The safety and efficacy of different methods for obtaining transbronchial lung cryobiopsy in diffuse lung diseases

Dhooria, DM Sahajal; Mehta, Ravindra; Srinivasan, DM Arjun; Madan, Karan; Sehgal, DM Inderpaul Singh; Pattabhiraman, Vallandramam; Yadav, Pavan; Sivaramakrishnan, Mahadevan; Mohan, Anant; Bal, Amanjit; Garg, Mandeep; Agarwal, Ritesh

doi:10.1111/crj.12734

Cited by 63 publications

(66 citation statements)

References 36 publications

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“…The expert statement published subsequent to the completion of this study recommends 3-5 biopsies per patient, though the authors acknowledge that "the optimal number of biopsies cannot be uniformly established" [10]. While increased diagnostic yield has been reported in studies where sampling was performed from more than one bronchial segment [12], complication rates were also higher [12,13]. Future studies are required to determine if CT-fluoroscopy allows increased biopsy number without a concomitant increased complication rate.…”

Section: Discussionmentioning

confidence: 98%

“…High rates of complications have been observed in procedures per- formed without fluoroscopic vision [13,19], and subsequent comment has noted the importance of fluoroscopic guidance during transbronchial cryobiopsy [20]. It is possible that high complication rates observed in some studies utilizing fluoroscopy are a result of sub-optimal imaging achieved by 2-D C-arm fluoroscopy.…”

Section: Discussionmentioning

confidence: 99%

“…We sought to perform 2 biopsies per patient, as is our standard institutional practice. This number was chosen based on available evidence indicating a good balance between diagnostic yield [12], and complication rates [13]. Patients routinely underwent post-procedure chest X-ray to screen for pneumothorax.…”

Section: Ct-fluoroscopic Imaging and Performance Of Cryobiopsymentioning

confidence: 99%

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CT-Fluoroscopic Guidance for Performance of Targeted Transbronchial Cryobiopsy: A Preliminary Report

et al. 2018

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Background: Bronchoscopic transbronchial cryobiopsy is increasingly used for the histological assessment of diffuse parenchymal lung disease. Diagnostic performance may be improved by more accurate targeting of biopsy to radiologic abnormalities, and complication rates may be reduced by avoiding biopsy of pleura or larger vessels. Objectives: To report the preliminary experience of using CT-fluoroscopic guidance for accurate targeting of bronchoscopic transbronchial cryobiopsy. Methods: Bronchoscopic cryobiopsy was performed in a hybrid CT theatre. 3D CT images were acquired following positioning of the cryoprobe in a distal airway segment. Where cryoprobe position was observed to be too close to the chest wall/diaphragm pleura, or not within the region of interest within the lung parenchyma, re-positioning of probe was undertaken and repeat 3D images were acquired to confirm positioning prior to cryobiopsy. Results: CT-fluoroscopic transbronchial cryobiopsy was successfully performed in 4 patients: 3 patients with interstitial lung infiltrates, and one with an enlarging left upper lobe mass. Images were reviewed following each acquisition to accurately assess the probe position within the lung parenchyma, and relative to other thoracic structures. Intra-procedural imaging was of sufficient quality to allow the accurate positioning of the cryoprobe tip with respect to both the parenchymal region of interest and pleural surfaces. No complications were experienced, and all procedures yielded diagnostic specimens. Conclusions: Our preliminary experience confirms the feasibility of performing transbronchial cryobiopsy under CT-fluoroscopic guidance. Accurate targeting of transbronchial cryobiopsy may be achieved using CT-fluoroscopic guidance. Positioning of the probe tip, both with respect to parenchymal region of interest and to pleural surfaces, can be established with high accuracy.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Ct-fluoroscopic Imaging and Performance Of Cryobiopsymentioning

confidence: 99%

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CT-Fluoroscopic Guidance for Performance of Targeted Transbronchial Cryobiopsy: A Preliminary Report

et al. 2018

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“…Dhooria et al [23] reported the outcomes of TBLC carried out in different ways – with and without the fluoroscopic guidance and with and without the bronchial blocker. The study showed that fewer pneumothoraces and moderate-to-severe bleeding were observed using fluoroscopy and bronchial blocker, respectively [23].…”

Section: Different Approachesmentioning

confidence: 99%

“…The study showed that fewer pneumothoraces and moderate-to-severe bleeding were observed using fluoroscopy and bronchial blocker, respectively [23]. Alternatively, two scopes alternated during the procedure may avoid the need for intubation [24].…”

Section: Different Approachesmentioning

confidence: 99%

Transbronchial Lung Cryobiopsy in Interstitial Lung Diseases: Best Practice

et al. 2018

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The lung biopsy in interstitial lung disease (ILD) represents an important diagnostic step when the clinical and radiological data are insufficient for a firm diagnosis. A growing body of evidence suggests the utility of transbronchial lung cryobiopsy (TBLC) in the diagnostic algorithm of ILD as it allows, compared to transbronchial lung biopsy with conventional forceps, a better identification of complex histological patterns – such as usual interstitial pneumonia – and can provide information which has a clinical impact on the multidisciplinary discussion similar to that provided by surgical lung biopsy. Performed correctly, it appears to have a better safety profile than surgery. The decision to perform a lung biopsy should be a multidisciplinary decision process where it is felt that there is sufficient diagnostic doubt after a careful clinical evaluation including review of the computed tomograms of the thorax. The presence of severe pulmonary hypertension (> 50 mm Hg), poor lung function (FVC < 50%), or dismissed gas transfer (DLCO of < 35%) are considered relative contraindications for TBLC. Anticoagulants and antiplatelet drugs should be discontinued for the minimum period required for the specific drugs. The greatest consideration should be given to ensure the biopsy is performed safely and we recommend the use of either an endotracheal tube or rigid bronchoscopy. Deep sedation or general anesthesia allow better control of the procedure and a better patient experience. Prophylactic balloon blockers should be used to tamponade any bleeding and also to prevent overspill of blood from the segment that is being sampled. The procedure should be performed under fluoroscopy to ensure that samples are ideally obtained about 10 mm from the pleural edge. The cryoprobe is activated for about 5 s for the first biopsy and then adjusted according to the sample size obtained. With a careful standardized approach it is possible to obtain good-quality lung specimens for diagnosis in a safe manner.

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Technique and Equipment in Transbronchial Cryobiopsy

Colella¹

2019

Transbronchial Cryobiopsy in Diffuse Parenchymal Lung Disease

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The safety and efficacy of different methods for obtaining transbronchial lung cryobiopsy in diffuse lung diseases

Abstract: Transbronchial lung cryobiopsy was found to offer a reasonable yield in the diagnosis of DPLDs. The incidence of pneumothorax and moderate-to-severe bleeding was lower with the use of fluoroscopy and an occlusion balloon, respectively.

Cited by 63 publications

References 36 publications

CT-Fluoroscopic Guidance for Performance of Targeted Transbronchial Cryobiopsy: A Preliminary Report

CT-Fluoroscopic Guidance for Performance of Targeted Transbronchial Cryobiopsy: A Preliminary Report

Transbronchial Lung Cryobiopsy in Interstitial Lung Diseases: Best Practice

Technique and Equipment in Transbronchial Cryobiopsy

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