publications

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“…The use of a bronchial blocker or balloon catheter may be more necessary when flexible endoscopy is used, and indeed recently recommended by an expert working group [7]. Nevertheless, this aspect represents one of several specific differences in procedural details that vary greatly across reported series of cTBB, again highlighting the need for standardization of cTBB methods [7, 16, 17]. …”

Section: Discussionmentioning

confidence: 99%

Transbronchial Cryobiopsies for Diagnosing Interstitial Lung Disease: Real-Life Experience from a Tertiary Referral Center for Interstitial Lung Disease

et al. 2018

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Background: Transbronchial cryobiopsy (cTBB) may offer an alternative to surgical lung biopsy (SLB) for histopathological diagnosis of interstitial lung diseases (ILDs). However, real-life experience is limited, although case series are increasingly reported. Objectives: We aimed to evaluate the value of cTBB performed under real-life conditions in a tertiary care center for ILDs. Methods: Data on all patients undergoing a cTBB for evaluation of suspected ILD between October 2015 and January 2017 were included in this retrospective case series. Procedure details, complication rates, histopathological results, and diagnostic consensus reached by a multidisciplinary team (MDT) discussion were collated and evaluated. Results: A total of 109 patients (mean age 64 years, range 19–85; 66% male, 38% never smokers) referred to our center with features suggestive of ILD underwent cTBB. The mean FVC% predicted was 77% (range 41–131), with a mean DLCO of 51% (range 20–86), and a 6-min walking test (6MWT) of 402 m (range 100–642). On average, 4 samples were taken from each patient (range 1–8), with a mean biopsy diameter of 5 mm (range 2–12). Complications included pneumothorax (11.9%), all treated with chest drain. Moderate bleeding occurred in 28.4% (all resolved without active measures). No acute disease exacerbations and no deaths occurred. A histopathological pattern diagnosis was possible in 80 cases (73.4%), and 26.6% of cases were considered nonspecific. An MDT consensus diagnosis was reached in 83.5% of cases. Subsequent SLB was proposed in 13 cases and performed in 8 cases. Conclusions: In the real-world setting, cTBB has a meaningful diagnostic value in the context of a MDT approach and may enable histopathological assessment even in patients with more advanced disease unsuitable for SLB.

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Section: Discussionmentioning

confidence: 99%

Transbronchial Cryobiopsies for Diagnosing Interstitial Lung Disease: Real-Life Experience from a Tertiary Referral Center for Interstitial Lung Disease

et al. 2018

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“…Table 3. Management of mTOR inhibitor-associated pneumonitis [14,51,54,57]: Pretreatment assessment Pretreatment assessment (i.e., prior to initiating everolimus therapy)…”

Section: Treatmentmentioning

confidence: 99%

“…If an infectious cause for pneumonitis has been ruled out, the daily use of corticosteroids, such as oral prednisone (0.75-1.0 mg/kg) or, in severe cases, intravenous methylprednisolone, can be administered to patients with grade 2 mTOR inhibitor-associated pneumonitis and continued until Table 4. Management of mTOR inhibitor-associated pneumonitis [14,51,54,57] symptoms improve to grade 1 [34]. Furthermore, the coadministration of broad-spectrum antibiotic may also be considered for grade 3 or 4 mTOR inhibitor-associated pneumonitis because of the potential for everolimus-induced immunosuppression or for impending respiratory distress [54,58].…”

Section: Obtain History Of Pulmonary Conditionsmentioning

confidence: 99%

Emerging Perspectives on mTOR Inhibitor-Associated Pneumonitis in Breast Cancer

et al. 2018

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This article summarizes the pathogenesis, clinical presentation, incidence, detection, and optimal management of everolimus-related noninfectious pneumonitis in breast cancer. In particular, this article provides a detailed overview of the important aspects of the detection, accurate diagnosis, and appropriate management of mammalian target of rapamycin inhibitor-associated pneumonitis. In addition, this article emphasizes that effective management of this adverse drug event in patients with breast cancer will require a multidisciplinary approach and collaboration among various health care professionals.

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“…Many studies indicated that the mean length and area of the specimens from lung parenchymal tissues by TBLC were substantially larger than TBLB, and the specimens didn't have crush artifacts [6,10,12,13,14]. Samples obtained through TBLC contained peripheral structures of the secondary pulmonary lobules [8]. There was a significant difference between TBLC and TBLB in terms of the percentage of sampled tissue containing open alveoli [10].…”

Section: Resultsmentioning

confidence: 99%

“…Recently, flexible cryoprobes have been used for peripheral lung parenchymal biopsy. Studies on the use of flexible cryoprobes for transbronchial lung cryobiopsy (TBLC) have shown improvements in diagnostic yield, sample size, and architectural preservation of the biopsy specimens [8,9]. Its adverse events is significantly lower than SLB [10].…”

Section: Introductionmentioning

confidence: 99%

The significance of multidisciplinary classifications based on transbronchial pathology in possible idiopathic interstitial pneumonias

Wang

Feng

et al. 2019

Preprint

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Background the multidisciplinary diagnosis based on clinic–radiologic–pathologic information had been widely used as the diagnostic gold standard for idiopathic interstitial pneumonias (IIPs). Surgical lung biopsy (SLB) had been recommended as the standard method to sample lung parenchymal lesions for suspected IIPs. Here, we attempted to show the diagnostic conﬁdence of multidisciplinary classifications based on transbronchial pathology including transbronchial lung cryobiopsy (TBLC), bronchoalveolar lavage fluid (BALF) and endobronchial ultrasound-guided transbronchial needle aspiration biopsy (EBUS-TBNA) in IIPs. Methods all new suspected interstitial lung diseases (ILD) were in-patient at the respiratory department of Dalian Municipal Central Hospital from June 2016 to December 2018. The multidisciplinary discussion (MDD) were made to exclude known causes of ILD and typical IPF depending on clinical, radiological information. The cases of atypical IPF, and possible IIPs were included and suggested to transbronchial pathological evaluation. Initial MDD classifications were made depending on clinical, radiological and transbronchial pathological information. The final MDD classifications was confirmed by following therapeutic effect. Results 70 subjects were eligible including 24 males and 46 females. The sampled lung parenchyma from TBLC were enough for confirmation of pathological diagnosis in 68.6% (48/70) cases. If the confirmed pathological evaluations through EBUS-TBNA and BALF were involved, 77.1% (54/70) cases had gotten the defined diagnosis. All cases were following up. Meanwhile, 60% was improved, 11.43% was relapsed when glucocorticoid was reduced to small dose or withdrawal, 14.29% was steady and 8.57% was progressed in which the diagnosis were modified in 4 cases. 94.3% initial MDD classifications based on transbronchial pathology were agreed with the final MDD, the difference of diagnostic yield wasn’t significant between initial and final MDD (Z=-1.414, p=0.157). Conclusion classifications of IIPs based on transbronchial pathology were useful and quite agreed with final MDD.

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How might transbronchial cryobiopsy improve diagnosis and treatment of diffuse parenchymal lung disease patients?

Cited by 13 publications

References 33 publications

Transbronchial Cryobiopsies for Diagnosing Interstitial Lung Disease: Real-Life Experience from a Tertiary Referral Center for Interstitial Lung Disease

Transbronchial Cryobiopsies for Diagnosing Interstitial Lung Disease: Real-Life Experience from a Tertiary Referral Center for Interstitial Lung Disease

Emerging Perspectives on mTOR Inhibitor-Associated Pneumonitis in Breast Cancer

The significance of multidisciplinary classifications based on transbronchial pathology in possible idiopathic interstitial pneumonias

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