Diagnostic yield of transbronchial lung cryobiopsy in interstitial lung diseases

Abstract Background Transbronchial lung cryobiopsy (TBLC) has been introduced as an alternative to surgical lung biopsy (SLB) in the diagnostics of interstitial lung diseases (ILD). Despite controversy on safety, TBLC is increasingly implemented in ILD centers with an apparent diagnostic yield comparable to SLB. The aim of this study was to assess TBLC implementation experiences from a tertiary Danish ILD center regarding diagnosis, complications, and learning curves for TBLC performance. Methods TBLC was prospectively performed in a cohort of patients with unclassifiable ILD based on a preceding multidisciplinary clinical and radiological revision. TBLC was performed as an outpatient procedure with the patients in general anesthesia using a flexible bronchoscope with 1.9 or 2.4 mm cryoprobes. Learning curves for TBLC performance were calculated using cumulated sum (CUSUM) scores for diagnostic yield, pneumothorax, and bleeding. Results From February 2017 to March 2020 141 patients (86 (61%) men, median age 69 years [IQR, 60–74 years]) had TBLC performed. A histological and confirmative diagnosis was made in 101 patients (75.2%) and 124 patients (87.9%, i.e. clinical diagnostic yield), respectively, in whom idiopathic interstitial pneumonias constituted the majority (67.3%) of the clinical diagnoses. We observed 2 deaths (1.4%) within 30 days of TBLC, but no procedure-related mortality or severe bleeding. Moderate bleeding occurred in 23 patients (16.3%), pneumothorax in 21 patients (14.9%) with only 14 patients (9.9%) requiring a pleural drain. Based on the CUSUM score analysis, the diagnostic yield obtained was satisfactory throughout the period. Conclusion This study reports experiences of outpatient TBLC implementation in a tertiary referral ILD center from the largest investigated TBLC cohort in Scandinavia The diagnostic yield and prevalence of complications obtained by TBLC from this single center study on unclassifiable ILD support outpatient TBLC as a valuable and safe alternative to SLB to diagnose ILD in well-selected patients. The learning curves for TBLC were acceptable in the hands of experienced bronchoscopists.

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Implementation of Transbronchial Lung Cryobiopsy in a Tertiary Referral Center for Interstitial Lung Diseases – A Cohort Study on Diagnostic Yield, Complications, and Learning Curves

10.21203/rs.3.rs-138236/v1 ◽

2021 ◽

Author(s):

Jesper Davidsen ◽

Inge Skov ◽

Ida Louw ◽

Christian Laursen

Keyword(s):

Lung Diseases ◽

Diagnostic Yield ◽

Interstitial Lung Diseases ◽

Learning Curves ◽

Severe Bleeding ◽

Tertiary Referral ◽

Flexible Bronchoscope ◽

Safe Alternative ◽

Tertiary Referral Center ◽

Transbronchial Lung Cryobiopsy

Abstract BackgroundTransbronchial lung cryobiopsy (TBLC) has been introduced as an alternative to surgical lung biopsy (SLB) in the diagnostics of interstitial lung diseases (ILD). Despite controversy on safety, TBLC is increasingly implemented in ILD centers with an apparent diagnostic yield comparable to SLB. The aim of this study was to assess TBLC implementation experiences from a tertiary Danish ILD center regarding diagnosis, complications, and learning curves for TBLC performance.MethodsTBLC was prospectively performed in a cohort of patients with unclassifiable ILD based on a preceding multidisciplinary clinical and radiological revision. TBLC was performed as an outpatient procedure with the patients in general anesthesia using a flexible bronchoscope with 1.9 or 2.4 mm cryoprobes. Learning curves for TBLC performance were calculated using cumulated sum (CUSUM) scores for diagnostic yield, pneumothorax, and bleeding.Results From February 2017 to March 2020 141 patients (86 (61%) men, median age 69 years [IQR, 60 years to 74 years]) had TBLC performed. A histological and confirmative diagnosis was made in 101 patients (75.2%) and 124 patients (87.9%, i.e. clinical diagnostic yield), respectively, in whom idiopathic interstitial pneumonias constituted the majority (67.3%) of the clinical diagnoses. We observed 2 deaths (1.4%) within 30 days of TBLC, but no procedure-related mortality or severe bleeding. Moderate bleeding occurred in 23 patients (16.3%), pneumothorax in 21 patients (14.9%) with only 14 patients (9.9%) requiring a pleural drain. Based on the CUSUM score analysis, the diagnostic yield obtained was satisfactory throughout the period.ConclusionThis study reports experiences of outpatient TBLC implementation in a tertiary referral ILD center from the largest investigated TBLC cohort in Scandinavia The diagnostic yield and prevalence of complications obtained by TBLC from this single center study on unclassifiable ILD support outpatient TBLC as a valuable and safe alternative to SLB to diagnose ILD in well-selected patients. The learning curves for TBLC were acceptable in the hands of experienced bronchoscopists.Of note, the majority of the abstract details have been presented as a poster at the European Respiratory Society’s Congress in Madrid, Spain in 2019 (European Respiratory Journal 2019 54: PA3107; DOI: 10.1183/13993003.congress-2019.PA3107).

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Lung Cryobiopsy Outside of the Operating Room: A Safe Alternative to Surgical Biopsy

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/15569845211034506 ◽

2021 ◽

pp. 155698452110345

Author(s):

Vanessa Menezes ◽

Juan Carlos Molina ◽

Clare Pollock ◽

Philippe Romeo ◽

Julie Morisset ◽

...

Keyword(s):

Operating Room ◽

Lung Diseases ◽

Diagnostic Yield ◽

Interstitial Lung Diseases ◽

Minor Bleeding ◽

Hypoxemic Respiratory Failure ◽

Surgical Biopsy ◽

Histologic Diagnosis ◽

Safe Alternative ◽

Diffuse Parenchymal Lung Diseases

Objective Transbronchial lung cryobiopsy (TBLC) is a promising technique that can provide a histologic diagnosis in interstitial lung diseases (ILD) and is an alternative to surgical lung biopsy. The main concerns with the procedure are safety and diagnostic accuracy. The technique is applicable in patients unable to undergo surgical biopsy due to severe comorbidities or when patient transport to the operating room is dangerous. This study reports the initial experience with TBLC on a thoracic surgical service as a first attempt at diagnosis in patients with diffuse parenchymal lung diseases (DPLD). Methods Between May 2018 and July 2020, 32 patients underwent TBLC using bedside flexible bronchoscopy for suspected ILD on a thoracic surgical endoscopy service. Retrospective evaluation of the procedure details, complications, and diagnostic yield were analyzed and reported. Results A total of 89 pathological samples were obtained (mean 2.8 per patient). Pneumothorax and minor bleeding occurred in 25% and 16.7% of patients, respectively. Sixty-seven percent of complications occurred with use of the 2.4 mm cryoprobe ( P = 0.036). Concordance between the histologic diagnosis and final clinical diagnosis was observed in 62.5% of patients and the pathology guided the final treatment in 71% ( P = 0.027) with Kappa-concordance of 0.60 ( P < 0.001). Conclusions Cryobiopsy is becoming part of the diagnostic evaluation in patients with indeterminate DPLD or hypoxemic respiratory failure. TBLC is easy to perform and has a favorable safety profile. Thoracic specialists should consider adding TBLC to their procedural armamentarium as a first option for patients with indeterminate PLD.

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Diagnostic approach in parenchymal lung diseases: transbronchial lung biopsy or cryobiopsy?

TURKISH JOURNAL OF MEDICAL SCIENCES ◽

10.3906/sag-1910-47 ◽

2020 ◽

Vol 50 (6) ◽

pp. 1535-1539

Author(s):

Ali Kadri ÇIRAK ◽

Nuran KATGI ◽

Onur Fevzi ERER ◽

Pınar ÇİMEN ◽

Fatma Fevziye TUKSAVUL ◽

...

Keyword(s):

Lung Biopsy ◽

Lung Diseases ◽

Interstitial Lung Diseases ◽

Massive Hemorrhage ◽

Open Lung Biopsy ◽

Transbronchial Lung Biopsy ◽

Diffuse Parenchymal Lung Diseases ◽

Training And Research ◽

Transbronchial Lung Cryobiopsy ◽

Parenchymal Lung

Background/aim: Diagnosis of interstitial lung diseases requires a multidisciplinary approach, and a gold standard for histological diagnosis is open lung biopsy. Transbronchial lung biopsy (TBLB) and in recent years an alternative method, cryobiopsy (TBLC), are used for the diagnosis of parenchymal lung lesions. The aim of this study is to compare the efficacy of concomitant conventional TBLB and TBLC.Materials and methods: A total of 82 patients who underwent TBLC for diagnosis of diffuse parenchymal lung diseases at Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital between 2015 and 2018 were screened retrospectively and included in the study. Of the patients, 53.7% (n: 44) were male, and 46.4% (n:38) of them were female. The mean age was 58.37 (±9.33) years. First TBLB and then TBLC were performed to all patients in the same session and their diagnostic performances were compared.Results: Although both procedures were done in the same session, 45 patients (54.9%) were diagnosed with TBLB and 75 patients (91.5%) were diagnosed with TBLC (P ˂ 0.001). Hemorrhage was observed in 39 patients (47.6%), but only one had a massive hemorrhage. Pneumothorax was observed in 6 patients (7.3%) and none of them required tube drainage.Conclusion: Transbronchial lung cryobiopsy is a promising technique for the diagnosis of parenchymal lung diseases compared to transbronchial lung biopsy.

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Transbronchial Lung Cryobiopsy in Interstitial Lung Diseases: Best Practice

Respiration ◽

10.1159/000488910 ◽

2018 ◽

Vol 95 (6) ◽

pp. 383-391 ◽

Cited By ~ 25

Author(s):

Sara Colella ◽

Maik Haentschel ◽

Pallav Shah ◽

Venerino Poletti ◽

Jürgen Hetzel

Keyword(s):

Lung Diseases ◽

Best Practice ◽

Interstitial Lung Diseases ◽

Transbronchial Lung Cryobiopsy

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Study of CT-guided core needle biopsy in patients with interstitial lung diseases: Diagnostic yield and complications

Revista Portuguesa de Pneumologia (English Edition) ◽

10.1016/j.rppnen.2016.05.004 ◽

2016 ◽

Vol 22 (6) ◽

pp. 353-354

Author(s):

M. Oliveira ◽

T. Pereira ◽

M. Dias ◽

A. Sanches ◽

S. Campainha ◽

...

Keyword(s):

Core Needle Biopsy ◽

Needle Biopsy ◽

Lung Diseases ◽

Diagnostic Yield ◽

Interstitial Lung Diseases ◽

Ct Guided ◽

Core Needle

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Integration of transbronchial cryobiopsy into multidisciplinary board decision: a single center analysis of one hundred consecutive patients with interstitial lung disease

Respiratory Research ◽

10.1186/s12931-021-01821-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Katrin E. Hostettler ◽

Michael Tamm ◽

Lukas Bubendorf ◽

Peter Grendelmeier ◽

Kathleen Jahn ◽

...

Keyword(s):

Clinical Data ◽

Lung Biopsy ◽

Lung Diseases ◽

Diagnostic Yield ◽

Usual Interstitial Pneumonia ◽

Diagnostic Value ◽

Interstitial Lung Diseases ◽

Histological Findings ◽

Forceps Biopsy ◽

Consensus Diagnosis

Abstract Background Transbronchial cryobiopsy in the evaluation of patients with interstitial lung diseases (ILD) is expected to reduce the need for surgical lung biopsy (SLB). Objective To evaluate the diagnostic value of cryobiopsy in combination with bronchoalveolar lavage (BAL), radiologic and clinical data in patients with ILD. Methods Between 08/15 and 01/20 patients with ILD underwent cryobiopsy if they: did not have (i) an usual interstitial pneumonia (UIP)-pattern on CT, (ii) predominant ground-glass opacities suggesting alveolitis, (iii) findings suggestive of sarcoidosis on CT, or if they had (i) a CT showing UIP-pattern, but had findings suggesting alternative diagnosis than idiopathic pulmonary fibrosis (IPF), or (ii) had previous non-diagnostic conventional transbronchial forceps biopsy. Histological findings were integrated into the multidisciplinary team discussion (MDTD) and a diagnostic consensus was sought. Results One hundred patients underwent cryobiopsy. In 88/100 patients, cryobiopsy was representative with diagnostic findings in 45/88 and non-specific histological findings in 43/88 patients. In 25/43 with non-specific findings, a consensus diagnosis was reached after MDTD integrating BAL, radiologic and clinical data; eight of the remaining 18 patients with non-specific findings were referred to SLB. In 12/100 patients cryobiopsy was not representative and three of these patients were also referred to SLB. In 7/11 patients (64%) SLB was diagnostic. Complications of cryobiopsy included pneumothorax (14%) and locally controlled bleeding (24%). Conclusions The diagnostic yield of cryobiopsy was 70%:45% of cryobiopsies were diagnostic based on histology alone and an additional 25% provided non-specific, but valuable findings allowing a consensus diagnosis after MDTD. Our data demonstrate that the diagnostic value of cryobiopsy is high if combined with BAL, radiologic and clinical data.

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