Implementation of transbronchial lung cryobiopsy in a tertiary referral center for interstitial lung diseases: a cohort study on diagnostic yield, complications, and learning curves

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.

Download Full-text

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).

Download Full-text

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.

Download Full-text

Diagnostic yield of transbronchial lung cryobiopsy in interstitial lung diseases

10.1183/1393003.congress-2017.pa3023 ◽

2017 ◽

Author(s):

Ana Raquel Caldas Marçôa ◽

Rita Linhas ◽

Dulce Apolinario ◽

Ana Oliveira ◽

Carla Nogueira ◽

...

Keyword(s):

Lung Diseases ◽

Diagnostic Yield ◽

Interstitial Lung Diseases ◽

Transbronchial Lung Cryobiopsy

Download Full-text

Pirfenidone in Idiopathic Pulmonary Fibrosis: Real-Life Experience from a German Tertiary Referral Center for Interstitial Lung Diseases

Respiration ◽

10.1159/000363064 ◽

2014 ◽

Vol 88 (3) ◽

pp. 199-207 ◽

Cited By ~ 57

Author(s):

Ute Oltmanns ◽

Nicolas Kahn ◽

Karin Palmowski ◽

Annette Träger ◽

Heinrich Wenz ◽

...

Keyword(s):

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Lung Diseases ◽

Life Experience ◽

Real Life ◽

Interstitial Lung Diseases ◽

Tertiary Referral ◽

Tertiary Referral Center ◽

Referral Center

Download Full-text

Transbronchial cryobiopsy: an effective tool in the diagnosis of lymphoproliferative disorders of the lung

ERJ Open Research ◽

10.1183/23120541.00260-2019 ◽

2020 ◽

Vol 6 (3) ◽

pp. 00260-2019

Author(s):

Rita Bianchi ◽

Alessandra Dubini ◽

Silvia Asioli ◽

Claudia Ravaglia ◽

Sara Tomassetti ◽

...

Keyword(s):

Lung Diseases ◽

Pulmonary Involvement ◽

Interstitial Lung Diseases ◽

Lymphoproliferative Disorders ◽

Definitive Diagnosis ◽

Severe Bleeding ◽

Surgical Biopsy ◽

Molecular Tests ◽

Transbronchial Lung Cryobiopsy ◽

Ancillary Studies

IntroductionMalignant lymphoproliferative disorders are rarely observed in the lung and, considering their clinical and radiological heterogeneity, diagnosis is often difficult and may require invasive methods. Transbronchial cryobiopsy has been confirmed as a new tool in the diagnosis of interstitial lung diseases, given its fewer risks and costs compared to surgical approach. This study is aimed at assessing the effectiveness of cryobiopsy in the diagnosis of lymphoproliferative disorders.Materials and methodsAmong 970 consecutive cryobiopsies, performed between January 2011 and June 2018 at Morgagni Hospital of Forlì, Italy, 13 cases of lymphoproliferative disorders were collected.ResultsIn 12 out of 13 cases a precise pathological diagnosis could be reached with the support of immunohistochemistry (IHC) and molecular ancillary studies. In the only case in which cryobiopsy did not lead to a definitive diagnosis, the subsequent surgical biopsy also did not help to clarify the diagnosis. Severe bleeding or pneumothorax did not occur in any case. On average, five biopsies were obtained per case, with a mean total area of 1161 mm2, and only 5 out of 65 specimens were inadequate for diagnosis. Instant freezing did not produce tissue artefacts nor did it affect IHC and molecular tests. In all cases the amount of available tissue was sufficient for all ancillary studies.ConclusionsTransbronchial lung cryobiopsy is safe and effective for diagnosis in patients with suspected pulmonary involvement by lymphoproliferative disorders and it should therefore be considered a valid alternative to surgical biopsy in such cases.

Download Full-text

Diagnostic yield of transbronchial lung cryobiopsy in interstitial lung diseases

Revista Portuguesa de Pneumologia (English Edition) ◽

10.1016/j.rppnen.2017.07.002 ◽

2017 ◽

Vol 23 (5) ◽

pp. 296-298 ◽

Cited By ~ 1

Author(s):

R. Marçôa ◽

R. Linhas ◽

D. Apolinário ◽

S. Campainha ◽

A. Oliveira ◽

...

Keyword(s):

Lung Diseases ◽

Diagnostic Yield ◽

Interstitial Lung Diseases ◽

Transbronchial Lung Cryobiopsy

Download Full-text

Influence of autoimmune biomarkers on interstitial lung diseases: A tertiary referral center based case-control study

Respiratory Medicine ◽

10.1016/j.rmed.2015.01.011 ◽

2015 ◽

Vol 109 (3) ◽

pp. 397-405 ◽

Cited By ~ 9

Author(s):

Philippe R. Bauer ◽

Sanjay Kalra ◽

Thomas G. Osborn ◽

Jennifer St. Sauver ◽

Andrew C. Hanson ◽

...

Keyword(s):

Lung Diseases ◽

Case Control Study ◽

Case Control ◽

Interstitial Lung Diseases ◽

Tertiary Referral ◽

Tertiary Referral Center ◽

Referral Center ◽

Control Study

Download Full-text

Audit of surgical lung biopsies for interstitial lung diseases, with emphasis on 90-day survival data in a tertiary referral thoracic surgery specialist centre

10.26226/morressier.57a2f937d462b8028d8901e3 ◽

2016 ◽

Author(s):

Aurelie Fabre

Keyword(s):

Thoracic Surgery ◽

Survival Data ◽

Lung Diseases ◽

Interstitial Lung Diseases ◽

Tertiary Referral ◽

Specialist Centre ◽

Lung Biopsies

Download Full-text

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.

Download Full-text