Introduction of cryobiopsies in the diagnostics of interstitial lung diseases – experiences in a referral center

Abstract

Introduction: Transbronchial cryobiopsies (cTBB) has emerged as a new method for obtaining lung tissue biopsies in the diagnosis of interstitial lung diseases (ILDs). Until now, it has been used in a few highly specialized interventional centers and has shown promising results in obtaining a definite diagnosis of ILDs. Method: All patients undergoing a cTBB between November 2015 and June 2016 were included in this case series study. Data on patient demographics, high-resolution computed tomography patterns, size and number of biopsies, histology patterns, the contribution to a confident diagnosis and complications were registered. Results: Thirty-eight patients underwent cTBB in the period. cTBB contributed to the diagnosis in 28 (74%) of the 38 patients. Only few complications were observed; pneumothorax was the most frequent complication (10 patients, 26%). In six patients, local bleeding occurred during the procedure and was easily controlled by a Fogarty catheter balloon and in some cases tranexamic acid. Conclusion: Performing cTBB in the diagnostics of ILDs is a safe and feasible procedure. cTBB resulted in a confident diagnosis in 74% of cases.

Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges

“…In an in vivo animal study of large airway mucosal biopsy using both cryoprobes, mean biopsy diameter was only slightly larger using the 2.4 mm probe after 1, 2, and 3 second freeze times and biopsy weight was not significantly different after 3 second freezes (60); how well this reflects cryoprobe behavior in the peripheral lung is not clear. Neither probe size is predominant in published cases to date and some series report using both probes in an interchangeable fashion (5,44,45,47). Likewise, both carbon dioxide and nitrous oxide have seen wide use as the cryogen gas for cryobiopsy.…”

“…Two series have piloted the use of two bronchoscopes to allow more rapid re-entry into the airway after each biopsy in lieu of endobronchial blocker use, with low rate of serious hemorrhage reported (44,46). Kronborg-White et al, administered intravenous tranexamic acid at the start of all cryobiopsy procedures, with moderate bleeding in 16% of cases, some of whom received additional tranexamic acid (47). Finally, a smaller 1.1 mm cryoprobe used in conjunction with an oversheath is in development.…”

Transbronchial Cryobiopsies

“…Some studies define DY by histopathologic diagnosis alone while others report on DY by MDD diagnoses. 2,3,5,7,26,28,[31][32][33][34][35][36][37][38][39][40][41][42][43] Current guidelines recommend a MDD by expert pulmonologists, radiologists, and pathologists to reach a consensus clinical diagnosis based on the review of the clinical, radiologic, and pathologic data. 13,22,44,45 In the largest case series published to date which included 297 cases, Ravaglia et al reported a DY of 82.8% when TBLCB was utilized as a part of the MDD.…”

Guidelines of the Polish Respiratory Society for Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis

“…Transbronchial lung cryobiopsy (TBLC) is a new diagnostic technique [92,[122][123][124][125][126]. Its diagnostic effectiveness and complication rates are varied and depend on the experience of the person performing the procedure [123,125,[127][128][129][130][131][132][133][134][135][136][137][138][139]. The mean mortality due to this diagnostic procedure only has been estimated at 0.2%, with less frequent sudden exacerbations than in the case of SLB (1.2% vs 6.1%).…”

“…The mean mortality due to this diagnostic procedure only has been estimated at 0.2%, with less frequent sudden exacerbations than in the case of SLB (1.2% vs 6.1%). However, there are frequent complications of pneumothorax (0% vs 26% with TBLC; in the case of SLB, the rates of pneumothorax or persistent air leak are lower) and bleeding (on average, 5.3% vs 0.8% with SLB) [111,123,128,133,[135][136][137][138][139][140][141][142][143][144][145].…”