Optimize Initial Freezing Time of Transbronchial Cryobiopsy for the Diagnosis of Interstitial Lung Disease: A Prospective Randomized Parallel Group Study

Respiration ◽  
2021 ◽  
pp. 1-8
Author(s):  
Xiaobo Chen ◽  
Yongshun Ye ◽  
Qian Han ◽  
Zhenyu Liang ◽  
Weiquan Xiao ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Diagnostic Yield ◽  
Specimen Size ◽  
Severe Bleeding ◽  
Diagnostic Efficiency ◽  
Freezing Time ◽  
Parallel Group Study ◽  
Parallel Group ◽  
Initial Freezing

<b><i>Background:</i></b> Transbronchial cryobiopsy (TBCB) is increasingly being identified as a potential alternative for the diagnosis of interstitial lung disease (ILD). The specimen size of TBCB is positively related to the freezing time. However, the proper initial freezing time for the clinical application of TBCB in ILD remains unknown. <b><i>Methods:</i></b> A prospective randomized parallel group study was employed to investigate ILD patients with unclear diagnosis, who were admitted to the First Affiliated Hospital of Guangzhou Medical University from May 2019 to October 2020 and required TBCB. All patients were randomly divided into 4 groups according to the different freezing times of TBCB: 3 s, 4 s, 5 s, and 6 s groups. All operations were performed under intravenous anesthesia with endotracheal intubation, 60–65 bar pressure of freezing gas source, and 1.9-mm cryoprobe. Compare differences among groups in specimen size, complications, pathological diagnosis efficiency, and multidisciplinary discussion (MDD) diagnostic efficiency. <b><i>Results:</i></b> A total of 100 patients were recruited and randomly assigned into 4 groups (<i>n</i> = 25 each group). The specimen sizes of TBCB in ILD were positively correlated with the freezing time (<i>r</i> = 0.639, <i>p</i> &#x3c; 0.05). None of the patients experienced Grade 3 severe bleeding. Pneumothorax occurred in 1 patient in the 4 s, 5 s, and 6 s groups, respectively. The diagnostic yield of MDD in the 3 s, 4 s, 5 s, and 6 s groups were 64%, 88%, 88%, and 96%, respectively (<i>p</i> &#x3c; 0.05), but showing no significant differences among 4 s, 5 s, and 6 s groups. <b><i>Conclusions:</i></b> The specimen size and diagnostic efficiency of TBCB in ILD increased with a longer freezing time. When the freezing gas pressure is 60–65 bar, we recommended 4 s as the initial freezing time of TBCB, and this time is associated with high diagnostic efficiency and low incidence of complications.

Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: A randomized trial

Respirology ◽  
2014 ◽  
Vol 19 (6) ◽  
pp. 900-906 ◽  
Author(s):  
Virginia Pajares ◽  
Carmen Puzo ◽  
Diego Castillo ◽  
Enrique Lerma ◽  
M. Angeles Montero ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Randomized Trial ◽  
Diagnostic Yield

Comparison of Forceps, Cryoprobe, and Thoracoscopic Lung Biopsy for the Diagnosis of Interstitial Lung Disease − The CHILL Study

Respiration ◽  
2021 ◽  
pp. 1-7
Author(s):  
Momen M. Wahidi ◽  
Angela Christine Argento ◽  
Kamran Mahmood ◽  
Scott L. Shofer ◽  
Coral Giovacchini ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Lung Biopsy ◽  
Diagnostic Yield ◽  
Final Diagnosis ◽  
Cohen’S Kappa ◽  
Cohen's Kappa ◽  
Invasive Method ◽  
Transbronchial Lung Cryobiopsy ◽  
Multidisciplinary Conference

Rationale: Transbronchial lung cryobiopsy (TBLC) has emerged as a less invasive method to obtain a tissue diagnosis in patients with interstitial lung disease (ILD). The diagnostic yield of TBLC compared to surgical lung biopsy (SLB) remains uncertain. Objectives: The aim of this study was to determine the diagnostic accuracy of forceps transbronchial lung biopsy (TBLB) and TBLC compared to SLB when making the final diagnosis based on multidisciplinary discussion (MDD). Methods: Patients enrolled in the study underwent sequential TBLB and TBLC followed immediately by SLB. De-identified cases, with blinding of the biopsy method, were reviewed by a blinded pathologist and then discussed at a multidisciplinary conference. Main Results: Between August 2013 and October 2017, we enrolled 16 patients. The raw agreement between TBLC and SLB for the MDD final diagnosis was 68.75% with a Cohen’s kappa of 0.6 (95% CI 0.39, 0.81). Raw agreement and Cohen’s kappa of TBLB versus TBLC and TBLB versus SLB for the MDD final diagnosis were much lower (50%, 0.21 [95% CI 0, 0.42] and 18.75%, 0.08 [95% CI −0.03, 0.19], respectively). TBLC was associated with mild bleeding (grade 1 bleeding requiring suction to clear) in 56.2% of patients. Conclusions: In patients with ILD who have an uncertain type based on clinical and radiographic data and require tissue sampling to obtain a specific diagnosis, TBLC showed moderate correlation with SLB when making the diagnosis with MDD guidance. TBLB showed poor concordance with both TBLC and SLB MDD diagnoses.

scholarly journals Transbronchial cryobiopsy in interstitial lung disease: experience in 106 cases – how to do it

2017 ◽  
Vol 3 (1) ◽  
pp. 00148-2016 ◽  
Author(s):  
Antonio Bango-Álvarez ◽  
Miguel Ariza-Prota ◽  
Hector Torres-Rivas ◽  
Luis Fernández-Fernández ◽  
Amador Prieto ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
General Anaesthesia ◽  
Diagnostic Yield ◽  
Diagnostic Technique ◽  
Moderate Sedation ◽  
Severe Haemorrhage ◽  
Interstitial Disease ◽  
Disease Experience ◽  
A Prospective Study

Transbronchial biopsy using forceps (TBB) is the first diagnostic technique performed on patients with interstitial lung disease (ILD). However, the small size of the samples and the presence of artefacts in the tissue obtained make the yield variable.Our objectives were 1) to attempt to reproduce transbronchial cryobiopsy under the same conditions with which we performed conventional TBB, that is, in the bronchoscopy unit without intubating the patient and without fluoroscopy or general anaesthesia; 2) to describe the method used for its execution; and 3) to analyse the diagnostic yield and its complications.We carried out a prospective study that included 106 patients with clinical and radiological features suggestive of ILD who underwent cryo-transbronchial lung biopsy (cryo-TBB) under moderate sedation without endotracheal intubation, general anaesthesia or use of fluoroscopy. We performed the procedure using two flexible bronchoscopes connected to two video processors, which we alternated until obtaining the number of desired samples.A definitive diagnosis was obtained in 91 patients (86%). As for complications, there were five pneumothoraces (4.7%) and in no case was there severe haemorrhage or exacerbation of the underlying interstitial disease. Cryo-TBB following our method is a minimally invasive, rapid, safe and economic technique that can be performed in a bronchoscopy suite under moderate sedation without the need for intubating the patient or using fluoroscopy and without requiring general anaesthesia.

scholarly journals STRATUS, a Phase II Study of Abituzumab in Patients with Systemic Sclerosis-associated Interstitial Lung Disease

2020 ◽  
pp. jrheum.191365
Author(s):  
Dinesh Khanna ◽  
Donald P. Tashkin ◽  
Athol U. Wells ◽  
James R. Seibold ◽  
Stephen Wax ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Phase Ii ◽  
Phase Ii Study ◽  
Multicenter Trial ◽  
Rate Of Change ◽  
Double Blind ◽  
Parallel Group ◽  
To Receive

Objective To investigate the effects of abituzumab in systemic sclerosis-associated interstitial lung disease (SSc-ILD). Methods STRATUS was a Phase II, double-blind, parallel-group, multicenter trial (NCT02745145). Adults (≤75 years) with SSc-ILD on stable mycophenolate were randomized (2:2:1) to receive intravenous abituzumab 1500 mg, placebo, or abituzumab 500 mg every 4 weeks for 104 weeks. Primary endpoint: annual rate of change in absolute FVC. Results STRATUS was terminated prematurely due to slow enrolment (n=75 screened, n=24 randomized), precluding robust analysis of efficacy. Abituzumab was well-tolerated; no new safety signals were detected. Conclusion Further investigation of abituzumab for treatment of SSc-ILD is required.

scholarly journals SAFETY AND DIAGNOSTIC YIELD OF TRANSBRONCHIAL LUNG CRYOBIOPSY IN THE DIAGNOSIS OF INTERSTITIAL LUNG DISEASE

CHEST Journal ◽  
2020 ◽  
Vol 158 (4) ◽  
pp. A1941-A1942
Author(s):  
Reza Ronaghi ◽  
Tao He ◽  
Catherine Oberg ◽  
Colleen Channick ◽  
Irawan Susanto ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Diagnostic Yield ◽  
Transbronchial Lung Cryobiopsy

scholarly journals Transbronchial Cryobiopsy in the Diagnosis of Fibrotic Interstitial Lung Disease

2020 ◽  
Vol 144 (12) ◽  
pp. 1501-1508 ◽  
Author(s):  
Mitra Mehrad ◽  
Thomas V. Colby ◽  
Giulio Rossi ◽  
Alberto Cavazza
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Lung Biopsy ◽  
Diagnostic Yield ◽  
Prognostic Information ◽  
Surgical Lung Biopsy ◽  
Diffuse Parenchymal Lung Disease ◽  
The Status ◽  
Pubmed Search ◽  
Parenchymal Lung Disease

Context.— Transbronchial cryobiopsy is an emerging procedure to obtain lung tissue for diagnosis of interstitial lung disease and has gained popularity because it is less invasive and has a lower rate of complications compared with nonselective surgical lung biopsy. Objective.— To provide an overview of the status of the medical literature regarding transbronchial cryobiopsy. Data Sources.— A literature search was performed using PubMed search engine. The terms “cryobiopsy” or “cryoprobe” and “interstitial lung disease” or “diffuse parenchymal lung disease” or “pulmonary fibrosis” were used, with the search concluding at the end of November 2019. Conclusions.— While the diagnostic yield of transbronchial cryobiopsy is slightly lower than surgical lung biopsy, a growing amount of literature suggests that with a multidisciplinary approach cryobiopsy provides diagnostic and prognostic information approaching that of surgical lung biopsy with lower morbidity and mortality.

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