Morbidity and mortality in patients with usual interstitial pneumonia (UIP) pattern undergoing surgery for lung biopsy

Plönes, Till; Osei-Agyemang, T; Elze, Mirjam; Palade, Emanuel; Wagnetz, Dirk; Loop, Torsten; Kayser, Gian; Passlick, Bernward

doi:10.1016/j.rmed.2012.11.020

Cited by 22 publications

(20 citation statements)

References 14 publications

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“…Hospital duration was principally influenced by occurrence of pneumothorax, although other factors, including preprocedure assessment and early initiation of treatment influenced length of stay. In comparison to SLB, however, the duration of hospitalization remains lower with cTBB and was correspondingly more cost-effective, a finding also reported by other groups [6, 18, 19]. …”

Section: Discussionsupporting

confidence: 75%

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: Discussionsupporting

confidence: 75%

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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“…Regarding the length of hospitalization, the reported median time of hospitalization after the SLB procedure for any cause ranges between 4 and 8 days [43,45], with elderly patients with ILDs being at higher risk of prolonged hospitalization [46]. Our data confirm that the time of hospitalization for cryobiopsy is usually shorter than the length of stay after SLB and could also be performed in an outpatient setting.…”

Section: Discussionsupporting

confidence: 63%

Safety and Diagnostic Yield of Transbronchial Lung Cryobiopsy in Diffuse Parenchymal Lung Diseases: A Comparative Study versus Video-Assisted Thoracoscopic Lung Biopsy and a Systematic Review of the Literature

et al. 2016

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Background: A diagnosis of interstitial lung diseases (ILDs) may include surgical lung biopsy (SLB), which is associated with significant morbidity and mortality and also appreciable costs. Transbronchial lung cryobiopsy (TBLC) is adopting an important role. Objectives: The aim of this study was to compare the diagnostic yield (DY) and safety of TBLC and SLB in a large cohort of patients and to perform a systematic review of the literature as well as a meta-analysis. Methods: We performed a retrospective analysis of 447 cases with ILD undergoing TBLC and/or SLB and a systematic review of the literature (MEDLINE and Embase for all original articles on the DY and safety of TBLC in ILDs up to July 2015). Results: A total of 150 patients underwent SLB and 297 underwent TBLC. The median time of hospitalization was 6.1 days (SLB) and 2.6 days (TBLC; p < 0.0001). Mortality due to adverse events was observed for 2.7% (SLB) and 0.3% (TBLC) of the patients. Pneumothorax was the most common complication after TBLC (20.2%). No severe bleeding was observed. TBLC was diagnostic for 246 patients (82.8%), SLB for 148 patients (98.7%, p = 0.013). A meta-analysis of 15 investigations including 781 patients revealed an overall DY of 0.81 (0.75-0.87); the overall pooled probability of developing a pneumothorax, as retrieved from 15 studies including 994 patients, was 0.06 (95% CI 0.02-0.11). Conclusion: Cryobiopsy is safe and has lower complication and mortality rates compared to SLB. TBLC might, therefore, be considered the first diagnostic approach for obtaining tissue in ILDs, reserving the surgical approach for cases in which TBLC is not diagnostic.

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“…7 This is much lower than that for surgical lung biopsy (2-17%). [17][18][19][20][21][22][23] It is noteworthy that all of the studies considered in this review have excluded patients who had reduced lung function, evidence of pulmonary artery hypertension on echocardiography, hemodynamic instability, hypoxemia, or coagulopathy. Thus, the findings of safety of cryo-transbronchial lung biopsy in the present analysis do not apply to patients presenting with any of these features.…”

Section: Discussionmentioning

confidence: 99%

“…It may be associated with significant morbidity (2-20%), including prolonged air leak and prolonged hospital admission, and mortality (2-17%). [17][18][19][20][21][22][23] Transbronchial lung biopsy can also be performed using cryoprobes, termed cryo-transbronchial lung biopsy. 24 Cryotherapy works on the principle of the Joule-Thomson effect, wherein the adiabatic expansion of a compressed gas leads to rapid cooling.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Yield and Safety of Cryoprobe Transbronchial Lung Biopsy in Diffuse Parenchymal Lung Diseases: Systematic Review and Meta-Analysis

et al. 2016

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BACKGROUND: Transbronchial lung biopsy with flexible forceps is the most commonly used technique in diagnosis of diseases diffusely involving the lung parenchyma. Recently, transbronchial lung biopsy using the flexible cryoprobe (cryo-transbronchial lung biopsy) has also been reported. Herein, we perform a systematic review and meta-analysis describing the efficacy and safety of cryo-transbronchial lung biopsy. METHODS: The PubMed and EMBASE databases were searched for studies reporting the outcomes of cryo-transbronchial lung biopsy in subjects with diffuse parenchymal lung involvement. The quality of individual studies was assessed using the QualSyst tool. The pooled diagnostic yield of cryo-transbronchial lung biopsy was calculated using proportion meta-analysis (random effects model). Heterogeneity was evaluated using the I 2 test and Cochran Q test. Publication bias was determined using both statistical and graphical methods.

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Morbidity and mortality in patients with usual interstitial pneumonia (UIP) pattern undergoing surgery for lung biopsy

Abstract: We conclude that surgical biopsy can be safely performed in patients with suspected UIP.

Cited by 22 publications

References 14 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

Safety and Diagnostic Yield of Transbronchial Lung Cryobiopsy in Diffuse Parenchymal Lung Diseases: A Comparative Study versus Video-Assisted Thoracoscopic Lung Biopsy and a Systematic Review of the Literature

Diagnostic Yield and Safety of Cryoprobe Transbronchial Lung Biopsy in Diffuse Parenchymal Lung Diseases: Systematic Review and Meta-Analysis

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