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

Lentz, Robert J.; Argento, A. Christine; Colby, Thomas V.; Rickman, Otis B.; Maldonado, Fabien

doi:10.21037/jtd.2017.06.96

Cited by 132 publications

(145 citation statements)

References 66 publications

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“…The reason of an increased risk of bleeding in this context could be due to a hypertrophy of the bronchial artery. Transthoracic echocardiography is not routinely done prior to the TBLC [19]. Therefore, additional clues may be available from the CT scan of the thorax (when the pulmonary artery diameter is greater than 10 adjacent ascending aorta dimensions or when enlarged bronchial arteries may be detected).…”

Section: Tblc: the Proceduresmentioning

confidence: 99%

“…Severely compromised lung function is commonly described as relative contraindications: a FVC < 50% of predicted, a DLCO < 35%, and a FEV 1 < 0.80 L or < 50% of predicted are exclusion criteria in some studies although not in all [19]. …”

Section: Tblc: the Proceduresmentioning

confidence: 99%

“…Several reports [19, 20] indicated that TBLC is safe also in patients with lower pulmonary function and in ILDs with acute or subacute behavior. However, progressive clinical and functional deterioration and the onset of ground glass areas on HRCT could be predictors of high exacerbation risk.…”

Section: Tblc: the Proceduresmentioning

confidence: 99%

“…However, progressive clinical and functional deterioration and the onset of ground glass areas on HRCT could be predictors of high exacerbation risk. No age limits are suggested in TBLC and this makes TBLC more feasible than SLB [19]. A list of contraindications is summarized in Table 2.…”

Section: Tblc: the Proceduresmentioning

confidence: 99%

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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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Section: Tblc: the Proceduresmentioning

confidence: 99%

Section: Tblc: the Proceduresmentioning

confidence: 99%

Section: Tblc: the Proceduresmentioning

confidence: 99%

Section: Tblc: the Proceduresmentioning

confidence: 99%

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Transbronchial Lung Cryobiopsy in Interstitial Lung Diseases: Best Practice

et al. 2018

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“…Percutaneous approach has also been reported (23). Transbronchial cryobiopsy is an emerging technique for the diagnosis of parenchymal disease such as infiltrative lung disease (24). However, there is no publication of bronchoscopic cryotherapy in peripheral lung cancer.…”

Section: Cryotherapymentioning

confidence: 99%

Endobronchial treatment of peripheral tumors: ongoing development and perspectives

et al. 2018

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Abstract:The expanded possibilities to explore the lung deeper with new tools such as electromagnetic navigation bronchoscopy (ENB) or radial probe endobronchial ultrasonography (radial EBUS), combined with miniaturization of traditional local therapies such as radiofrequency ablation (RFA), radiotherapy, cryotherapy or photodynamic therapy, let the bronchoscopists hope for new ways of endoscopic treatments.This challenge could change the practice in the upcoming decades but raise some physical and technical issues. Safety and efficacy need to be solidly established to face the serious concurrence of stereotactic radiotherapy (SBRT) or percutaneous RFA. Here we describe ongoing development and perspectives for endobronchial treatment of peripheral lung tumors.

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Interstitial Pneumonia With Autoimmune Features

Wilfong

Lentz

Guttentag

et al. 2018

Arthritis & Rheumatology

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Interstitial lung disease (ILD) remains a cause of significant morbidity and mortality in patients with connective tissue disease (CTD)-associated ILD. While some patients meet clear classification criteria for a systemic rheumatic disease, a subset of patients do not meet classification criteria but still benefit from immunosuppressive therapy. In 2015, the American Thoracic Society and European Respiratory Society described classification criteria for interstitial pneumonia with autoimmune features (IPAF) to identify patients with lung-predominant CTD who lack sufficient features of a systemic rheumatic disease to meet classification criteria. Although these criteria are imperfect, they are an important attempt to classify the patient with undifferentiated disease for future study. Rheumatologists play a key role in the evaluation of potential IPAF in patients, especially as many patients with a myositis-spectrum disease (e.g., non-Jo-1 antisynthetase syndrome, anti-melanoma differentiation-associated protein 5 antibody inflammatory myositis, or anti-PM/Scl antibody-associated inflammatory myositis) would be classified under IPAF using the currently available criteria for inflammatory myositis, and would therefore benefit from rheumatologic comanagement. The aim of this review was to describe the historical context that led to the development of these criteria and to discuss the limitations of the current criteria, diagnostic challenges, treatment options, and strategies for disease monitoring.

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

Cited by 132 publications

References 66 publications

Transbronchial Lung Cryobiopsy in Interstitial Lung Diseases: Best Practice

Transbronchial Lung Cryobiopsy in Interstitial Lung Diseases: Best Practice

Endobronchial treatment of peripheral tumors: ongoing development and perspectives

Interstitial Pneumonia With Autoimmune Features

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