Risk factors of clinically significant complications in transbronchial lung cryobiopsy: A prospective multi-center study

Mononen, Minna; Saari, Eeva; Hasala, Hannele; Kettunen, Hannu-Pekka; Suoranta, Sanna; Nurmi, Hanna; Randell, Jukka; Laurikka, Jari; Uibu, Toomas; Koskela, Heikki; Kaarteenaho, Riitta; Purokivi, Minna

doi:10.1016/j.rmed.2022.106922

Cited by 7 publications

(10 citation statements)

References 41 publications

(65 reference statements)

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“…The presence of radiological traction bronchiectasis was associated with a seven‐fold increase in significant bleeding and correlated with TBT on multivariate analysis, independent of baseline characteristics, lung function parameters, the number of biopsies or biopsy location. Our data is consistent with that of Mononen et al, who found that the extent of traction bronchiectasis on a semi‐quantitative scale increased the risk of significant complications, the majority of which were bleeding 13 . Univariate regression analysis also identified that a DLCO of less than 60% predicted was associated with prolonged bleeding duration.…”

Section: Discussionsupporting

confidence: 92%

“…Our data is consistent with that of Mononen et al, who found that the extent of traction bronchiectasis on a semi-quantitative scale increased the risk of significant complications, the majority of which were bleeding. 13 Univariate regression analysis also identified that a DLCO of less than 60% predicted was associated with prolonged bleeding duration. Put together, caution should be exercised when performing TBLC for patients with radiological traction bronchiectasis, as a surrogate for more advanced or extensive fibrotic lung disease.…”

Section: Discussionmentioning

confidence: 92%

“…Information on the baseline use of steroids, which has been associated with bleeding risk in other studies, was not available. 13 Whilst TBT was recorded for the entire procedure, it was not possible to determine the bleeding time after each individual biopsy. As there are no established criteria for reporting blood vessels in TBLC specimens, it possible that incidence of medium-large vessels may have been underestimated.…”

Section: Discussionmentioning

confidence: 99%

“…Whilst the major complications of TBLC including bleeding and pneumothorax are well established, the reported incidence of haemorrhage has varied, 7–10 likely due to heterogeneity in procedural approach despite published guidelines 11,12 and the application of differing clinical scales to evaluate bleeding outcomes. Risk factors for significant post‐TBLC bleeding have only been reported in a handful of studies 8,13,14 …”

Section: Introductionmentioning

confidence: 99%

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Low bleeding rates following transbronchial lung cryobiopsy in unclassifiable interstitial lung disease

Taverner,

Lucena,

Garner

et al. 2024

Respirology

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Background and ObjectiveBronchoscopic transbronchial lung cryobiopsy (TBLC) is a guideline‐endorsed alternative to surgical lung biopsy for tissue diagnosis in unclassifiable interstitial lung disease (ILD). The reported incidence of post‐procedural bleeding has varied widely. We aimed to characterize the incidence, severity and risk factors for clinically significant bleeding following TBLC using an expert‐consensus airway bleeding scale, in addition to other complications and diagnostic yield.MethodsA retrospective cohort study of consecutive adult outpatients with unclassifiable ILD who underwent TBLC following multidisciplinary discussion at a single centre in the UK between July 2016 and December 2021. TBLC was performed under general anaesthesia with fluoroscopic guidance and a prophylactic endobronchial balloon.ResultsOne hundred twenty‐six patients underwent TBLC (68.3% male; mean age 62.7 years; FVC 86.2%; DLCO 54.5%). Significant bleeding requiring balloon blocker reinflation for >20 min, admission to ICU, packed red blood cell transfusion, bronchial artery embolization, resuscitation or procedural abandonment, occurred in 10 cases (7.9%). Significant bleeding was associated with traction bronchiectasis on HRCT (OR 7.1, CI 1.1–59.1, p = 0.042), a TBLC histological pattern of UIP (OR 4.0, CI 1.1–14, p = 0.046) and the presence of medium‐large vessels on histology (OR 37.3, CI 6.5–212, p < 0.001). BMI ≥30 (p = 0.017) and traction bronchiectasis on HRCT (p = 0.025) were significant multivariate predictors of longer total bleeding time (p = 0.017). Pneumothorax occurred in nine cases (7.1%) and the 30‐day mortality was 0%. Diagnostic yield was 80.6%.ConclusionTBLC has an acceptable safety profile in experienced hands. Radiological traction bronchiectasis and obesity increase the risk of significant bleeding following TBLC.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Low bleeding rates following transbronchial lung cryobiopsy in unclassifiable interstitial lung disease

Taverner,

Lucena,

Garner

et al. 2024

Respirology

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“…Including the use of oral corticosteroids, azathioprine, or mycophenolate. b. Re-categorized for this study, some of the results have been published previously [31] Variable presented disease progression regardless of antifibrotic treatment. In addition, we observed that the patients with higher extent of reticulation on HRCT had shorter median survival than patients with lower extent of reticulation as well as never smokers had shorter median survival than current or former smokers.…”

Section: Table 1 Characteristics Of Patients With Progressive Ild And...mentioning

confidence: 99%

Reticulation pattern without honeycombing on high-resolution CT is associated with the risk of disease progression in interstitial lung diseases

et al. 2022

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Background The disease course of idiopathic pulmonary fibrosis (IPF) is progressive and occasionally, other types of interstitial lung disease (ILD) may progress similarly to IPF. This study aimed to evaluate risk factors for disease progression within 24 months in patients with various ILDs. Methods This prospective study obtained 97 patients with a suspected ILD who underwent a transbronchial lung cryobiopsy. The extent of several high-resolution computed tomography (HRCT) patterns was assessed. Due to the inclusion criteria the study population presented a low extent of honeycombing and definite usual interstitial pneumonia (UIP) pattern on HRCT suggesting an early stage of ILD. Disease progression within 24 months despite treatment was defined as a relative decline of ≥ 10% in forced vital capacity (FVC), or a relative decline in FVC of ≥ 5% and one of the three additional criteria: (1) a decline in diffusion capacity to carbon monoxide (DLCO) ≥ 15%; (2) increased fibrosis on HRCT; (3) progressive symptoms, or progressive symptoms and increased fibrosis on HRCT. The same definition was utilized in patients with IPF and other ILDs. Risk factors for disease progression were evaluated in a multivariable logistic regression model. Results Disease progression was revealed in 52% of the patients with ILD, 51% of the patients with IPF, and 53% of the patients with other types of ILD. A high extent of reticulation on HRCT (Odds ratio [OR] 3.11, 95% Confidence interval [CI] 1.21–7.98, P = 0.019) and never smoking (OR 3.11, CI 1.12–8.63, P = 0.029) were associated with disease progression whereas platelet count (OR 2.06 per 100 units increase, CI 0.96–4.45, P = 0.065) did not quite reach statistical significance. Conclusion Higher extent of reticulation on HRCT and never smoking appeared to associate with the risk of disease progression within 24 months in ILD patients without honeycombing. Approximately half of the patients with ILD revealed disease progression, and similar proportions were observed in patients with IPF and in other types of ILD.

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Transbronchial lung cryobiopsy and pulmonary fibrosis: A never-ending story?

Ruaro¹,

Tavano²,

Confalonieri³

et al. 2023

Heliyon

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Risk factors of clinically significant complications in transbronchial lung cryobiopsy: A prospective multi-center study

Cited by 7 publications

References 41 publications

Low bleeding rates following transbronchial lung cryobiopsy in unclassifiable interstitial lung disease

Low bleeding rates following transbronchial lung cryobiopsy in unclassifiable interstitial lung disease

Reticulation pattern without honeycombing on high-resolution CT is associated with the risk of disease progression in interstitial lung diseases

Transbronchial lung cryobiopsy and pulmonary fibrosis: A never-ending story?

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