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Sharma D, V V, Saini JK, Sethi P, Kumar L, Dubey PK. Assessing the effectiveness and safety of transbronchial lung cryobiopsy utilizing a flexible bronchoscope with an endobronchial blocker in diffuse parenchymal lung lesions. Monaldi Arch Chest Dis 2025; 95. [PMID: 38497194 DOI: 10.4081/monaldi.2024.2887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/06/2024] [Indexed: 03/19/2024] Open
Abstract
Transbronchial lung cryobiopsy (TBLC) with flexible bronchoscope represents an encouraging modality to obtain a larger-sized specimen without crush artifact and a higher diagnostic yield in patients with diffuse parenchymal lung lesions/diseases as compared to conventional transbronchial lung biopsy, and fewer complications as opposed to surgical lung biopsy. An artificial airway is preferred as it provides better airway protection in cases of severe bleeding. Although various researchers have published data on different modalities, the data is not sufficient to standardize a single technique. This study describes the procedural technique, safety, and yield of TBLC using a flexible bronchoscope with an endobronchial blocker. We performed a retrospective analysis of 100 consecutive patients who underwent TBLC using flexible bronchoscopy from May 2018 to June 2022. TBLC samples were obtained under moderate sedation without the use of an artificial airway or fluoroscopy. Among the 100 patients, the majority were male (63%). The mean age of the enrolled patients was 44.43±15.92 years. The predominant diagnoses in our study were hypersensitivity pneumonitis (27%), followed by sarcoidosis (12%) and tuberculosis (10%). We obtained alveolated lung tissue in 90 out of 100 cases with a median biopsy size of 5 mm (in greatest dimension, interquartile range 5-4 mm), resulting in a specific histopathological diagnosis in 82 cases. The most frequent complications were bleeding and pneumothorax (13%). Mild bleeding occurred in 58% of the patients, and moderate bleeding occurred in 20%. There was no episode of severe/life-threatening bleeding. None of the patients required intensive care unit admission or endotracheal intubation. In conclusion, the use of TBLC through flexible bronchoscopy with an endobronchial blocker emerges as a minimally invasive, secure, time-efficient, and readily reproducible technique. Significantly, this procedure can be seamlessly executed in the bronchoscopy suite, eliminating the requirement for an artificial airway or general anesthesia.
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Affiliation(s)
- Deepak Sharma
- Department of Pulmonary and Critical Care Medicine, King George's Medical University, Lucknow
| | - Vinay V
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Patna
| | - Jitendra Kumar Saini
- Thoracic Oncology Clinic, National Institute of Tuberculosis and Respiratory Diseases, New Delhi
| | - Prabhpreet Sethi
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi
| | - Lokender Kumar
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi
| | - Praveen Kumar Dubey
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Raipur
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Liu H, Shen J, He C. Advances in idiopathic pulmonary fibrosis diagnosis and treatment. CHINESE MEDICAL JOURNAL PULMONARY AND CRITICAL CARE MEDICINE 2025; 3:12-21. [PMID: 40226606 PMCID: PMC11993042 DOI: 10.1016/j.pccm.2025.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Indexed: 04/15/2025]
Abstract
Significant advances have been made in diagnosing and treating idiopathic pulmonary fibrosis (IPF) in the last decade. The incidence and prevalence of IPF are increasing, and morbidity and mortality remain high despite the two Food and Drug Administration (FDA)-approved medications, pirfenidone and nintedanib. Hence, there is an urgent need to develop new diagnostic tools and effective therapeutics to improve early, accurate diagnosis of IPF and halt or reverse the progression of fibrosis with a better safety profile. New diagnostic tools such as transbronchial cryobiopsy and genomic classifier require less tissue and generally have good safety profiles, and they have been increasingly utilized in clinical practice. Advances in artificial intelligence-aided diagnostic software are promising, but challenges remain. Both pirfenidone and nintedanib focus on growth factor-activated pathways to inhibit fibroblast activation. Novel therapies targeting different pathways and cell types (immune and epithelial cells) are being investigated. Biomarker-based personalized medicine approaches are also in clinical trials. This review aims to summarize recent diagnostic and therapeutic development in IPF.
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Affiliation(s)
- Hongli Liu
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Jiaxi Shen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Chao He
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX 77024, USA
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Afrifa‐Yamoah E, Adua E, Peprah‐Yamoah E, Anto EO, Opoku‐Yamoah V, Acheampong E, Macartney MJ, Hashmi R. Pathways to chronic disease detection and prediction: Mapping the potential of machine learning to the pathophysiological processes while navigating ethical challenges. Chronic Dis Transl Med 2025; 11:1-21. [PMID: 40051825 PMCID: PMC11880127 DOI: 10.1002/cdt3.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/03/2024] [Accepted: 05/27/2024] [Indexed: 03/09/2025] Open
Abstract
Chronic diseases such as heart disease, cancer, and diabetes are leading drivers of mortality worldwide, underscoring the need for improved efforts around early detection and prediction. The pathophysiology and management of chronic diseases have benefitted from emerging fields in molecular biology like genomics, transcriptomics, proteomics, glycomics, and lipidomics. The complex biomarker and mechanistic data from these "omics" studies present analytical and interpretive challenges, especially for traditional statistical methods. Machine learning (ML) techniques offer considerable promise in unlocking new pathways for data-driven chronic disease risk assessment and prognosis. This review provides a comprehensive overview of state-of-the-art applications of ML algorithms for chronic disease detection and prediction across datasets, including medical imaging, genomics, wearables, and electronic health records. Specifically, we review and synthesize key studies leveraging major ML approaches ranging from traditional techniques such as logistic regression and random forests to modern deep learning neural network architectures. We consolidate existing literature to date around ML for chronic disease prediction to synthesize major trends and trajectories that may inform both future research and clinical translation efforts in this growing field. While highlighting the critical innovations and successes emerging in this space, we identify the key challenges and limitations that remain to be addressed. Finally, we discuss pathways forward toward scalable, equitable, and clinically implementable ML solutions for transforming chronic disease screening and prevention.
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Affiliation(s)
| | - Eric Adua
- Rural Clinical School, Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
| | | | - Enoch O. Anto
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Victor Opoku‐Yamoah
- School of Optometry and Vision ScienceUniversity of WaterlooWaterlooOntarioCanada
| | - Emmanuel Acheampong
- Department of Genetics and Genome BiologyLeicester Cancer Research CentreUniversity of LeicesterLeicesterUK
| | - Michael J. Macartney
- Faculty of Science Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | - Rashid Hashmi
- Rural Clinical School, Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
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Zanini U, Faverio P, Bonfanti V, Falzone M, Cortinovis D, Arcangeli S, Petrella F, Ferrara G, Mura M, Luppi F. The 'Liaisons dangereuses' Between Lung Cancer and Interstitial Lung Diseases: A Focus on Acute Exacerbation. J Clin Med 2024; 13:7085. [PMID: 39685543 DOI: 10.3390/jcm13237085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 11/13/2024] [Accepted: 11/19/2024] [Indexed: 12/18/2024] Open
Abstract
Patients with interstitial lung disease (ILD) are about five times more likely to develop lung cancer than those without ILD. The presence of ILD in lung cancer patients complicates diagnosis and management, resulting in lower survival rates. Diagnostic and treatment procedures needed for cancer can increase the risk of acute exacerbation (AE), one of the most severe complications for these patients. Bronchoscopic techniques are generally considered safe, but they can trigger AE-ILD, particularly after cryoprobe biopsies. Surgical procedures for lung cancer, including lung biopsies and resections, carry an elevated risk of AE-ILD. Postoperative complications and mortality rates highlight the importance of meticulous surgical planning and postoperative care. Furthermore, cancer treatments, such as chemotherapy, are all burdened by a risk of AE-ILD occurrence. Radiotherapy is important for managing both early-stage and advanced lung cancer, but it also poses risks. Stereotactic body radiation and particle beam therapies have varying degrees of safety, with the latter potentially offering a lower risk of AE. Percutaneous ablation techniques can help patients who are not eligible for surgery. However, these procedures may complicate ILD, and their associated risks still need to be fully understood, necessitating further research for improved safety. Overall, while advancements in lung cancer treatment have improved outcomes for many patients, the complexity of managing patients with concomitant ILD needs careful consideration and multidisciplinary assessment. This review provides a detailed evaluation of these risks, emphasizing the need for personalized treatment approaches and monitoring to improve patient outcomes in this challenging population.
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Affiliation(s)
- Umberto Zanini
- Department of Medicine and Surgery, University of Milano-Bicocca, SC Pneumologia, Fondazione IRCCS "San Gerardo dei Tintori", 20900 Monza, Italy
| | - Paola Faverio
- Department of Medicine and Surgery, University of Milano-Bicocca, SC Pneumologia, Fondazione IRCCS "San Gerardo dei Tintori", 20900 Monza, Italy
| | - Valentina Bonfanti
- Department of Medicine and Surgery, University of Milano-Bicocca, SC Pneumologia, Fondazione IRCCS "San Gerardo dei Tintori", 20900 Monza, Italy
| | - Maria Falzone
- Department of Medicine and Surgery, University of Milano-Bicocca, SC Pneumologia, Fondazione IRCCS "San Gerardo dei Tintori", 20900 Monza, Italy
| | - Diego Cortinovis
- Department of Medicine and Surgery, University of Milano-Bicocca, SC Oncologia, Fondazione IRCCS "San Gerardo dei Tintori", 20900 Monza, Italy
| | - Stefano Arcangeli
- Department of Medicine and Surgery, University of Milano-Bicocca, SC Radioterapia, Fondazione IRCCS "San Gerardo dei Tintori", 20900 Monza, Italy
| | - Francesco Petrella
- Department of Medicine and Surgery, University of Milano-Bicocca, SC Chirurgia Toracica, Fondazione IRCCS "San Gerardo dei Tintori", 20900 Monza, Italy
| | - Giovanni Ferrara
- Division of Pulmonary Medicine, University of Alberta, and Alberta Health Services, Edmonton, AB T6G 2B7, Canada
| | - Marco Mura
- Division of Respirology, Western University, London, ON N6A 3K7, Canada
| | - Fabrizio Luppi
- Department of Medicine and Surgery, University of Milano-Bicocca, SC Pneumologia, Fondazione IRCCS "San Gerardo dei Tintori", 20900 Monza, Italy
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Austin A, Jaber J, Fu K, Zeineddine L, Omballi M, Mckenney G, Abdelghani R, Espinoza D, Becnel D, Mehta HJ. Acute exacerbation of interstitial lung diseases and mortality post-cryobiopsy: a multicenter cohort study. J Thorac Dis 2024; 16:4340-4349. [PMID: 39144357 PMCID: PMC11320243 DOI: 10.21037/jtd-24-270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/31/2024] [Indexed: 08/16/2024]
Abstract
Background Interstitial lung diseases (ILDs) are a group of pulmonary disorders affecting the lung's structure. Acute exacerbation of ILD (AE-ILD) following medical procedures is a significant clinical concern. Lung cryoprobe transbronchial biopsy (cryobiopsy) is a relatively new diagnostic technique for ILD, but data on AE-ILD post-cryobiopsy is limited. This study aims to fill this gap by examining the prevalence, risk factors, and outcomes of AE-ILD following cryobiopsy. Methods This multicenter retrospective study analyzed data from patients who underwent cryobiopsy for ILD diagnosis at three U.S. institutions between January 2014 and August 2022. The study included patients over 18 years with confirmed or suspected ILD, categorized into those who experienced AE-ILD post-cryobiopsy and those who did not. Results Out of 111 patients, 3.6% experienced AE-ILD, with a 50% mortality rate in these cases. The study cohort was predominantly white, with a median age of 69.0 years. Common comorbidities included tobacco use and hypertension. Patients who developed AE-ILD had an increased median number of biopsies. The overall 30-day mortality was 1.8%. Overall complication rate was 32%, including pneumonia, pneumothorax, AE-ILD, and bleeding requiring intervention. The study findings suggest that bronchoscopic cryobiopsy may be associated with lower overall mortality, particularly in patients with compromised lung function. Conclusions This study provides significant insights into AE-ILD following cryobiopsy, underscoring the need for careful patient selection and procedural assessment. While cryobiopsy may offer a safer alternative to surgical lung biopsy in specific patient cohorts, the elevated risk of AE-ILD necessitates further research to optimize patient outcomes and procedural safety.
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Affiliation(s)
- Adam Austin
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Johnny Jaber
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Katherine Fu
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Lauran Zeineddine
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Mohamed Omballi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - George Mckenney
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Ramsy Abdelghani
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Diana Espinoza
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - David Becnel
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Hiren J. Mehta
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
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Long W, Luo J, Ma L, Wei J, Xiang H, Hong L, Luo M. The efficacy and safety of modified transbronchial cryobiopsy in the diagnosis of interstitial lung disease. Medicine (Baltimore) 2024; 103:e38269. [PMID: 38996169 PMCID: PMC11245189 DOI: 10.1097/md.0000000000038269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/26/2024] [Indexed: 07/14/2024] Open
Abstract
The objective of this study is to investigate the efficacy and safety of flexible transbronchial cryobiopsy (TBCB) in the diagnosis of diffuse parenchymal lung disease (DPLD) in a routine bronchoscopy examination room under analgesia and sedation, using neither endotracheal intubation or rigid bronchoscope nor fluoroscopy or general anesthesia. The data from 50 DPLD patients with unknown etiology who were treated in the Affiliated Hospital of Guilin Medical College from May 2018 to September 2020 were collected, and 43 were eventually included. The specimens obtained from these 43 patients were subjected to pathological examination, pathogenic microorganism culture, etc, and were analyzed in the clinical-radiological-pathological diagnosis mode to confirm the efficacy of TBCB in diagnosing the cause of DPLD. Subsequently, the intraoperative and postoperative complications of TBCB and their severity were closely observed and recorded to comprehensively evaluate the safety of TBCB. For the 43 patients included, a total of 85 TBCB biopsies were performed (1.98 [1, 4] times/case), and 82 valid tissue specimens were obtained (1.91 [1, 4] pieces/case), accounting for 96.5% (82/85) of the total sample. The average specimen size was 12.41 (1, 30) mm2. Eventually, 38 cases were diagnosed, including 11 cases of idiopathic pulmonary fibrosis, 5 cases of connective tissue-related interstitial lung disease, 5 cases of nonspecific interstitial pneumonia, 4 cases of tuberculosis, 4 cases of occupational lung injury, 3 cases of interstitial pneumonia with autoimmune characteristics, 1 case of lung cancer, 2 cases of interstitial lung disease (unclassified interstitial lung disease), 1 case of hypersensitivity pneumonitis, 1 case of pulmonary alveolar proteinosis, and 1 case of fungal infection. The remaining 5 cases were unclarified. For infectious diseases, the overall etiological diagnosis rate was 88.4% (38/43). With respect to complications, pneumothorax occurred in 4 cases (9.3%, 4/43, including 1 mild case and 3 moderate cases), of which 3 cases (75%) were closed by thoracic drainage and 1 case (25%) was absorbed without treatment. In addition, 22 cases experienced no bleeding (51.2%) and 21 cases suffered bleeding to varying degrees based on different severity assessment methods. TBCB is a minimally invasive, rapid, economical, effective, and safe diagnostic technique.
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Affiliation(s)
| | | | - Libing Ma
- Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Jianghong Wei
- Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Hui Xiang
- Guilin Medical University, Guilin, China
| | | | - Miao Luo
- Affiliated Hospital of Guilin Medical University, Guilin, China
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Lachowicz JA, Smallwood NE, Prasad JD, Patel P, Voutier C, Khor YH, Steinfort DP. A systematic review of procedural and sampling techniques for cryobiopsy in interstitial lung disease. Eur Respir Rev 2024; 33:240035. [PMID: 39142710 PMCID: PMC11322826 DOI: 10.1183/16000617.0035-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/11/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Transbronchial lung cryobiopsy (TBLC) is an alternative to surgical lung biopsy for histopathological evaluation of unclassifiable interstitial lung disease (ILD) or ILD diagnosed with low confidence. This meta-analysis synthesised current literature regarding cryobiopsy diagnostic performance and safety, focusing on procedural and sampling techniques. METHODS Medline and Embase were searched on 11 April 2022. Studies included adults with unclassifiable ILD, reporting diagnostic yield, complications and methodological techniques of TBLC. Meta-analyses were performed for diagnostic yield, pneumothorax and bleeding. Subgroup analyses and meta-regression assessed methodological variables. PROSPERO registration: CRD42022312386. RESULTS 70 studies were included with 6183 participants. Diagnostic yield of TBLC was 81% (95% CI 79-83%, I2=97%), with better yield being observed with general anaesthesia (p=0.007), ILD multidisciplinary meeting prior to cryobiopsy (p=0.02), 2.4 mm cryoprobe (p=0.04), higher mean forced vital capacity (p=0.046) and higher mean diffusing capacity for carbon monoxide (p=0.023). Pneumothorax rate was 5% (95% CI 4-5%, I2=91%), with higher rates associated with a 2.4 mm cryoprobe (p<0.00001), routine post-procedure imaging (p<0.00001), multiple lobe sampling (p<0.0001), reduced mean diffusing capacity for carbon monoxide (p=0.028) and general anaesthesia (p=0.05). Moderate-to-severe bleeding rate was 12% (11-14%, I2=95%) and higher rates were associated with a 2.4 mm cryoprobe (p=0.001) and bleeding score selection (p=0.04). INTERPRETATION Patient characteristics and modifiable factors, including procedural methods and anaesthetic techniques, impacted diagnostic yield and safety outcomes of TBLC in people with unclassifiable ILD and contributed to heterogeneity of clinical outcomes. These variables should be considered for individualised clinical decision making and guideline development and warrant routine reporting in future research.
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Affiliation(s)
- Julia A Lachowicz
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Natasha E Smallwood
- Department of Respiratory Medicine, The Alfred, Melbourne, Australia
- Faculty of Medicine, Monash University, Melbourne, Australia
| | - Jyotika D Prasad
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, Monash University, Melbourne, Australia
- Department of Respiratory Medicine and Lung Transplant Unit, The Alfred, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Purab Patel
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Catherine Voutier
- Health Sciences Library, Royal Melbourne Hospital, Melbourne, Australia
| | - Yet H Khor
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
| | - Daniel P Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
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Aburto M, Rodríguez-Portal JA, Fernandez-Fabrellas E, García Sevila R, Herrera Lara S, Bollo de Miguel E, González Ruiz JM, Molina-Molina M, Safont Muñoz B, Godoy Mayoral R, Romero Ortiz AD, Soler Sempere MJ, Castillo Villegas D, Gaudó Navarro J, Tomás López L, Nuñez Sanchez B, Palacios Hidalgo Z, Sellares Torres J, Sacristán Bou L, Nieto Barbero MA, Casanova Espinosa A, Portillo-Carroz K, Cano-Jimenez E, Acosta Fernández O, Legarreta MJ, Valenzuela C, en representación del Grupo SEPAR-IPF National Registry. [Influence of Clinical Practice Guidelines on the Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis. Data from the Registry of the Spanish Society of Pulmonology and Thoracic Surgery]. OPEN RESPIRATORY ARCHIVES 2024; 6:100334. [PMID: 39021619 PMCID: PMC11253673 DOI: 10.1016/j.opresp.2024.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/26/2024] [Indexed: 07/20/2024] Open
Abstract
Objective The objective of the study was to analyze the diagnostic process and the time until the start of treatment of patients with idiopathic pulmonary fibrosis in relation to the publication of successive clinical practice guide. Material and methods Multicenter, observational, ambispective study, in which patients includes in the idiopathic pulmonary fibrosis registry of the Spanish Society of Pulmonologist and Thoracic Surgery were analyzed. An electronic data collection notebook was enabled on the society's website. Sociodemographic and clinical variables were collected at diagnosis and follow-up of the patients. Results From January 2012 to december 2019, 1064 patients were included in the registry, with 929 finally analyzed. The diagnosis process varied depending on the year in which it was performed, and the radiological pattern observed in the high-resolution computed tomography. Up to 26.3% of the cases (244) were diagnosed with chest high-resolution computed tomography and clinical evaluation. Surgical biopsy was used up to 50.2% of cases diagnosed before 2011, while it has been used in 14.2% since 2018. The median time from the onset of symptoms to diagnosis was 360 days (IQR 120-720), taking more than 2 years in the 21.0% of patients. A percentage of 79.4 of patients received antifibrotic treatment. The average time from diagnosis to the antifibrotic treatment has been 309 ± 596.5 days, with a median of 49 (IQR 0-307). Conclusions The diagnostic process, including the time until diagnosis and the type of test used, has changed from 2011 to 2019, probably due to advances in clinical research and the publication of diagnostic-therapeutic consensus guidelines.
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Affiliation(s)
- Myriam Aburto
- Servicio de Neumología, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, España
- Departamento de Medicina, Universidad del País Vasco- Euskal Herriko Unibertsitatea, País Vasco, España
- Biobizkaia, Barakaldo, Bizkaia, España
| | | | - Estrella Fernandez-Fabrellas
- Servicio de Neumología, Consorci Hospital General Universitari de Valencia, Valencia, España
- Departamento de Medicina, Universidad de Valencia, Valencia, España
| | - Raquel García Sevila
- Servicio de Neumología, Hospital General Universitario de Dr. Balmis, Alicante, España
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, España
| | - Susana Herrera Lara
- Servicio de Neumología, Hospital Universitario Doctor Peset, Valencia, España
| | | | | | - María Molina-Molina
- Unidad de EPID, Servicio de Neumología, Hospital Universitari de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, Barcelona, España
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Belén Safont Muñoz
- Servicio de Neumología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - Raul Godoy Mayoral
- Servicio de Neumología, Hospital Universitario de Albacete, Albacete, España
| | | | | | | | | | - Laura Tomás López
- Departamento de Medicina, Universidad del País Vasco- Euskal Herriko Unibertsitatea, País Vasco, España
- Servicio de Neumología, Hospital Universitario de Araba, Vitoria-Gazteiz, Araba, Vitoria-Gazteiz, Araba, España
| | - Belén Nuñez Sanchez
- Servicio de Neumología, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | | | | | - Lirios Sacristán Bou
- Servicio de Neumología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | | | | | - Karina Portillo-Carroz
- Servicio de Neumología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | | | - Orlando Acosta Fernández
- Servicio de Neumología, Complejo Hospitalario Universitario de Canarias, San Cristóbal de La Laguna, Santa Cruz de Tenerife, España
| | - María José Legarreta
- Research Unit, Osakidetza Basque Health Service, Galdakao-Usansolo University Hospital, Galdakao, Bizkaia, España
- Biosistemak Kronikgune Institute for Health Services Research, Galdakao, Bizkaia, España
- Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), Galdakao, Bizkaia, España
| | - Claudia Valenzuela
- Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, España
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Poletti V, Femia D, Petrarulo S, Marinelli A, Ravaglia C, Piciucchi S. Pulmonary capillary hemangiomatosis/veno-occlusive disease diagnosed by transbronchial cryobiopsy. Pulmonology 2024; 30:310-312. [PMID: 37806921 DOI: 10.1016/j.pulmoe.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Venerino Poletti
- Department of Medical Specialities-Pulmonology, GB Morgagni Hospital /Bologna University-Forlì-Ravenna Campus, Forlì, Italy; Department of Medical and Surgical Sciences (DIMEC), Bologna University, Bologna, Italy; Department of Respiratory Diseases & Allergy, Aarhus University, Aarhus, Denmark.
| | - Davide Femia
- Department of Medical Specialities-Pulmonology, GB Morgagni Hospital /Bologna University-Forlì-Ravenna Campus, Forlì, Italy
| | - Simone Petrarulo
- Department of Medical Specialities-Pulmonology, GB Morgagni Hospital /Bologna University-Forlì-Ravenna Campus, Forlì, Italy
| | - Alessandro Marinelli
- Department of Internal Medicine-Cardiology, GB Morgagni Hospital/Bologna University-Forlì-Ravenna Campus, Forlì, Italy
| | - Claudia Ravaglia
- Department of Medical Specialities-Pulmonology, GB Morgagni Hospital /Bologna University-Forlì-Ravenna Campus, Forlì, Italy
| | - Sara Piciucchi
- Department of Radiology, GB Morgagni Hospital, Forlì, Italy
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Lyberis P, Verri G, Solidoro P, Femia F, Perotti C, Limerutti G, Delsedime L, Della Beffa E, Papotti MG, Ruffini E, Albera C, Guerrera F. Correlation between high-resolution computed tomography appearance and histopathological features in the diagnosis of interstitial lung diseases. A real-life study. Minerva Surg 2024; 79:133-139. [PMID: 37218142 DOI: 10.23736/s2724-5691.23.09948-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND According to current guidelines, a surgical biopsy is rarely required when a high-confidence radiologic interstitial lung disease (ILD) diagnosis is made on thin-section high-resolution computed tomography (HRCT). Nevertheless, disowning HRCT scans diagnosed by biopsy are more common than presumed. Our study aimed to describe the concordance rate between HRCT scans and pathological diagnoses of ILDs obtained by surgical biopsy. The current guideline suggests the use of surgical lung biopsy (SLB) in patients with newly detected ILD of unknown cause. METHODS Patients who underwent mini-invasive surgical biopsies for interstitial lung diseases from January 2018 to August 2022 were analyzed. The HRCT scans were reviewed by an observer blinded to the patient's clinical information. The concordance between histological and HRCT-scan were assessed. RESULTS Data from 104 patients with uncertain low confidence diagnosis of interstitial lung diseases at HRCT were analyzed. Most of the patients are male (65; 62.5%). The more frequent HRCT pattern were: alternative diagnoses (46; 44.23%), UIP probable (42; 40.38%), UIP indeterminate (7; 6.73%), and non-specific interstitial pneumonia (NSIP) (9, 8.65%). The more common histological diagnosis was UIP definite (30; 28.84%), hypersensitivity pneumonia [HP](19; 18.44%), NSIP (15; 14.42%), sarcoidosis (10; 9.60%). In 7 (20%) cases, the final pathological finding denies HRCT-scans diagnoses; indeed, a moderate agreement was observed between HRCT-scan findings and the definitive histological diagnosis (kappa index: 0.428). CONCLUSIONS HRCT-scan has limitations if the objective is to define interstitial lung diseases accurately. Consequently, pathological assessment should be taken into account in order to provide more accurate tailored treatment strategies because the risk is to wait from 12 to 24 months to ascertain if the ILD will be treatable as progressive pulmonary fibrosis (PPF). Undeniably true, video-assisted surgical lung biopsy (VASLB) with endotracheal intubation and mechanical ventilation is associated with a risk of mortality and morbidity that is far from nil. Nevertheless, in recent years a VASLB approach performed in awake subjects under loco-regional anesthesia (awake-VASLB) has been suggested as an effective method to obtain a highly confident diagnosis in patients with diffuse pathologies of the lung parenchyma.
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Affiliation(s)
- Paraskevas Lyberis
- Unit of Thoracic Surgery, Cardio-Vascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giulia Verri
- Unit of Pulmonology, Cardio-Vascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Paolo Solidoro
- Department of Medical Sciences, University of Turin, Turin, Italy -
| | - Federico Femia
- Department of Surgical Science, University of Turin, Turin, Italy
| | - Costanza Perotti
- Unit of Pulmonology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giorgio Limerutti
- Unit of Radiology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Luisa Delsedime
- Unit of Pathology, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | | | - Enrico Ruffini
- Department of Surgical Science, University of Turin, Turin, Italy
| | - Carlo Albera
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesco Guerrera
- Unit of Thoracic Surgery, Cardio-Vascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
- Department of Surgical Science, University of Turin, Turin, Italy
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11
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Menezes V, Pollock C, Ferraro P, Nasir B, Leduc C, Morisset J, Liberman M. Defining Optimal Settings for Lung Cryobiopsy in End-Stage Pulmonary Disease. A Human, Ex Vivo, Diseased Lung Clinical Trial. J Bronchology Interv Pulmonol 2024; 31:188-198. [PMID: 37975519 DOI: 10.1097/lbr.0000000000000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/14/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND To evaluate optimal settings of probe size, freezing time, and distance to the pleura that influence the size and quality of biopsy specimens during transbronchial lung cryobiopsies in ESPD. METHODS We prospectively recruited 17 patients undergoing lung transplantation. We created a nonperfused ex vivo bronchoscopy setting to perform multiple cryobiopsies with different probe sizes (1.7, 1.9, and 2.4 mm), freezing times (3, 5, 7, 10, 20, 30 seconds), and probe distance from pleura (5, 10, and 20 mm). Alveolated pulmonary parenchyma area≥50% in histology was considered a good quality biopsy, with a minimum procedural artifact. We used logistic regression to identify independent parameters as risk factors for histologic adequacy. RESULTS A total of 545 cryobiopsies were obtained from 34 explanted lungs after pneumonectomy for lung transplantation. The mean maximum diameter of the specimen achieved with the 1.7 probe was larger (13.5 mm) than those obtained with 1.9 and 2.4 mm probes (11.3 and 10.7 mm, P= 0.07). More pleural macroscopic damage and pleural tissue in histology occurred with the 2.4 mm probe ( P <0.001). There was no difference in the quality of specimens between the different freezing times and the distance from the pleura. CONCLUSIONS Freezing time and distance from the pleura did not affect the histologic quality for diagnosing ESPD in severely damaged lungs. Smaller cryoprobe size did not negatively affect sample adequacy.
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Affiliation(s)
- Vanessa Menezes
- Division of Thoracic Surgery, Centre Hospitalier de l' Université de Montreal (CHUM), CHUM Endoscopic Tracheo-bronchial and Oesophageal Center (CETOC)
| | - Clare Pollock
- Division of Thoracic Surgery, Centre Hospitalier de l' Université de Montreal (CHUM), CHUM Endoscopic Tracheo-bronchial and Oesophageal Center (CETOC)
| | - Pasquale Ferraro
- Division of Thoracic Surgery, Centre Hospitalier de l' Université de Montreal (CHUM), CHUM Endoscopic Tracheo-bronchial and Oesophageal Center (CETOC)
| | - Basil Nasir
- Division of Thoracic Surgery, Centre Hospitalier de l' Université de Montreal (CHUM), CHUM Endoscopic Tracheo-bronchial and Oesophageal Center (CETOC)
| | - Charles Leduc
- Department of Pathology, Centre Hospitalier de l' Université de Montreal (CHUM)
| | - Julie Morisset
- Division of Pulmonology, Centre Hospitalier de l' Université de Montreal (CHUM), Montreal, Quebec, Canada
| | - Moishe Liberman
- Division of Thoracic Surgery, Centre Hospitalier de l' Université de Montreal (CHUM), CHUM Endoscopic Tracheo-bronchial and Oesophageal Center (CETOC)
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12
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Lucà S, Pagliuca F, Perrotta F, Ronchi A, Mariniello DF, Natale G, Bianco A, Fiorelli A, Accardo M, Franco R. Multidisciplinary Approach to the Diagnosis of Idiopathic Interstitial Pneumonias: Focus on the Pathologist's Key Role. Int J Mol Sci 2024; 25:3618. [PMID: 38612431 PMCID: PMC11011777 DOI: 10.3390/ijms25073618] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Idiopathic Interstitial Pneumonias (IIPs) are a heterogeneous group of the broader category of Interstitial Lung Diseases (ILDs), pathologically characterized by the distortion of lung parenchyma by interstitial inflammation and/or fibrosis. The American Thoracic Society (ATS)/European Respiratory Society (ERS) international multidisciplinary consensus classification of the IIPs was published in 2002 and then updated in 2013, with the authors emphasizing the need for a multidisciplinary approach to the diagnosis of IIPs. The histological evaluation of IIPs is challenging, and different types of IIPs are classically associated with specific histopathological patterns. However, morphological overlaps can be observed, and the same histopathological features can be seen in totally different clinical settings. Therefore, the pathologist's aim is to recognize the pathologic-morphologic pattern of disease in this clinical setting, and only after multi-disciplinary evaluation, if there is concordance between clinical and radiological findings, a definitive diagnosis of specific IIP can be established, allowing the optimal clinical-therapeutic management of the patient.
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Affiliation(s)
- Stefano Lucà
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Francesca Pagliuca
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Fabio Perrotta
- Department of Translational Medical Science, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.P.); (D.F.M.); (A.B.)
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Domenica Francesca Mariniello
- Department of Translational Medical Science, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.P.); (D.F.M.); (A.B.)
| | - Giovanni Natale
- Division of Thoracic Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Miraglia, 2, 80138 Naples, Italy; (G.N.); (A.F.)
| | - Andrea Bianco
- Department of Translational Medical Science, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.P.); (D.F.M.); (A.B.)
| | - Alfonso Fiorelli
- Division of Thoracic Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Miraglia, 2, 80138 Naples, Italy; (G.N.); (A.F.)
| | - Marina Accardo
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
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13
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Nishiyama K, Baba T, Oda T, Sekine A, Niwa T, Yamada S, Kaburaki S, Nagasawa R, Okudela K, Takemura T, Iwasawa T, Mineshita M, Ogura T. Bilateral Pneumothorax after a Transbronchial Lung Cryobiopsy for Interstitial Lung Disease. Intern Med 2024; 63:839-842. [PMID: 37532548 PMCID: PMC11009005 DOI: 10.2169/internalmedicine.2149-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Abstract
We herein report a case of bilateral pneumothorax after a unilateral transbronchial lung cryobiopsy (TBLC). A 73-year-old man with no history of cardiothoracic surgery underwent a TBLC for the reevaluation of interstitial lung disease. Five hours later, he developed bilateral pneumothorax, pneumomediastinum, and subcutaneous emphysema. He underwent bilateral chest drainage and was discharged 18 days later. The lung biopsy specimens obtained from the TBLC contained visceral pleura and bronchial cartilage, suggesting bronchial injury as the cause of the bilateral pneumothorax.
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Affiliation(s)
- Kazuhiro Nishiyama
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tsuneyuki Oda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Takashi Niwa
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Sho Yamada
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Shota Kaburaki
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Ryo Nagasawa
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Koji Okudela
- Department of Pathology, Yokohama City University Graduate School of Medicine, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
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14
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Zaizen Y, Umemoto S, Matama G, Mitsui Y, Horii T, Yano R, Tsuneyoshi S, Sasaki J, Ishii H, Okamoto M, Tominaga M, Hoshino T. Obesity may be a risk factor for transbronchial lung cryobiopsy-related adverse events in Japanese patients with interstitial lung disease. Respir Investig 2024; 62:102-106. [PMID: 38070359 DOI: 10.1016/j.resinv.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/13/2023] [Accepted: 11/04/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Transbronchial lung cryobiopsy (TBLC) is known to be associated with a high incidence of adverse events. However, few studies have investigated the correlation between obesity and the risk of TBLC-related adverse events, especially in Asians, who are known to have characteristic differences in height and weight as compared to individuals of other ethnicities. METHODS We retrospectively assessed 102 Japanese patients who underwent TBLC for the diagnosis of interstitial lung disease to evaluate the correlation between patient characteristics and the occurrence of TBLC-related adverse events (hemorrhage, pneumothorax, and acute exacerbation of interstitial lung disease). RESULTS TBLC-related adverse events occurred in 19 patients (18.6 %), with hemorrhage being the most common adverse event (in 14 patients, 13.7 %). There was no correlation between age, sex, or pulmonary function test results and the occurrence of adverse events. The body mass index (BMI) cut-off predicting the occurrence of all adverse events was 26.6 kg/m2 (sensitivity of 0.389 and specificity of 0.852), and that predicting the occurrence of adverse events of hemorrhage was 26.8 kg/m2 (sensitivity of 0.462 and specificity of 0.907). Among patients with a BMI >26.8 kg/m2, adverse events of hemorrhage occurred in 37.5 % of cases, which was higher than among those with a BMI <26.8 kg/m2. CONCLUSIONS Obesity is a risk factor for the incidence of TBLC-related adverse events, particularly adverse events of hemorrhage, in Japanese patients. The BMI cut-off values that predicted an increased frequency of TBLC-related adverse events and hemorrhage specifically were 26.6 and 26.8 kg/m2, respectively.
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Affiliation(s)
- Yoshiaki Zaizen
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan; Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Shushi Umemoto
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Goushi Matama
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Yousuke Mitsui
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Takayuki Horii
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Ryo Yano
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Shingo Tsuneyoshi
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Jun Sasaki
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Hidenobu Ishii
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Masaki Okamoto
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan; Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyouhama, Chuo-ku, Fukuoka 810-8563, Japan
| | - Masaki Tominaga
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan; Department of Community Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
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15
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Kho SS, Nyanti LE, Chai CS, Tie ST. Exploring the optimal freeze time and passes of the ultrathin cryoprobe in transbronchial cryobiopsy of peripheral pulmonary lesions. ERJ Open Res 2024; 10:00506-2023. [PMID: 38259810 PMCID: PMC10801766 DOI: 10.1183/23120541.00506-2023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/20/2023] [Indexed: 01/24/2024] Open
Abstract
In PPL-TBLC, quality of tissue matters more than quantity for accurate diagnosis. Comparable diagnostic yield with 1.1-mm cryoprobe can potentially be achieved in 6 s of freezing and three or more passes. https://bit.ly/49cbmbW.
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Affiliation(s)
- Sze Shyang Kho
- Division of Respiratory Medicine, Department of Medicine, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Malaysia
| | - Larry Ellee Nyanti
- Medical Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Chan Sin Chai
- Division of Respiratory Medicine, Department of Medicine, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Malaysia
| | - Siew Teck Tie
- Division of Respiratory Medicine, Department of Medicine, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Malaysia
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16
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Zheng Y, Zhang L, Lou Y, Fan B, Cui Y, Wu X, Tan X. The cryobiopsy in interstitial lung diseases guided by probe-based confocal laser endomicroscopy is feasible. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:998-1005. [PMID: 37584411 PMCID: PMC10542996 DOI: 10.1111/crj.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/16/2023] [Accepted: 07/12/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Transbronchial lung cryobiopsy (TBLB) is routinely used to diagnose the interstitial lung disease (ILD). These results are consistent with those of surgical lung biopsy. Fluoroscopy is also used to confirm the final position of the cryoprobe; however, it can increase radiation exposure for both patients and medical care personnel. Probe-based confocal laser endomicroscopy (pCLE) is a novel optical imaging technique that allows real-time imaging at the cellular level in vivo. pCLE technology can also be used to identify malignancy, acute rejection in lung transplantation, amiodarone lung, and pulmonary alveolar proteinosis and visualize elastin fibres in the alveolar compartment. OBJECTIVES The aim of this study is to investigate the ability of pCLE to distinguish fibrotic pulmonary issues from normal lung disease and the safety and feasibility of CLE-guided bronchoscopy and transbronchial lung cryobiopsy (TBLC) in patients with interstitial lung disease (ILD). METHODS pCLE images from 17 ILD patients were obtained during TBLB. These images were then compared with histology results to assess the correspondence rate. RESULTS pCLE imaging of the alveolar structures was performed. Key characteristics were visible, which could potentially influence the diagnostic rate (fibrotic areas) and the complication rate (blood vessel and pleura). CONCLUSION pCLE may reduce complications and increase the diagnostic yield. It is a potential guidance tool for cryobiopsy in the patients with ILD without fluoroscopy.
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Affiliation(s)
- Yu Zheng
- Department of Respiratory Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Liyan Zhang
- Department of Respiratory Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yueyan Lou
- Department of Respiratory Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Bijun Fan
- Department of Respiratory Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yongqi Cui
- Department of Respiratory Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Xueling Wu
- Department of Respiratory Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Xiaoming Tan
- Department of Respiratory Medicine, Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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17
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Husnain SMN, Sarkar A, Huseini T. Utility and Safety of Bronchoscopic Cryotechniques-A Comprehensive Review. Diagnostics (Basel) 2023; 13:2886. [PMID: 37761254 PMCID: PMC10530195 DOI: 10.3390/diagnostics13182886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Cryosurgical techniques are employed for diagnostic and therapeutic bronchoscopy and serve as important tools for the management of pulmonary diseases. The diagnosis of interstitial lung disease requires multidisciplinary team discussions after a thorough assessment of history, physical exam, computed tomography, and lung-function testing. However, histological diagnosis is required in selected patients. Surgical lung biopsy has been the gold standard but this can be associated with increased morbidity and mortality. Transbronchial lung cryobiopsy is an emerging technique and multiple studies have shown that it has a high diagnostic yield with a good safety profile. There is wide procedural variability and the optimal technique for cryobiopsy is still under investigation. There is emerging data that demonstrate that cryobiopsy is safe and highly accurate in the diagnosis of thoracic malignancies. Furthermore, cryorecanalization procedures are a useful adjunct for the palliation of tumors in patients with central airway obstruction. One should keep in mind that these procedures are not free from complications and should be carried out in a specialized center by a trained and experienced bronchoscopy team. We present a review of the literature on the diagnostic and therapeutic utility of bronchoscopy-guided cryosurgical procedures and their safety profile.
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Affiliation(s)
- Shaikh M. Noor Husnain
- Department of Internal Medicine, Division of Interventional Pulmonary Medicine, Westchester Medical Center, New York, NY 10595, USA
| | - Abhishek Sarkar
- Department of Internal Medicine, Division of Interventional Pulmonary Medicine, Westchester Medical Center, New York, NY 10595, USA
| | - Taha Huseini
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA 6150, Australia
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18
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Freund O, Wand O, Schneer S, Barel N, Shalmon T, Borsekofsky S, Hershko T, Gershman E, Adir Y, Bar-Shai A, Shitrit D, Unterman A. Transbronchial Cryobiopsy Is Superior to Forceps Biopsy for Diagnosing both Fibrotic and Non-Fibrotic Interstitial Lung Diseases. Respiration 2023; 102:852-860. [PMID: 37634496 DOI: 10.1159/000533197] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/19/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) evaluation often requires lung biopsy for definite diagnosis. In recent years, transbronchial cryobiopsy (TBCB) emerged as a procedure with higher diagnostic yield than transbronchial forceps biopsy (TBFB), especially for fibrotic ILDs. Nonetheless, studies comparing these modalities in non-fibrotic ILDs and for specific ILD diagnoses are scarce. OBJECTIVES The aim of this study was to evaluate the diagnostic yield and safety of TBCB and TBFB in patients with fibrotic and non-fibrotic ILDs. METHOD An observational retrospective multicenter study including patients with ILD diagnosis by multidisciplinary discussion that underwent TBCB or TBFB between 2017 and 2021. Chest CT scans were reviewed by a chest radiologist. Biopsy specimens were categorized as diagnostic (with specific histological pattern), nondiagnostic, or without lung parenchyma. Nondiagnostic samples were reassessed by a second lung pathologist. TBCB and TBFB diagnostic yields were analyzed by multivariate regression. Procedural complications were evaluated as well. RESULTS 276 patients were included, 116 (42%) underwent TBCB and 160 (58%) TBFB. Fibrotic ILDs were present in 148 patients (54%). TBCB diagnostic yield was 78% and TBFB 48% (adjusted odds ratio [AOR] 4.2, 95% CI: 2.4-7.6, p < 0.01). The diagnostic yield of TBCB was higher than TBFB among patients with fibrotic ILD (AOR 3.8, p < 0.01), non-fibrotic ILD (AOR 5.8, p < 0.01), and across most ILD diagnoses. TBCB was associated with higher risk for significant bleeding (10% vs. 3%, p < 0.01), but similar risk for pneumothorax. CONCLUSIONS Diagnostic yield of TBCB was superior to that of TBFB for both fibrotic and non-fibrotic ILDs, and across most diagnoses.
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Affiliation(s)
- Ophir Freund
- Center of Excellence for Interstitial Lung Diseases, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel,
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel,
| | - Ori Wand
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sonia Schneer
- Pulmonary Division, Lady Davis Carmel Medical Center, Faculty of Medicine, The Technion Institute of Technology, Haifa, Israel
| | - Nevo Barel
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Shalmon
- Department of Radiology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Sarah Borsekofsky
- Pathology Department, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Tzlil Hershko
- Center of Excellence for Interstitial Lung Diseases, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Evgeni Gershman
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Yochai Adir
- Pulmonary Division, Lady Davis Carmel Medical Center, Faculty of Medicine, The Technion Institute of Technology, Haifa, Israel
| | - Amir Bar-Shai
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - David Shitrit
- Pulmonary Department, Meir Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Avraham Unterman
- Center of Excellence for Interstitial Lung Diseases, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
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19
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Fortin M, Liberman M, Delage A, Dion G, Martel S, Rolland F, Soumagne T, Trahan S, Assayag D, Albert E, Kelly MM, Johannson KA, Guenther Z, Leduc C, Manganas H, Prenovault J, Provencher S. Transbronchial Lung Cryobiopsy and Surgical Lung Biopsy: A Prospective Multi-Centre Agreement Clinical Trial (CAN-ICE). Am J Respir Crit Care Med 2023; 207:1612-1619. [PMID: 36796092 DOI: 10.1164/rccm.202209-1812oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 02/16/2023] [Indexed: 02/18/2023] Open
Abstract
Rationale: Transbronchial cryobiopsy (TBCB) for the diagnosis of interstitial lung disease (ILD) has shown promising results, but prospective studies with matched surgical lung biopsy (SLB) have yielded conflicting results. Objectives: We aimed to assess within- and between-center diagnostic agreement between TBCB and SLB at both the histopathologic and multidisciplinary discussion (MDD) levels in patients with diffuse ILD. Methods: In a multicenter prospective study, we performed matched TBCB and SLB in patients referred for SLB. After a blinded review by three pulmonary pathologists, all cases were reviewed by three independent ILD teams in an MDD. MDD was performed first with TBCB, then with SLB in a second session. Within-center and between-center diagnostic agreement was evaluated using percentages and correlation coefficients. Measurements and Main Results: Twenty patients were recruited and underwent contemporaneous TBCB and SLB. Within-center diagnostic agreement between TBCB-MDD and SLB-MDD was reached in 37 of the 60 (61.7%) paired observations, resulting in a Cohen's κ value of 0.46 (95% confidence interval [CI], 0.29-0.63). Diagnostic agreement increased among high-confidence or definitive diagnoses on TBCB-MDD (21 of 29 [72.4%]), but not significantly, and was more likely among cases with SLB-MDD diagnoses of idiopathic pulmonary fibrosis than fibrotic hypersensitivity pneumonitis (13 of 16 [81.2%] vs. 16 of 31 [51.6%]; P = 0.047). Between-center agreement for cases was markedly higher for SLB-MDD (κ = 0.71 [95% CI, 0.52-0.89]) than TBCB-MDD (κ = 0.29 [95% CI, 0.09-0.49]). Conclusions: This study demonstrated moderate TBCB-MDD and SLB-MDD diagnostic agreement for ILD, while between-center agreement was fair for TBCB-MDD and substantial for SLB-MDD. Clinical trial registered with www.clinicaltrials.gov (NCT02235779).
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Affiliation(s)
- Marc Fortin
- Department of Pulmonary Medicine and Thoracic Surgery
| | | | - Antoine Delage
- Department of Medicine, Charles-Lemoyne Hospital, Sherbrooke University, Longueuil, Canada
| | | | - Simon Martel
- Department of Pulmonary Medicine and Thoracic Surgery
| | - Fabien Rolland
- Departement of Pulmonary Medicine, Cannes Medical Center, Cannes, France
| | - Thibaud Soumagne
- Departement of Pulmonary Medicine and Intensive Care, Georges Pompidou European Hospital, Paris Hospital Public Assistance, Paris, France
| | | | - Deborah Assayag
- Department of Medicine, McGill University Health Center, McGill University, Montreal, Quebec, Canada; and
| | - Elisabeth Albert
- Department of Radiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Zachary Guenther
- Department of Radiology, South Health Campus, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Julie Prenovault
- Department of Radiology, University of Montreal Health Center, University of Montreal, Montreal, Quebec, Canada
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20
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Hayat Syed MK, Bruck O, Kumar A, Surani S. Acute exacerbation of interstitial lung disease in the intensive care unit: Principles of diagnostic evaluation and management. World J Crit Care Med 2023; 12:153-164. [PMID: 37397591 PMCID: PMC10308341 DOI: 10.5492/wjccm.v12.i3.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/18/2023] [Accepted: 05/17/2023] [Indexed: 06/08/2023] Open
Abstract
Interstitial lung disease (ILD) is typically managed on an outpatient basis. Critical care physicians manage patients with ILD in the setting of an acute exacerbation (ILD flare) causing severe hypoxia. The principles of management of acute exacerbation of ILD are different from those used to manage patients with acute respiratory distress syndrome from sepsis, etc. Selected patients may be candidates for aggressive measures like extracorporeal membrane oxygenation and lung transplantation, while almost all patients will benefit from early palliative care. This review focused on the types of ILD, diagnosis, and management pathways for this challenging condition.
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Affiliation(s)
- Muhammad K Hayat Syed
- Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX 77030, United States
| | - Or Bruck
- Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX 77030, United States
| | - Anupam Kumar
- Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX 77030, United States
| | - Salim Surani
- Department of Medicine and Pharmacology, Texas A&M University, College Station, TX 77843, United States
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21
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Menigoz C, Dirou S, Sagan C, Corne F, Moui A, Defrance C, Liberge R, Morla O, Patarin V, Nicolas A, Kandel-Aznar C, Lacoste P, Clarke JP, Cavailles A, Cellerin L, Blanc FX. [Transbronchial lung cryobiopsy in interstitial lung diseases]. Rev Mal Respir 2023; 40:469-478. [PMID: 37308261 DOI: 10.1016/j.rmr.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/13/2023] [Indexed: 06/14/2023]
Abstract
In some cases of interstitial lung disease (ILD), clinical and biological findings associated with CT scan pattern during multidisciplinary discussion (MDD) fail to yield a confident diagnosis. In these cases, histology may be necessary. Transbronchial lung cryobiopsy (TBLC) is a bronchoscopic procedure that has been developed in recent years and currently contributes to diagnostic work-up in patients with ILD. TBLC provides tissue samples for histological analysis with an acceptable risk of complications, consisting mainly in pneumothorax or bleeding. In addition to higher diagnostic yield than conventional forceps biopsies, the procedure shows a better safety profile than surgical biopsies. The indication to perform TBLC is decided during a 1st MDD and during a 2nd MDD, results can provide a diagnostic yield approximating 80%. TBLC appears to be an attractive, minimally invasive technique to be proposed as a first-line procedure in selected patients in experienced centers, while surgical lung biopsy may be considered as a second-line solution.
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Affiliation(s)
- C Menigoz
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France.
| | - S Dirou
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France
| | - C Sagan
- Nantes Université, CHU Nantes, service d'anatomopathologie, Nantes, France
| | - F Corne
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France; Clinique Jules Verne, consultation de pneumologie, Nantes, France
| | - A Moui
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France
| | - C Defrance
- Nantes Université, CHU Nantes, service d'imagerie médicale, Nantes, France
| | - R Liberge
- Nantes Université, CHU Nantes, service d'imagerie médicale, Nantes, France
| | - O Morla
- Nantes Université, CHU Nantes, service d'imagerie médicale, Nantes, France
| | - V Patarin
- Nantes Université, CHU Nantes, service d'imagerie médicale, Nantes, France
| | - A Nicolas
- Nantes Université, CHU Nantes, service d'imagerie médicale, Nantes, France
| | - C Kandel-Aznar
- Nantes Université, CHU Nantes, service d'anatomopathologie, Nantes, France
| | - P Lacoste
- Nantes Université, CHU Nantes, service de chirurgie thoracique et cardiovasculaire, l'institut du thorax, Nantes, France
| | - J P Clarke
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France; Clinique ELSAN Santé Atlantique, consultation de pneumologie, Saint-Herblain, France
| | - A Cavailles
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France
| | - L Cellerin
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France
| | - F-X Blanc
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France
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22
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Ruaro B, Tavano S, Confalonieri P, Pozzan R, Hughes M, Braga L, Volpe MC, Ligresti G, Andrisano AG, Lerda S, Geri P, Biolo M, Baratella E, Confalonieri M, Salton F. Transbronchial lung cryobiopsy and pulmonary fibrosis: A never-ending story? Heliyon 2023; 9:e14768. [PMID: 37025914 PMCID: PMC10070648 DOI: 10.1016/j.heliyon.2023.e14768] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Background The diagnostic process of pulmonary fibrosis (PF) is often challenging, requires a collaborative effort of several experts, and often requires bioptic material, which can be difficult to obtain, both in terms of quality and technique. The main procedures available to obtain such samples are transbronchial lung cryobiopsy (TBLC) and surgical lung biopsy (SLB). Objective The purpose of this paper is to review the evidence for the role of TBLC in the diagnostic-therapeutic process of PF. Methods A comprehensive review was performed to identify articles to date that addressed the role of TBLC in the diagnostic-therapeutic process of PF using the PubMed® database. Results The reasoned search identified 206 papers, including 21 manuscripts (three reviews, one systematic review, two guidelines, two prospective studies, three retrospective studies, one cross-sectional study, one original article, three editorials, three clinical trials, and two unclassifiable studies), which were included in the final review. Conclusions TBLC is gaining increasing efficacy and improving safety profile; however, there are currently no clear data demonstrating its superiority over SLB. Therefore, the two techniques should be considered with careful rationalization on a case-by-case basis. Further research is needed to further optimize and standardize the procedure and to thoroughly study the histological and molecular characteristics of PF.
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23
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Tertemiz KC, Alpaydın AÖ, Güler N, Karaçam V, Gürel D, Gezer NS. Transbronchial lung cr onchial lung cryobiopsy for the diagnosis of diffuse obiopsy for the diagnosis of diffuse parenchymal lung disease: Pitfalls and challenges, a single center experience. Turk J Med Sci 2023; 53:100-108. [PMID: 36945960 PMCID: PMC10388003 DOI: 10.55730/1300-0144.5563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/04/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND : Transbronchial lung cryobiopsy (TBLC) is a minimally invasive technique of the diagnosis of diffuse parenchymal lung diseases (DPLD). The aim of this study is to determine the clinical-radiological and histopathological characteristics of patients in whom cryobiopsy contributes to the diagnosis. METHODS : In this retrospective study, we searched for the medical records of patients who underwent TBLC from July 2015 to March 2020 at the pulmonology department of our university hospital clinic. Radiological images were evaluated by a chest radiologist experienced in DPLD. Prediagnosis was indicated by clinical-radiological findings. The final diagnosis was determined by the contribution of histopathological diagnosis. The agreement of pretest/posttest diagnosis and the diagnostic yield of TBLC were calculated. RESULTS Sixty-one patients with female predominance (59.0%) and current or ex-smoker (49.2%) made up the study population. We found the diagnostic yield of TBLC 88.5%. The most common radiological and clinical-radiological diagnosis was idiopathic pulmonary fibrosis (IPF) (n = 12, 19.6%) while the most common multidisciplinary final diagnosis was cryptogenic organizing pneumonia (COP) (n = 14, %22.9). The concordance of pre/posttests was significant (p < 0.001) with a kappa agreement = 0.485. The usual interstitial pneumonia (UIP) diagnosis was detected in six patients among 12 who were prediagnosed as IPF having also a suspicion of other DPLD by clinical-radiological evaluation (p < 0.001). After the contribution of TBLC, the multidisciplinary final diagnosis of 22(36.1) patients changed. The histopathological diagnosis in which the clinical-radiological diagnosis changed the most was nonspecific interstitial pneumonia (NSIP). DISCUSSION We found the overall diagnostic yield of TBLC high. The pretest clinical-radiological diagnosis was often compatible with the multidisciplinary final diagnosis. However, TBLC is useful for the confirmation of clinical radiological diagnosis as well as clinical entities such as NSIP which is difficult to diagnose clinical-radiological. We also suggest that TBLC should be considered in patients whose clinicopathological IPF diagnosis is not precise.
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Affiliation(s)
- Kemal Can Tertemiz
- Department of Respiratory Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Aylin Özgen Alpaydın
- Department of Respiratory Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Nurcan Güler
- Department of Respiratory Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Volkan Karaçam
- Department of Thoracic Surgery, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Duygu Gürel
- Department of Pathology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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24
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Loor K, Culebras M, Sansano I, Álvarez A, Sacanell J, García-de-Acilu M, Berastegui C, Polverino E, Clofent D, de Gracia J. Lung allograft transbronchial cryobiopsy for critical ventilated patients: a randomised trial. Eur Respir J 2023; 61:13993003.02354-2021. [PMID: 35896217 DOI: 10.1183/13993003.02354-2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 07/18/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Transbronchial lung cryobiopsy is an emerging technique for diagnosing pulmonary rejection. However, no prospective studies of this procedure for critically ill lung transplant recipients who require mechanical ventilation in the intensive care unit (ICU) have been performed. METHODS From March 2017 to January 2020, we performed a prospective, randomised, comparative study to assess the diagnostic yield, histological quality and safety of transbronchial lung biopsy using biopsy forceps, a 1.9-mm cryoprobe or a 2.4-mm cryoprobe. RESULTS 89 out of 129 consecutive transbronchial biopsy procedures (forceps group, 28 procedures; 1.9-mm cryoprobe group, 31 procedures; 2.4-mm cryoprobe group, 30 procedures) were randomised. Compared with lung samples from the forceps and 1.9-mm cryoprobe groups, lung samples from the 2.4-mm cryoprobe group allowed the most definitive diagnoses (p<0.01 and p=0.02, respectively), the most diagnoses of acute lung rejection (p<0.01 and p=0.01, respectively) and the most diagnoses of rejection severity (p<0.01 and p<0.01, respectively). These samples were larger (p<0.01 and p=0.04, respectively), had the most adequate alveolar tissue (p<0.01 and p=0.02, respectively), had more vessels per procedure (p<0.01 and p=0.01, respectively) and had no significant crush artefacts. Moderate bleeding was observed in 23% of cases (p=0.01 and p=0.08, respectively). No severe bleeding was observed. CONCLUSIONS Transbronchial lung biopsy using a 2.4-mm cryoprobe allows the safe collection of lung tissue samples from critically ill lung transplant recipients who require mechanical ventilation in the ICU and has good diagnostic performance.
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Affiliation(s)
- Karina Loor
- Department of Respiratory Medicine, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mario Culebras
- Department of Respiratory Medicine, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Irene Sansano
- Institute of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Antonio Álvarez
- Department of Respiratory Medicine, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Judith Sacanell
- Department of Intensive Care, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Cristina Berastegui
- Department of Respiratory Medicine, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Eva Polverino
- Department of Respiratory Medicine, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - David Clofent
- Department of Respiratory Medicine, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier de Gracia
- Department of Respiratory Medicine, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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25
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Ravaglia C, Doglioni C, Chilosi M, Piciucchi S, Dubini A, Rossi G, Pedica F, Puglisi S, Donati L, Tomassetti S, Poletti V. Clinical, radiological and pathological findings in patients with persistent lung disease following SARS-CoV-2 infection. Eur Respir J 2022; 60:2102411. [PMID: 35301248 PMCID: PMC8932282 DOI: 10.1183/13993003.02411-2021] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 02/13/2022] [Indexed: 12/18/2022]
Abstract
Some patients experience pulmonary sequelae after SARS-CoV-2 infection, ranging from self-limited abnormalities to major lung diseases. Morphological analysis of lung tissue may help our understanding of pathogenic mechanisms and help to provide consistent personalised management. The aim of this study was to ascertain morphological and immunomolecular features of lung tissue. Transbronchial lung cryobiopsy was carried out in patients with persistent symptoms and computed tomography suggestive of residual lung disease after recovery from SARS-CoV-2 infection. 164 patients were referred for suspected pulmonary sequelae after COVID-19; 10 patients with >5% parenchymal lung disease underwent lung biopsy. The histological pattern of lung disease was not homogeneous and three different case clusters could be identified, which was mirrored by their clinical and radiological features. Cluster 1 ("chronic fibrosing") was characterised by post-infection progression of pre-existing interstitial pneumonias. Cluster 2 ("acute/subacute injury") was characterised by different types and grades of lung injury, ranging from organising pneumonia and fibrosing nonspecific interstitial pneumonia to diffuse alveolar damage. Cluster 3 ("vascular changes") was characterised by diffuse vascular increase, dilatation and distortion (capillaries and venules) within otherwise normal parenchyma. Clusters 2 and 3 had immunophenotypical changes similar to those observed in early/mild COVID-19 pneumonias (abnormal expression of STAT3 in hyperplastic pneumocytes and PD-L1, IDO and STAT3 in endothelial cells). This is the first study correlating histological/immunohistochemical patterns with clinical and radiological pictures of patients with post-COVID lung disease. Different phenotypes with potentially different underlying pathogenic mechanisms have been identified.
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Affiliation(s)
- Claudia Ravaglia
- Dept of Thoracic Diseases, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Claudio Doglioni
- Dept of Pathology, University Vita-Salute, Milan and San Raffaele Scientific Institute, Milan, Italy
| | - Marco Chilosi
- Dept of Pathology, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Sara Piciucchi
- Dept of Radiology, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Alessandra Dubini
- Dept of Pathology, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Giulio Rossi
- Dept of Pathology, Fondazione Poliambulanza Istituto Ospedaliero Multispecialistico, Brescia, Italy
| | - Federica Pedica
- Dept of Pathology, San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Puglisi
- Dept of Thoracic Diseases, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Luca Donati
- Biostatistics and Clinical Trial Unit, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori"-IRST S.r.l., IRCCS, Meldola, Italy
| | - Sara Tomassetti
- Dept of Experimental and Clinical Medicine, Careggi University Hospital, Firenze, Italy
| | - Venerino Poletti
- Dept of Thoracic Diseases, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
- DIMES, University of Bologna, Bologna, Italy
- Dept of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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26
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Falerno I, Paolini A, Tamburro R, Aste G, De Bonis A, Terragni R, Vignoli M. Imaging and endoscopic diagnosis of lung diseases in small animals. A review. Top Companion Anim Med 2022; 51:100701. [PMID: 36041659 DOI: 10.1016/j.tcam.2022.100701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 08/10/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022]
Abstract
Diagnostic imaging plays a fundamental role in the diagnosis of pulmonary diseases. Radiography, ultrasound, computed tomography, and endoscopy are important tools for achieving a diagnosis. The choice of diagnostic procedure varies according to the patient, the suspected diagnosis and the risk/benefit ratio. Culture, cytology and histology are nearly always necessary to obtain a definitive diagnosis. Several biopsy sampling techniques are described. Surgical biopsies are the gold standard for the diagnosis of bronchiolitis or interstitial lung diseases but often not performed due to the high risk. In humans, the introduction of transbronchial cryobiopsies has led to excellent results in the study of interstitial lung diseases.
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Affiliation(s)
- Ilaria Falerno
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy.
| | - Andrea Paolini
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy.
| | - Roberto Tamburro
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy.
| | - Giovanni Aste
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy.
| | - Andrea De Bonis
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy.
| | | | - Massimo Vignoli
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy.
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27
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Zhou G, Ren Y, Li J, Yang T, Su N, Zhao L, Wang S, Wang D, Li Y, Tian Z, Liu R, Dai H, Wang C. The associations of radiological features of high-resolution computed tomography with the outcomes of transbronchial cryobiopsy in interstitial lung diseases: A cohort study. Front Med (Lausanne) 2022; 9:959129. [PMID: 35983090 PMCID: PMC9379136 DOI: 10.3389/fmed.2022.959129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Transbronchial cryobiopsy (TBCB) is a critical procedure in the diagnosis of interstitial lung diseases (ILD). The associations between high-resolution computed tomography (HRCT) features and outcomes of TBCB were unknown. Methods This study was conducted as a single-center prospective cohort study between September 2018 and January 2020 (NCT04047667). HRCT was obtained before performing TBCB. The clinical and radiological characteristics, complications, pathological and multidisciplinary discussion (MDD) diagnoses were recorded. The relationships between HRCT features and outcomes of TBCB were analyzed. Results TBCB was performed on 216 ILD patients. The radiological features usually interstitial pneumonia (UIP) or probable UIP, indeterminate for UIP, ground-glass opacities (GGO) and cysts were found in 55 (25.5%), 38 (17.6%), 84 (38.9%) and 9 (4.2%) patients, respectively. And 118 (54.6%) patients had high HRCT score (involved lung proportion ≥50%) in the biopsied lobe. Multivariate analysis suggested radiological probable UIP pattern may be an independent risk factor for moderate bleeding (OR = 4.304; 95% CI: 1.383–13.393; P = 0.012), while GGO may be a protective factor from moderate bleeding (OR = 0.173, 95% CI: 0.043–0.687; P = 0.013). The pathological diagnostic yield in patients presenting cysts on HRCT was significantly lower than others (44.4 vs. 87.9%; P = 0.009). While performing TBCB in the lobe with high HRCT score increased pathological diagnostic yield (91.5 vs. 79.6%; P = 0.022). Neither pneumothorax nor MDD diagnostic yields were found to be associated with HRCT features. Conclusions HRCT features were associated with moderate bleeding and pathological diagnosis. Pre-TBCB assessments of HRCT pattern and scores were helpful for bronchoscopists to make a better patient selection and procedure planning.
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Affiliation(s)
- Guowu Zhou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Yanhong Ren
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Jun Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Nan Su
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Ling Zhao
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Shumeng Wang
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Dan Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Ying Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Zheng Tian
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Ruihong Liu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Huaping Dai
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, Beijing, China
- *Correspondence: Huaping Dai
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, Beijing, China
- Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Ronaghi R, Oh S. Transbronchial Lung Cryobiopsy for Diffuse Parenchymal Lung Disease. Semin Respir Crit Care Med 2022; 43:536-540. [PMID: 35777417 DOI: 10.1055/s-0042-1748918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Transbronchial lung cryobiopsy (TBLC) offers a minimally invasive option for the diagnosis of diffuse parenchymal lung diseases, of which interstitial lung diseases comprise the most common diagnoses. It has a high diagnostic yield with prognostic and therapeutic implications. TBLC has a favorable safety profile compared with surgical lung biopsy, but associated complications include pneumothorax and bleeding. However, TBLC techniques remain variable. Here we review the latest techniques described to maximize diagnostic yield and mitigate complications of TBLC as well as how this modality has been incorporated into guidelines.
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Affiliation(s)
- Reza Ronaghi
- Division of Pulmonary and Critical Care Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Scott Oh
- Division of Pulmonary and Critical Care Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, California
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29
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Mononen M, Saari E, Hasala H, Kettunen HP, Suoranta S, Nurmi H, Randell J, Laurikka J, Uibu T, Koskela H, Kaarteenaho R, Purokivi M. Risk factors of clinically significant complications in transbronchial lung cryobiopsy: A prospective multi-center study. Respir Med 2022; 200:106922. [PMID: 35759888 DOI: 10.1016/j.rmed.2022.106922] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 06/07/2022] [Accepted: 06/18/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The use of a transbronchial lung cryobiopsy (TBLC) is increasing as a diagnostic method of interstitial lung diseases (ILD). This study aimed to evaluate risk factors associated with clinically significant complications of TBLC in ILD patients. METHODS Patients referred to Kuopio or Tampere university hospitals, in Finland, for a suspected ILD were included. The TBLC was performed in an outpatient setting for 100 patients. Patients were mechanically ventilated in general anesthesia. Fluoroscopy guidance and prophylactic bronchial balloon were used. Complications, such as bleeding, pneumothorax, infections, and mortality were recorded. Moderate or serious bleeding, pneumothorax, or death ≤90 days were defined as clinically significant complications. A multivariable model was created to assess clinically significant complications. RESULTS The extent of traction bronchiectasis (Odds ratio [OR] 1.30, Confidence interval [CI] 1.03-1.65, p = 0.027) and young age (OR 7.96, CI 2.32-27.3, p = 0.001) were associated with the risk of clinically significant complications whereas the use of oral corticosteroids ≤30 days before the TBLC (OR 3.65, CI 0.911-14.6, p = 0.068) did not quite reach statistical significance. A history of serious cough was associated with the risk of pneumothorax (OR 4.18, CI 1.10-16.0, p = 0.036). Procedure associated mortality ≤90 days was 1%. CONCLUSION The extent of traction bronchiectasis on HRCT and young age were associated with the risk of clinically significant complications whereas oral corticosteroid use did not quite reach statistical significance. A history of serious cough was associated with the risk of clinically significant pneumothorax.
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Affiliation(s)
- Minna Mononen
- Division of Respiratory Medicine, Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland; Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, POB 100, 70029, Kuopio, Finland.
| | - Eeva Saari
- Division of Respiratory Medicine, Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland; Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, POB 100, 70029, Kuopio, Finland
| | - Hannele Hasala
- Department of Respiratory Medicine, Tampere University Hospital, POB 2000, 33521, Tampere, Finland
| | - Hannu-Pekka Kettunen
- Department of Clinical Radiology, Kuopio University Hospital, POB 100, 70029, Kuopio, Finland
| | - Sanna Suoranta
- Department of Clinical Radiology, Kuopio University Hospital, POB 100, 70029, Kuopio, Finland; Institute of Clinical Radiology, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
| | - Hanna Nurmi
- Division of Respiratory Medicine, Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland; Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, POB 100, 70029, Kuopio, Finland
| | - Jukka Randell
- Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, POB 100, 70029, Kuopio, Finland
| | - Jari Laurikka
- Tampere University Heart Hospital, and Finnish Cardiovascular Research Center, Tampere University, FI-33014, Tampere, Finland
| | - Toomas Uibu
- Department of Respiratory Medicine, Tampere University Hospital, POB 2000, 33521, Tampere, Finland
| | - Heikki Koskela
- Division of Respiratory Medicine, Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland; Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, POB 100, 70029, Kuopio, Finland
| | - Riitta Kaarteenaho
- Research Unit of Internal Medicine, University of Oulu and Medical Research Center Oulu, Oulu University Hospital, POB 20, 90029, Oulu, Finland
| | - Minna Purokivi
- Center of Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, POB 100, 70029, Kuopio, Finland
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30
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Falerno I, Tamburro R, Collivignarelli F, Della Salda L, Navas L, Terragni R, Crisi PE, Paolini A, Simeoni F, Vignoli M. Comparison between Image-Guided Transbronchial Cryobiopsies and Thoracoscopic Lung Biopsies in Canine Cadaver: A Pilot Study. Animals (Basel) 2022; 12:ani12111388. [PMID: 35681852 PMCID: PMC9179493 DOI: 10.3390/ani12111388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/04/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary A definitive diagnosis for most pulmonary diseases is possible only through histopathological examination. The literature describes different methods of lung biopsy sampling depending on the case. However, for the diagnosis of diffuse interstitial pulmonary diseases and some peripheral neoplasms, the gold standard is represented by surgical lung biopsies. Given their invasiveness and the high percentage of risk for the patient, in most cases they are not carried out, resulting in a serious diagnostic gap. In human medicine, transbronchial lung cryobiopsies have been introduced as an alternative, which have shown high efficacy and reduced invasiveness. This study aims to evaluate the feasibility of the new technique in dogs by subjecting dog cadavers to pulmonary cryobiopsy and surgical lung biopsies, and to compare the samples obtained for histopathological quality. In total, 42 tissue samples were compared. Pulmonary cryobiopsies were smaller than surgical biopsies but with high levels of agreement upon histological evaluation. This study demonstrates the feasibility of the technique in dogs and the collection of specimens with size and histological features comparable to those from surgical biopsies. Abstract To date, the only method of sampling lung tissue with a high diagnostic yield is represented by surgical lung biopsies (SLB), which are highly invasive and have a high risk/benefit ratio. In humans, transbronchial lung cryobiopsies (TBLC) have recently been introduced, which are described to be less invasive and able to significantly increase diagnostic confidence in most patients with interstitial lung diseases. The aim of this study was to evaluate the feasibility and diagnostic yield of TBLC compared to SLB in small animals. A total of 21 pulmonary cryobiopsies under fluoroscopic and real-time CT fluoroscopic guidance and 21 video-assisted thoracoscopic surgery (VATS) lung biopsies were collected from three dog cadavers. Upon histological examination, cryobiopsy samples were smaller than VATS biopsies, but were still large enough to reach a specific diagnosis or to allow pattern recognition. Morphological features on TBLC and SLB were concordant in all cases. Cryobiopsy samples showed fewer artifacts and a higher percentage of alveolar tissue than VATS samples. TBLC is a feasible and useful alternative to SLB for lung histopathological examination in dogs. The effectiveness and reduced invasiveness of TBLC compared to SLB could represent many advantages in the diagnosis of diffuse lung diseases in small animals.
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Affiliation(s)
- Ilaria Falerno
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
- Correspondence: (I.F.); (L.D.S.)
| | - Roberto Tamburro
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
| | - Francesco Collivignarelli
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
| | - Leonardo Della Salda
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
- Correspondence: (I.F.); (L.D.S.)
| | - Luigi Navas
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80137 Naples, Italy;
| | | | - Paolo Emidio Crisi
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
| | - Andrea Paolini
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
| | - Francesco Simeoni
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
| | - Massimo Vignoli
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (R.T.); (F.C.); (P.E.C.); (A.P.); (F.S.); (M.V.)
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31
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Okabayashi H, Fukuda T, Iwasawa T, Oda T, Kitamura H, Baba T, Takemura T, Sakagami T, Ogura T. The new useful high-resolution computed tomography finding for diagnosing fibrotic hypersensitivity pneumonitis: "hexagonal pattern": a single-center retrospective study. BMC Pulm Med 2022; 22:76. [PMID: 35246090 PMCID: PMC8897846 DOI: 10.1186/s12890-022-01869-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Centrilobular nodules, ground-glass opacity (GGO), mosaic attenuation, air trapping, and three-density pattern were reported as high-resolution computed tomography (HRCT) findings characteristic of fibrotic hypersensitivity pneumonitis (HP). However, it is often difficult to differentiate fibrotic HP from idiopathic pulmonary fibrosis (IPF). In fibrotic HP, the HRCT sometimes shows tortoiseshell-like interlobular septal thickening that extends from the subpleural lesion to the inner layers. This finding is called “hexagonal pattern,” and this study is focused on the possibility that such finding is useful for differentiating fibrotic HP from IPF. Methods This study included patients with multidisciplinary discussion (MDD) diagnosis of fibrotic HP or IPF undergoing surgical lung biopsy between January 2015 and December 2017 in Kanagawa Cardiovascular and Respiratory Center. Two radiologists have evaluated the HRCT findings without clinical and pathological information. Results A total of 23 patients were diagnosed with fibrotic HP by MDD and 48 with IPF. Extensive GGO, centrilobular nodules, and hexagonal pattern were more frequent findings in fibrotic HP than in IPF. No significant difference was observed between the two groups in the presence or absence of mosaic attenuation, air trapping, or three-density pattern. In the multivariate logistic regression, the presence of extensive GGO and hexagonal pattern was associated with increased odds ratio of fibrotic HP. The sensitivity and specificity of the diagnosis of fibrotic HP in the presence of the hexagonal pattern were 69.6% and 87.5%, respectively. Conclusion Hexagonal pattern is a useful finding for differentiating fibrotic HP from IPF.
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Affiliation(s)
- Hiroko Okabayashi
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-Higashi, Kanazawa-ku, Yokohama City, Kanagawa, 236-0051, Japan. .,Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.
| | - Taiki Fukuda
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-Higashi, Kanazawa-ku, Yokohama City, Kanagawa, 236-0051, Japan.,Department of Radiology, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-Higashi, Kanazawa-ku, Yokohama City, Kanagawa, 236-0051, Japan
| | - Tsuneyuki Oda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-Higashi, Kanazawa-ku, Yokohama City, Kanagawa, 236-0051, Japan
| | - Hideya Kitamura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-Higashi, Kanazawa-ku, Yokohama City, Kanagawa, 236-0051, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-Higashi, Kanazawa-ku, Yokohama City, Kanagawa, 236-0051, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-Higashi, Kanazawa-ku, Yokohama City, Kanagawa, 236-0051, Japan
| | - Takuro Sakagami
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-Higashi, Kanazawa-ku, Yokohama City, Kanagawa, 236-0051, Japan
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32
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Rivière F, Cazes A, Bylicki O, Le Floch H, Gaspard W, Cornetto MA, Charton F, Margery J, Grassin F. Single-centre experience of transbronchial cryobiopsy as a first choice method for the diagnosis of interstitial lung disease. Indian J Thorac Cardiovasc Surg 2022; 38:142-148. [PMID: 35221552 PMCID: PMC8857330 DOI: 10.1007/s12055-021-01299-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/04/2021] [Accepted: 11/07/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The diagnosis of interstitial lung disease is based on clinical and biological analysis associated with computed tomography (CT) pattern after discussion in multidisciplinary discussion. Lung transbronchial cryobiopsy has emerged with acceptable diagnostic reliability and low morbidity and mortality. The goal of our work is to describe our experience with lung cryobiopsy. METHODS This is monocentric and retrospective analysis of prospectively collected data on epidemiological, clinical, biological, CT, respiratory and histological features of patients with lung transbronchial cryobiopsy between January 1st, 2017, and July 1st, 2020. RESULTS Lung transbronchial cryobiopsy has been done for 23 patients with sex ratio M/F of 1.1, majority of smoker/former smoker. Thirty-nine percent of procedures were complicated by pneumothorax. On the haemorrhagic level, we reported 1 grade 2 bleeding (no serious bleeding). An histological diagnosis was obtained for 19 patients (82%). Only 4 patients needed to discuss surgical lung biopsy: 2 (8.6%) surgical lung biopsy, 1 refused surgical lung biopsy and 1 patient lost to follow-up. CONCLUSION Our results suggest that transbronchial lung cryobiopsy may be considered the first diagnostic modality instead of surgical lung biopsy for interstitial lung disease in appropriate patients. Larger studies are, however, needed to confirm our observations.
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Affiliation(s)
- Frédéric Rivière
- Respiratory Department, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - Aurélie Cazes
- Anatomopathological Department, Bichat Teaching Hospital, Paris, France
| | - Olivier Bylicki
- Respiratory Department, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - Hervé Le Floch
- Respiratory Department, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - Wanda Gaspard
- Respiratory Department, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - Marie Alice Cornetto
- Respiratory Department, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - France Charton
- Respiratory Department, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - Jacques Margery
- Respiratory Department, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
| | - Frédéric Grassin
- Respiratory Department, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
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33
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Ravaglia C, Poletti V. Transbronchial lung cryobiopsy for the diagnosis of interstitial lung diseases. Curr Opin Pulm Med 2022; 28:9-16. [PMID: 34750300 DOI: 10.1097/mcp.0000000000000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Transbronchial lung cryobiopsy has shown promise in several studies in providing meaningful histological information in the multidisciplinary team diagnosis of fibrotic interstitial lung diseases. The purpose of this review is to describe recent literature providing support for the formal integration of cryobiopsy into the algorithm for interstitial lung disease diagnosis. RECENT FINDINGS Histopathological concordance between cryobiopsy and surgical biopsy and diagnostic agreement at multidisciplinary discussion have been reported good; furthermore, cryobiopsy may provide an increased diagnostic confidence to a level likely to influence management. Finally, although cryobiopsy is more likely to provide a probable usual interstitial pneumonia (UIP) pattern than a definite UIP pattern, given the limited sampling of sub-pleural lung parenchyma in most cases, finding of a probable UIP pattern at cryobiopsy samples is strongly predictive of a definite UIP pattern in the corresponding surgical biopsy and when a UIP pattern is found on cryobiopsy sample, this is associated with higher mortality compared with other histological patterns. SUMMARY Cryobiopsy is becoming a valid alternative to surgical lung biopsy for making histopathological diagnosis in patients with interstitial lung diseases of undetermined type in experienced centres, with standardized protocols, in order to have the best risks/diagnostic yields ratio.
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Affiliation(s)
- Claudia Ravaglia
- Department of Thoracic Diseases, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Venerino Poletti
- Department of Thoracic Diseases, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Abstract
Acute exacerbation is a major cause of morbidity and mortality in patients with idiopathic pulmonary fibrosis. Although the real nature of it is still not clear and there is no proven effective therapy, progress has been made since the consensus definition and diagnostic criteria were proposed. The trial results of several new innovative therapies in idiopathic pulmonary fibrosis have suggested a potential for benefit in acute exacerbation of idiopathic pulmonary fibrosis, leading to double blind randomized clinical trials in this area. This article reviews the present knowledge on acute exacerbation of idiopathic pulmonary fibrosis, focusing on the triggering factors and treatment.
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35
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Andreo García F, Torky M, Centeno Clemente C, Serra Mitjà P, Rosell Gratacós A, Tazi Mezalek R. Transbronchial Cryobiopsy of Peripheral Pulmonary Lesions Guided With Real-Time Transthoracic Ultrasonography. Arch Bronconeumol 2021; 57:772-774. [PMID: 35698989 DOI: 10.1016/j.arbr.2020.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/20/2020] [Indexed: 06/15/2023]
Affiliation(s)
- Felipe Andreo García
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Ciber de Enfermedades Respiratorias (CIBERES), Spain.
| | - Mohamed Torky
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Chest Department, Tanta University, Egypt
| | - Carmen Centeno Clemente
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Pere Serra Mitjà
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Antoni Rosell Gratacós
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Ciber de Enfermedades Respiratorias (CIBERES), Spain
| | - Rachid Tazi Mezalek
- Respiratory Department, Thorax Clinic Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Coelho DB, Boaventura R, Meira L, Guimarães S, Moura CS, Mota P, Melo N, Carvalho A, Pereira JM, Magalhães A, Morais A, Novais Bastos H. The Role of Ultrasonography in the Diagnosis and Decision Algorithm for the Management of Pneumothorax after Transbronchial Lung Cryobiopsy. Respiration 2021; 101:67-75. [PMID: 34818255 DOI: 10.1159/000518140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pneumothorax is one of the main complications of transbronchial lung cryobiopsy (TBLC). Chest ultrasound (CUS) is a radiation-free alternative method for pneumothorax detection. OBJECTIVE We tested CUS diagnostic accuracy for pneumothorax and assessed its role in the decision algorithm for pneumothorax management. Secondary objectives were to evaluate the post-procedure pneumothorax occurrence and risk factors. METHODS Eligible patients underwent TBLC, followed by chest X-ray (CXR) evaluation 2 h after the procedure, as our standard protocol. Bedside CUS was performed within 30 min and 2 h after TBLC. Pneumothorax by CUS was defined by the absence of lung sliding and comet-tail artefacts and confirmed with the stratosphere sign on M-mode. Pneumothorax size was determined through lung point projection on CUS and interpleural distance on CXR and properly managed according to clinical status. RESULTS Sixty-seven patients were included. Nineteen pneumothoraces were detected at 2 h after the procedure, of which 8 (42.1%) were already present at the first CUS evaluation. All CXR-detected pneumothoraces had a positive CUS detection. There were 3 discordant cases (κ = 0.88, 95% CI: 0.76-1.00, p < 0.001), which were detected by CUS but not by inspiration CXR. We calculated a specificity of 97.5% (95% CI: 86.8-99.9) and a sensitivity of 100% (95% CI: 87.2-100) for CUS. Pneumothorax rate was higher when biopsies were taken in 2 lobes and if histology had pleural representation. Final diagnosis was achieved in 79.1% of patients, with the most frequent diagnosis being hypersensitivity pneumonitis. Regarding patients with large-volume pneumothorax needing drainage, the rate of detection was similar between CUS and CRX. CONCLUSION CUS can replace CXR in detecting the presence of pneumothorax after TBLC, and the lung point site can reliably indicate its size. This useful method optimizes time spent at the bronchology unit and allows immediate response in symptomatic patients, helping to choose optimal treatment strategies, while preventing ionizing radiation exposure.
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Affiliation(s)
- David Barros Coelho
- Department of Pneumology, Centro Hospitalar São João, Porto, Portugal, .,Faculty of Medicine, University of Porto, Porto, Portugal,
| | - Rita Boaventura
- Department of Pneumology, Centro Hospitalar São João, Porto, Portugal
| | - Leonor Meira
- Department of Pneumology, Centro Hospitalar São João, Porto, Portugal.,Department of Pneumology, Hospital de Braga, Braga, Portugal
| | - Susana Guimarães
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal
| | | | - Patrícia Mota
- Department of Pneumology, Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Natália Melo
- Department of Pneumology, Centro Hospitalar São João, Porto, Portugal
| | - André Carvalho
- Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Radiology, Centro Hospitalar São João, Porto, Portugal
| | | | - Adriana Magalhães
- Department of Pneumology, Centro Hospitalar São João, Porto, Portugal
| | - António Morais
- Department of Pneumology, Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal.,IBMC/i3S - Instituto de Biologia Molecular e Celular/Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Helder Novais Bastos
- Department of Pneumology, Centro Hospitalar São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal.,IBMC/i3S - Instituto de Biologia Molecular e Celular/Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
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37
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Shabalina IY, Tikhonov AM, Shishova SV, Semenova LA, Sivokozov IV. [Radial endobronchial ultrasound combined with transbronchial lung cryobiopsy in differential diagnosis of pulmonary infiltrate]. Khirurgiia (Mosk) 2021:84-89. [PMID: 34270199 DOI: 10.17116/hirurgia202107184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Differential diagnosis of pulmonary infiltrates is difficult due to the absence of specific clinical and radiological manifestations. Differential diagnosis of pulmonary infiltrates usually includes the following «triad»: pneumonia, tuberculosis, lung cancer. Diagnosis of pulmonary tuberculosis is based on microbiological examination of sputum and bronchoscopic respiratory samples - bronchial washing and bronchoalveolar lavage. Efficiency of molecular genetic methods (including express tests) in detecting M. tuberculosis DNA can reach 91-98%. Therefore, treatment may be started without data of microbiological examination. Nevertheless, there are rare cases of false-positive results of PCR in patients with non-tuberculous lung lesions. This aspect often results false diagnosis and delayed verification of true cause of lung lesion. Another adverse effect is associated with anti-tuberculosis therapy. Endoscopic transbronchial lung biopsy and its modern version (transbronchial cryobiopsy) as a minimally invasive diagnostic procedure are performed in such patients. These methods require a sufficiently high experience and qualification of specialist and following such aspects as navigation techniques and balloon bronchial blocking. We present this clinical case as a demonstration of modern possibilities of multimodal navigational bronchoscopic diagnosis with transbronchial cryobiopsy for local pulmonary infiltrate.
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Affiliation(s)
| | - A M Tikhonov
- Central Tuberculosis Research Institute, Moscow, Russia
| | - S V Shishova
- Central Tuberculosis Research Institute, Moscow, Russia
| | - L A Semenova
- Central Tuberculosis Research Institute, Moscow, Russia
| | - I V Sivokozov
- Central Tuberculosis Research Institute, Moscow, Russia
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Goel MK, Kumar A, Maitra G, Singh B, Ahlawat S, Jain P, Garg N, Verma RK. Radial EBUS-Guided Cryobiopsy of Peripheral Lung Lesions With Flexible Bronchoscopy Without Using Guide-Sheath. J Bronchology Interv Pulmonol 2021; 28:184-191. [PMID: 33828049 DOI: 10.1097/lbr.0000000000000768] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND A guide-sheath (GS) is conventionally used as a conduit for biopsy forceps under the guidance of radial endobronchial ultrasound (REBUS) for sampling the peripheral pulmonary lesions (PPLs). As compared with forceps, the cryoprobe has the advantage of obtaining larger samples. There is a paucity of literature on the use of cryobiopsy for PPL. We evaluated the diagnostic yield and safety of the REBUS-guided cryobiopsy (REBUS-CB) without using GS for the diagnosis of PPL. METHODS We retrospectively analyzed the database of 126 patients with PPL between November 2015 and December 2019. The REBUS-CB was performed using a flexible bronchoscopy without GS. Multidisciplinary consensus diagnostic yield was determined and procedural complications were recorded. RESULTS The histopathologic diagnosis by REBUS-CB, which is the primary objective of the study was obtained in 99 (78.6%) of total 126 cases. Yield was significantly higher in central lesions as compared to adjacent lesions visualized by the REBUS probe (81.4% versus 53.8%, P=0.021) but not significantly different between large (≥30 mm) and small (<30 mm) lesions (81.6% versus 71.8%, P=0.214). The average largest diameter of biopsy specimens was 6.9 mm (range 1-12, SD 2.132). We witnessed moderate bleeding in 7 (5.6%) and post procedure hypoxic respiratory failure in 4 (3.2%) cases which could be managed without escalation of care. CONCLUSION The REBUS-CB from peripheral lung lesions are feasible even without using GS and significantly large samples can be obtained.
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Affiliation(s)
- Manoj K Goel
- Department of Pulmonology, Critical Care and Sleep Medicine
| | - Ajay Kumar
- Department of Pulmonology, Critical Care and Sleep Medicine
| | - Gargi Maitra
- Department of Pulmonology, Critical Care and Sleep Medicine
| | | | | | | | | | - Radha Krishan Verma
- Radiology, Fortis Memorial Research Institute, Gurugram (Delhi NCR), Haryana, India
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Shin YJ, Yun G, Yoon SH, Song H, Kim J, Kim J, Park JS, Lee KW, Lee KH. Accuracy and complications of percutaneous transthoracic needle lung biopsy for the diagnosis of malignancy in patients with idiopathic pulmonary fibrosis. Eur Radiol 2021; 31:9000-9011. [PMID: 34003347 DOI: 10.1007/s00330-021-08038-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To determine the accuracy of CT-guided percutaneous transthoracic needle lung biopsy (PTNB) for the diagnosis of malignancy and the associated complication rates in patients with idiopathic pulmonary fibrosis (IPF). METHODS This retrospective study included 91 CT-guided PTNBs performed in 80 patients with IPF from April 2003 through December 2016. Data regarding patients, target lesions, procedures, complications, and pathological reports were collected, and the final diagnosis was made. The diagnostic accuracy, sensitivity, specificity, percentage of nondiagnostic results, and complication rates were determined. Multivariable logistic regression analyses were performed to identify risk factors for nondiagnostic results and major complications. RESULTS Three biopsies (technical failure [n = 2] and undetermined final diagnosis [n = 1]) were excluded from the diagnostic accuracy calculation. The diagnostic accuracy, sensitivity, and specificity were 89% (78/88), 90% (62/69), and 84% (16/19), respectively. The percentage of nondiagnostic results was 34% (30/88). Lesion size ≤ 3 cm (odds ratio [OR], 8.8; 95% confidence interval [CI], 2.5-31.2; p = 0.001) and needle tip placement outside the target lesion (OR, 13.7; 95% CI, 1.4-132.2; p = 0.02) were risk factors for nondiagnostic results. The overall and major complication rates were 51% (46/91) and 12% (11/91), respectively. The presence of honeycombing along the path of the needle (OR, 11.2; 95% CI, 1.4-89.1; p = 0.02) was an independent risk factor for major complications. CONCLUSIONS CT-guided PTNB shows a relatively reasonable accuracy in diagnosing malignancy in patients with IPF. The complication rate may be high, especially when the needle passes through honeycomb lesions. KEY POINTS • In patients with idiopathic pulmonary fibrosis (IPF), CT-guided percutaneous transthoracic needle lung biopsy (PTNB) showed a relatively reasonable accuracy for the diagnosis of malignancy. • Target lesion size ≤ 3 cm and biopsy needle tip placement outside the target lesion were risk factors for nondiagnostic results of CT-guided PTNB. • The complication rate may be high, especially in cases where the biopsy needle passes through honeycomb lesions.
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Affiliation(s)
- Yoon Joo Shin
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea.,Department of Radiology, Konkuk University Medical Center, Seoul, Korea
| | - Gabin Yun
- Department of Radiology, Division of Cardiothoracic Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sung Hyun Yoon
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Hwayoung Song
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea.,Department of Radiology , Seongnam Citizens Medical Center , Seongnam, Korea
| | - Junghoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Jihang Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Deptartment of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Kyung Hee Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea. .,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
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Safety and Performance of Transbronchial Cryobiopsy for Parenchymal Lung Lesions. Chest 2021; 160:1512-1519. [PMID: 33971147 DOI: 10.1016/j.chest.2021.04.063] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite advances in technology, the bronchoscopic diagnosis of parenchymal pulmonary lesions (PPLs) remains difficult to achieve. Transbronchial lung cryobiopsy (TLCB) offers the potential for larger samples with improved diagnostic yield; however, a paucity of data exists describing its safety and usefulness for the diagnosis of PPL. RESEARCH QUESTION What is the safety profile of TLCB for PPL? STUDY DESIGN AND METHODS An observational, retrospective, multicenter cohort study enrolled patients without endobronchial disease undergoing TLCB of PPL from 2015 through 2019. All procedures were performed using both rigid and flexible bronchoscopy with a flexible cryoprobe. Complication rates, including bleeding and pneumothorax rates, were collected. Bleeding was graded on a scale from 0 (trace) to 4 (requiring surgical intervention) with a grade of ≥ 3 considered clinically significant. Pneumothorax, tube thoracostomy placement, diagnostic yield, and need for subsequent interventions were recorded. RESULTS One thousand twenty-four patients underwent TLCB. One hundred eighty-eight patients (18%) experienced bleeding; in 36 patients (3.5%), the bleeding was clinically significant. Sixty-eight patients (6.6%) demonstrated a pneumothorax and 64 patients (6.3%) required drainage with tube thoracostomy. All chest drains were removed within 4 days, and no cases of prolonged air leak occurred. A definitive diagnosis was achieved in 932 patients (91%). Adenocarcinoma (46%) and metastatic disease (21%) were the most common diagnoses. INTERPRETATION TLCB showed an acceptable safety profile and diagnostic yield for the evaluation of PPL in this large retrospective cohort. Prospective clinical trials are underway to validate these findings further.
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Xu W, Cui H, Liu H, Feng R, Tian X, Yang Y, Xu KF. The value of transbronchial lung biopsy in the diagnosis of lymphangioleiomyomatosis. BMC Pulm Med 2021; 21:146. [PMID: 33941134 PMCID: PMC8091759 DOI: 10.1186/s12890-021-01518-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transbronchial lung biopsy (TBLB) in the diagnosis of lymphangioleiomyomatosis (LAM) is not a common approach, although TBLB is often performed in diffuse lung diseases. We aimed to examine the diagnostic value and safety of TBLB in LAM patients based on the data collected in our center. METHODS We reviewed LAM patients registered in our LAM Clinic from December 8, 2006, to December 31, 2019. All patients with definite or probable diagnosis of LAM who had been examined using TBLB were included. All available pathology slides were reviewed by an experienced LAM pathologist. All complications were reviewed by the medical records and confirmed using telephone interviews. RESULTS The pathology results of 86 patients (including 74 definite LAM and 12 probable LAM) were available. The positive rate of TBLB in LAM patients was 49/86 (57.0%). The positive rates of SMA, HMB-45, ER, and PR in LAM patients were 97.6%, 93%, 84.6%, and 78.4% respectively. The positive rate of TBLB was 40%, 60% and 60.8% in patients with CT Grade I, Grade II, and Grade III respectively, and the difference was not significant. Patients who had 3-4 or 5-6 biopsied specimens had a higher rate of diagnosis than those with 1-2 biopsied specimens. Four patients (5.6%) reported pneumothorax. No major hemoptysis was reported. CONCLUSIONS TBLB is a feasible and safe procedure for obtaining a pathological diagnosis of LAM. Taking more than 2 samples during the biopsy procedure increased the rate of diagnosis.
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Affiliation(s)
- Wenshuai Xu
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Han Cui
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China.,Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hongrui Liu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ruie Feng
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xinlun Tian
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China
| | - Yanli Yang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China.
| | - Kai-Feng Xu
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100730, China.
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Bondue B, Schlossmacher P, Allou N, Gazaille V, Taton O, Gevenois PA, Vandergheynst F, Remmelink M, Leduc D. Trans-bronchial lung cryobiopsy in patients at high-risk of complications. BMC Pulm Med 2021; 21:135. [PMID: 33902504 PMCID: PMC8074461 DOI: 10.1186/s12890-021-01503-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 04/16/2021] [Indexed: 12/23/2022] Open
Abstract
Background The surgical lung biopsy (SLB) is the recommended sampling technique when the pathological analysis of the lung is required in the work-up of an interstitial lung disease (ILD) but trans-bronchial lung cryobiopsy (TBLC) is increasingly recognized as an alternative approach. As TBLCs have lower mortality and morbidity risks than SLB, this study aimed to investigate the safety of TBLCs in patients at higher risk of complications and for whom SLB was not considered as an alternative. Method This prospective study was conducted in two hospitals in which TBLCs were performed in patients with body mass index (BMI) > 35, and/or older than 75 years, and/or with severely impaired lung function (FVC < 50% or DLCO < 30%), and/or systolic pulmonary artery pressure > 45 mmHg, and/or a clinically significant cardiac disease. Patients with any of these risk factors constituted the high-risk group. Clinical outcomes were compared with those obtained in patients without these risk factors (low-risk group). Results Ninety-six patients were included between April 2015 and April 2020, respectively 38 and 58 in the high-risk or the low-risk group. No statistically significant difference was observed between both groups in terms of severity and rate of bleeding, pneumothorax, or duration of hospital stay (p value ranging from 0.419 to 0.914). Conclusion This preliminary study on a limited number of patients suggests that TBLC appears safe in those in whom lung biopsy is at high-risk of complications according to their age, BMI, lung impairment, and cardiac comorbidities. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01503-9.
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Affiliation(s)
- Benjamin Bondue
- Department of Pneumology, Hôpital Erasme, Université libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium.
| | - Pascal Schlossmacher
- Department of Pneumology, University Hospital of La Reunion, Saint Denis, France
| | - Nathalie Allou
- Department of Pneumology, University Hospital of La Reunion, Saint Denis, France
| | - Virgile Gazaille
- Department of Pneumology, University Hospital of La Reunion, Saint Denis, France
| | - Olivier Taton
- Department of Pneumology, Hôpital Erasme, Université libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium
| | - Pierre Alain Gevenois
- Department of Radiology, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Frederic Vandergheynst
- Department of Internal Medicine, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Myriam Remmelink
- Department of Pathology, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Dimitri Leduc
- Department of Pneumology, Hôpital Erasme, Université libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium
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Turan D, Uğur Chousein EG, Koç AS, Çörtük M, Yıldırım Z, Demirkol B, Özgül MA, Çınarka H, Akalın N, Yardımcı AH, Çetinkaya E. Transbronchial cryobiopsy for diagnosing parenchymal lung diseases: real-life experience from a tertiary referral center. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2021; 38:e2021004. [PMID: 33867791 PMCID: PMC8050620 DOI: 10.36141/svdld.v38i1.11029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/23/2021] [Indexed: 11/21/2022]
Abstract
Background and Objectives: Transbronchial cryobiopsy (cryo-TBB) is increasingly being used in the diagnosis of diffuse parenchymal lung diseases (DPLD). Varying diagnostic success and complication rates have been reported. Herein we report our experience with cryo-TBB, focusing on diagnostic yield, factors affecting diagnosis, and safety. Methods: This retrospective study was conducted in a tertiary referral chest diseases hospital. Data regarding the patients, procedures, complication rates, diagnostic yield, and the final diagnosis made by a multidisciplinary committee at all diagnosis stages were evaluated. Results: We recruited 147 patients with suspected DPLD. The definitive diagnosis was made pathologically in 98 of 147 patients (66.6%) and using a multidisciplinary approach in 109 of 147 (74.1%) cases. The number of samples had a significant effect on diagnostic success. Histopathologic diagnostic yield and diagnostic yield with a multidisciplinary committee after a single biopsy were 50%, and histopathological diagnostic yield and diagnostic yield with multidisciplinary committee increased to 71.4% and 85.7%, respectively, with a second biopsy (p = 0.034). The incidence of mild-to-moderate hemorrhage was 31.9%; no severe hemorrhage occurred. Pneumothorax rate was 15.6%, and the mortality rate was 0.68%. Conclusions: Cryo-TBB has sufficient diagnostic yield in the context of a multidisciplinary diagnosis with acceptable complication rates. Performing at least 2 biopsies and from at least 2 segments increases diagnostic success.
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Affiliation(s)
- Demet Turan
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Efsun Gonca Uğur Chousein
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Aysu Sinem Koç
- Ministry of Health, Dr. Yaşar Eryilmaz Dogubayazit State Hospital, Clinic of Chest Diseases, Agri, Turkey
| | - Mustafa Çörtük
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Zeynep Yıldırım
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Bariş Demirkol
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Mehmet Akif Özgül
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Halit Çınarka
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Neslihan Akalın
- University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Department of Pathology, Istanbul, Turkey
| | - Aytül Hande Yardımcı
- University of Health Sciences Turkey, Basaksehir Cam and Sakura City Hospital, Department of Radiology, Istanbul, Turkey
| | - Erdoğan Çetinkaya
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
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Davidsen JR, Skov IR, Louw IG, Laursen CB. Implementation of transbronchial lung cryobiopsy in a tertiary referral center for interstitial lung diseases: a cohort study on diagnostic yield, complications, and learning curves. BMC Pulm Med 2021; 21:67. [PMID: 33632180 PMCID: PMC7908747 DOI: 10.1186/s12890-021-01438-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/12/2021] [Indexed: 02/07/2023] Open
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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Affiliation(s)
- Jesper Rømhild Davidsen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark. .,Department of Respiratory Medicine, South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Kloevervaenget 2, 5000, Odense C, Denmark. .,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Inge Raadal Skov
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ida Guldbæk Louw
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Department of Respiratory Medicine, South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Kloevervaenget 2, 5000, Odense C, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Endobronchial Balloon Blockers: A Retrospective Analysis of Their Implementation for Use in Transbronchial Cryobiopsy Under Conscious Sedation. Lung 2021; 199:187-193. [PMID: 33595686 DOI: 10.1007/s00408-021-00424-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Transbronchial lung cryobiopsy (TBLC) is a promising technique that is evolving as a standard diagnostic procedure in the diagnosis of interstitial lung disease. However, there are a variety of non-standardised techniques adopted for this procedure. We aim to describe our approach to TBLC with balloon blockade under conscious sedation (CS). METHODS We performed a retrospective analysis of patients undergoing TBLC using flexible bronchoscopy under CS in our institution over the calendar years 2017-2018; before and after a transition to the use of endobronchial balloon blockers (EBB) in 2017. RESULTS 25 patients underwent transbronchial cryobiopsy during the study period. Of these; 12 procedures used EBB. EBB subjects had significantly less moderate or severe airway bleeding (8.3% vs 38.5%) despite higher biopsy rates in the EBB group, 2.9 (2-4) vs 2.4 (1-4) in the non-EBB group. No severe airway bleeding occurred in the EBB group. A multidisciplinary meeting (MDM) confirmed diagnosis was achieved in 88% of patients. 10/12 subjects (83%) in the EBB group and 12/13 subjects (92%) in the non-EBB group (p = 0.5). CONCLUSION Our institution is novel in using EBB as standard during TBLC specifically under CS with flexible bronchoscopy in the bronchoscopy suite. This retrospective analysis demonstrates that EBB enhances the safety profile of performing TBLC under CS and did not appear to impact diagnostic yield or patient safety.
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O'Mahony AM, Burke L, Cavazza A, Maher MM, Kennedy MP, Henry MT. Transbronchial lung cryobiopsy (TBLC) in the diagnosis of interstitial lung disease: experience of first 100 cases performed under conscious sedation with flexible bronchoscope. Ir J Med Sci 2021; 190:1509-1517. [PMID: 33471301 DOI: 10.1007/s11845-020-02453-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diagnosing the aetiology of interstitial lung disease (ILD) may require histology via a surgical lung biopsy (SLB). SLB is associated with significant complications. Transbronchial lung cryobiopsy (TBLC) can provide large, adequate biopsies with fewer complications offering a potential alternative to SLB. AIMS This study evaluated the safety, diagnostic yield and impact of TBLC on diagnostic certainty in the multidisciplinary diagnosis (MDD) of ILD within routine clinical practice. METHODS A retrospective study of all TBLC performed in a tertiary institute from March 2014 to December 2016 was performed. Procedures were performed using a flexible bronchoscope and cryoprobe without fluoroscopic guidance. RESULTS One hundred procedures were performed on 85 patients. A total of 272 cryobiopsies were obtained with a mean biopsy diameter of 5.9 ± 3.2 mm. Ninety-seven percent contained alveolated lung tissue. Diagnosis based against MDD gold standard was confirmed using TBLC in 67.1% of patients and in 72/100 procedures. Three patients proceeded to SLB. The addition of histological information changed the clinic-radiological diagnosis in twelve patients. The most common diagnosis based on clinical-radiologic-pathologic correlation at MDD was idiopathic pulmonary fibrosis (IPF) (51.2%) and hypersensitivity pneumonitis (15.9%). Moderate bleeding occurred in 18% of cases and five patients (5%) developed pneumothorax requiring intervention. Eleven patients required admission, with a mean length of stay of 1.3 ± 0.9 days. CONCLUSION TBLC aids the diagnosis of ILD in the appropriate patient and may be an acceptable alternative to SLB with fewer complications. Further work on standardizing the procedure is required.
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Affiliation(s)
- Anne M O'Mahony
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland.
| | - Louise Burke
- Department of Histopathology, Cork University Hospital, Cork, Ireland
| | - Alberto Cavazza
- Department of Pathology, Arcispedale S Maria Nuova, Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Marcus P Kennedy
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland
| | - Michael T Henry
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland
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Mehrad M, Colby TV, Rossi G, Cavazza A. Transbronchial Cryobiopsy in the Diagnosis of Fibrotic Interstitial Lung Disease. Arch Pathol Lab Med 2021; 144:1501-1508. [PMID: 32320274 DOI: 10.5858/arpa.2020-0007-ra] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2020] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Mitra Mehrad
- From the Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Mehrad)
| | - Thomas V Colby
- the Department of Pathology, Mayo Clinic, Scottsdale, Arizona (Colby)
| | - Giulio Rossi
- the Pathology Unit, Azienda USL della Romagna, St. Maria delle Croci Hospital, Ravenna, Italy (Rossi)
| | - Alberto Cavazza
- and the Pathology Unit, Azienda USL/IRCCS di Reggio Emilia, Reggio Emilia, Italy (Cavazza)
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Goel MK, Kumar A, Maitra G, Singh B, Ahlawat S, Jain P, Garg N, Verma RK. Safety and diagnostic yield of transbronchial lung cryobiopsy by flexible bronchoscopy using laryngeal mask airway in diffuse and localized peripheral lung diseases: A single-center retrospective analysis of 326 cases. Lung India 2021; 38:109-116. [PMID: 33687002 PMCID: PMC8098897 DOI: 10.4103/lungindia.lungindia_220_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Intubation with either an endotracheal tube or a rigid bronchoscope is generally preferred to provide airway protection as well as to manage unpredictable complications during transbronchial lung cryobiopsy (TBLC). The laryngeal mask airway has been described as a safe and convenient tool for airway control during bronchoscopy. Aims and Objectives In this study, we evaluated the safety and outcome of using a laryngeal mask airway (LMA) as a conduit for performing TBLC by flexible video bronchoscopy (FB). Methods We retrospectively analyzed the database of the patients who underwent TBLC between November 2015 and September 2019. The procedure was performed using FB through LMA under general anesthesia. Prophylactic occlusion balloon was routinely used starting January 2017 onwards. Radial endobronchial ultrasound (R-EBUS) guidance was used for TBLC in the localized lung lesions when deemed necessary. Multidisciplinary consensus diagnostic yield was determined and periprocedural complications were recorded. Results A total of 326 patients were analysed. The overall diagnostic yield was 81.60% (266/326) which included a positive yield of 82.98% (161/194) in patients with diffuse lung disease and 79.54% (105/132) in patients with localized disease. Serious bleeding complication occurred in 3 (0.92%) cases. Pneumothorax was encountered in 8 (2.45%) cases. A total of 9 (2.76%) cases had at least 1 major complication. Conclusion This study demonstrates that the use of LMA during TBLC by flexible bronchoscopy allows for a convenient port of entry, adequate airway support and effective endoscopic management of intrabronchial haemorrhage especially with the use of occlusion balloon.
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Affiliation(s)
- Manoj Kumar Goel
- Department of Pulmonology, Critical Care and Sleep Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Ajay Kumar
- Department of Pulmonology, Critical Care and Sleep Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Gargi Maitra
- Department of Pulmonology, Critical Care and Sleep Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Balkar Singh
- Department of Anesthesiology, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Sunita Ahlawat
- Department of Pathology, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Priti Jain
- Department of Pathology, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Neeraj Garg
- Department of Pathology, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - R K Verma
- Department of Radiology, Fortis Memorial Research Institute, Gurugram, Haryana, India
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Barata M, Caetano Mota P, Melo N, Novais Bastos H, Guimarães S, Souto Moura C, Pereira JM, Morais A. Transbronchial lung cryobiopsy in smoking-related interstitial lung diseases. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2020; 37:e2020013. [PMID: 33597800 PMCID: PMC7883511 DOI: 10.36141/svdld.v37i4.9934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/02/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transbronchial lung cryobiopsy (TBLC) is an emerging technique in the diagnostic approach to diffuse parenchymal lung diseases. However, the role of TBLC in smoking-related Interstitial Lung Diseases (ILDs) is still under discussion. OBJECTIVES The aim of the present study was to describe our experience with TBLC in diagnostic work-up of patients with smoking-related ILDs. METHOD We retrospectively reviewed data of patients evaluated in a tertiary hospital ILDs outpatient clinic, who underwent TBLC, from September 2014 to December 2019. TBLC was performed in accordance with the 2018 expert statement from the Cryobiopsy Working Group. RESULTS Forty-five patients (25 men [55.6%]) with a mean age of 53.9 years [SD, 9.1] were included. The most frequent radiological pattern was ground glass opacity (42 patients). TBLC was performed in different segments of the same lobe in 38 patients and in two lobes in 7 patients. The mean maximal diameter of the samples was 5.2 mm (range, 3-16 mm [SD 2.0]). Pneumothorax occurred in seven patients (15%) and moderate bleeding occurred in one patient. A specific pathological diagnosis was achieved in 43 of 45 patients. The most frequent histopathologic pattern found was desquamative interstitial pneumonia (33 patients), followed by smoking-related interstitial fibrosis (7 patients), respiratory bronchiolitis - ILD (1 patient) and pulmonary Langerhans cell histiocytosis (1 patient). Two patients had alternative diagnosis (Pneumoconiosis and Interstitial Pneumonia with unspecific features) and one patient had normal lung parenchyma. A definitive multidisciplinary team (MDT) diagnosis was reached in 95.5% (43 of 45 cases). Two patients were submitted to additional diagnostic techniques. CONCLUSIONS The results from this series support TBLC as a safe procedure with a meaningful diagnostic value in the context of a MDT approach of smoking-related ILDs. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (4): e2020013).
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Affiliation(s)
- Margarida Barata
- Pulmonology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Patrícia Caetano Mota
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of Porto University, Porto, Portugal
| | - Natália Melo
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Hélder Novais Bastos
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of Porto University, Porto, Portugal
| | - Susana Guimarães
- Faculty of Medicine of Porto University, Porto, Portugal
- Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Conceição Souto Moura
- Faculty of Medicine of Porto University, Porto, Portugal
- Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Miguel Pereira
- Faculty of Medicine of Porto University, Porto, Portugal
- Radiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - António Morais
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of Porto University, Porto, Portugal
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50
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Thillai M, Atkins CP, Crawshaw A, Hart SP, Ho LP, Kouranos V, Patterson K, Screaton NJ, Whight J, Wells AU. BTS Clinical Statement on pulmonary sarcoidosis. Thorax 2020; 76:4-20. [PMID: 33268456 DOI: 10.1136/thoraxjnl-2019-214348] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Muhunthan Thillai
- Cambridge Interstitial Lung Disease Unit, Royal Papworth Hospital, Cambridge, Cambridgeshire, UK
| | - Christopher P Atkins
- Department of Respiratory Medicine, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Anjali Crawshaw
- Interstitial Lung Disease Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Simon P Hart
- Respiratory Research Group, Hull York Medical School/University of Hull, Cottingham, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, Oxford, UK.,Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
| | - Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, London, UK
| | - Karen Patterson
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | | | | | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, London, UK
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