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

Ravaglia, Claudia; Bonifazi, Martina; Wells, Adrian; Tomassetti, Sara; Gurioli, Carlo; Piciucchi, Sara; Dubini, Alessandra; Tantalocco, Paola; Sanna, Stefano; Negri, Eva; Tramacere, Irene; Ventura, Valentina Anna; Cavazza, Alberto; Rossi, Andrea; Chilosi, Marco; Vecchia, Carlo La; Gasparini, Stefano; Poletti, Venerino

doi:10.1159/000444089

Cited by 315 publications

(438 citation statements)

References 40 publications

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“…Pajares and coworkers (65) compared TBCB with standard forceps biopsies in a randomized control trial and showed that there was no significant difference in the occurrence of pneumothorax or moderate bleeding between the two groups. Lastly, TBCB has also been shown to have a lower median time of hospitalization (2.6 vs. 6.1 days, P<0.0001), and has been shown to have a lower mortality due to adverse events (0.3% vs. 2.7%) in comparison with VATS biopsy (67).…”

Section: Bronchoscopic Cryobiopsiesmentioning

confidence: 96%

Recent advances in diagnostic bronchoscopy

2016

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EBUSConvex-Probe EBUS is a technique that allows real-time sonographic visualization of peri-bronchial structures during bronchoscopy using an ultrasound transducer which is mounted at the tip of the bronchoscope (3). Its advent at the beginning of the 21st century dramatically changed Abstract: The field of diagnostic bronchoscopy has been revolutionized in the last decade primarily with the advent of endobronchial ultrasound (EBUS) but also with the addition of multiple different techniques for "guided-bronchoscopy". These advances have had a substantial impact in the management of lung cancer with bronchoscopy now providing both diagnosis and mediastinal staging in a single procedure.EBUS has, in fact, become the first choice for staging of the mediastinum over cervical mediastinoscopy (CM). Although EBUS is now a well-established technique, there are continuous efforts from the scientific community to improve its diagnostic performance, and these will be reviewed in this manuscript. The term "guided-bronchoscopy" was recently coined to describe a myriad of techniques that guide our bronchoscopes or bronchoscopic tools into the periphery of the lungs in addition to our conventional fluoroscopy.Electromagnetic and non-electromagnetic navigation, thin and ultrathin scopes, as well as radial-probe EBUS have collectively increased our yield for smaller peripheral lung lesions and continue to evolve.Despite this improved diagnostic yield, there is still ample room for improvement and newer techniques are under way. With new therapies available for patients with interstitial lung disease, achieving a specific histologic diagnosis is now of paramount importance. Given the high morbidity and mortality of surgical biopsies, bronchoscopic cryobiopsy is being rapidly adopted as a safer and effective alternative, and it is likely going to play a major role in the management of these diseases in the near future. This manuscript we will focus on recent advances in EBUS, guided-bronchoscopy, and the use of cryobiopsy.

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Section: Bronchoscopic Cryobiopsiesmentioning

confidence: 96%

Recent advances in diagnostic bronchoscopy

2016

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“…Overall, a more cautious approach and a possibly lower mortality rate can be expected now that risk factors have been identified. In the future, it is conceivable that cryobiopsy may be associated with a lower risk of mortality than video-assisted thoracoscopic surgery [23], although published studies show a variable incidence of complications.…”

mentioning

confidence: 99%

Lung biopsy in interstitial lung disease: balancing the risk of surgery and diagnostic uncertainty

Cottin

2016

Eur Respir J

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“…Only two patients needed subsequent surgical biopsy. cryobiopsy vs video-assisted thoracoscopic (VATS) lung biopsy (82.8% vs 98.7%, p=0.013) [15]. There was a signifi cant decrease in number of hospital days with cryobiopsy when compared to VATS lung biopsy (2.6 d vs 6.1 d, p<0.0001).…”

Section: Reviewmentioning

confidence: 96%

Usefulness of Transbronchial Cryobiopsy in Interstitial Lung Disease

UA¹

2017

Arch Pulmonol Respir Care

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ReviewInterstitial lung disease (ILD) is a term that describes a group of more than 200 lung disorders that show varying degrees of infl ammation and fi brosis of the pulmonary interstitium. The etiology and pathophysiology of many of these disorders still remains poorly understood and is the topic of ongoing research and debate. The diagnostic approach to ILD can be complex and often requires a multidisciplinary team approach with involvement of a pulmonologist, radiologist and pathologist.A lung biopsy is often needed to determine the particular subcategory of interstitial lung disease. Unfortunately, conventional transbronchial biopsy with forceps has a very poor diagnostic yield in ILD. A large review of 801 patients showed a diagnostic yield of less than 30% [1]. Surgical lung biopsy is considered the "gold standard" but has a high mortality with several studies showing a mortality of 1.7% to 4.2% in elective cases and 16% to 17.5% in urgent cases [2][3][4][5][6]. In the last several years, the introduction of bronchoscopic transbronchial cryobiopsy has been an exciting development in this regard. This particular diagnostic intervention has the potential to provide diagnosis in ILD with a safety profi le closer to conventional transbronchial biopsy and a diagnostic yield approaching surgical lung biopsy.The cryobiopsy apparatus consists of a cryo-generator that contains Nitric Oxide or Nitrous Oxide gas. Cryo-generators with Carbon Dioxide as the cyogen are also available and are less costly than Nitric Oxide or Nitrous Oxide based systems.A fl exible cryoprobe ranging in diameter from 1.9 to 2.6 mm is connected to the generator. A foot paddle allows the operator to release the gas from the generator to exit at the tip of the probe. Utilizing Joule-Thompson effect of fl uids, the rapid expansion of gas exiting at the tip of the probe causes a rapid drop in temperature and freezes the tissue surrounding the tip of the probe. Freezing times from 3-6 seconds are generally considered adequate. Care is taken to keep the probe 5-10 mm away from the pleural lining on the fl uoroscopic view to avoid advertent freezing of the visceral pleura which could cause a pneumothorax. The probe and scope are then pulled back gently removing the frozen tissue attached at the tip of the cryoprobe. An endobronchial blocker has been used by some operators to control bleeding but its use is not universal or standardized [7]. As opposed to conventional transbronchial biopsy with forceps, cryobiopsy provides a larger specimen with the area of sample ranging from 11.11 mm2 to 64.2 mm2 as compared to 0.58 mm2 to 20.88 mm2 for conventional transbronchial biopsy sample size [8][9][10][11][12]. Moreover, there is avoidance of crush artifact leading to better preservation of tissue architecture.The larger sample size and preservation of tissue architecture translates into a better diagnostic yield as well. A systematic review and meta-analysis of 11 studies (731 patients), showed a diagnostic yield from 74 to 98% when transbronchial cryob...

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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

Cited by 315 publications

References 40 publications

Recent advances in diagnostic bronchoscopy

Recent advances in diagnostic bronchoscopy

Lung biopsy in interstitial lung disease: balancing the risk of surgery and diagnostic uncertainty

Usefulness of Transbronchial Cryobiopsy in Interstitial Lung Disease

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