https://doi.org/10.4081/monaldi.2024.2887
Assessing the effectiveness and safety of transbronchial lung cryobiopsy utilizing a flexible bronchoscope with an endobronchial blocker in diffuse parenchymal lung lesions
Submitted: December 25, 2023
Accepted: March 6, 2024
Published: March 15, 2024
Accepted: March 6, 2024
Abstract Views: 541
PDF: 350
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Transbronchial lung cryobiopsy (TBLC) with flexible bronchoscope represents an encouraging modality to obtain a larger size 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. 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 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% of the patients. 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.
Maldonado F, Danoff SK, Wells AUet al. Transbronchial cryobiopsy for the diagnosis of interstitial lung diseases: CHEST guideline and expert panel report. Chest 2020;157:1030-42.
DOI: https://doi.org/10.1016/j.chest.2019.10.048
Hetzel J, Maldonado F, Ravaglia C, et al. Transbronchial cryobiopsies for the diagnosis of diffuse parenchymal lung diseases: expert statement from the cryobiopsy working group on safety and utility and a call for standardization of the procedure. Respiration 2018;95:188-200.
DOI: https://doi.org/10.1159/000484055
Dhooria S, Bal A, Sehgal IS, et al. Transbronchial lung biopsy with a flexible cryoprobe: first case report from India. Lung India 2016;33:64-8.
DOI: https://doi.org/10.4103/0970-2113.173066
Madan K, Mittal S, Hadda V, Mohan A. Cryoprobe transbronchial lung biopsy with flexible bronchoscope using Arndt endobronchial blocker. Lung India 2019;36:241-3.
DOI: https://doi.org/10.4103/0970-2113.257708
Madan K, Mittal S, Gupta N, et al. Cryoprobe transbronchial lung biopsy: how we do it? Lung India 2018;35:520-2.
DOI: https://doi.org/10.4103/lungindia.lungindia_52_17
O’Mahony AM, Burke L, Cavazza A, et al. 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;190:1509-17.
DOI: https://doi.org/10.1007/s11845-020-02453-7
Ramaswamy A, Homer R, Killam J, et al. Comparison of transbronchial and cryobiopsies in evaluation of diffuse parenchymal lung disease. J Bronchology Interv Pulmonol 2016;23:14-21.
DOI: https://doi.org/10.1097/LBR.0000000000000246
Dhooria S, Sehgal IS, Bal A, et al. Transbronchial lung biopsy with a flexible cryoprobe during rigid bronchoscopy: standardizing the procedure. Lung India 2016;33:248-9.
DOI: https://doi.org/10.4103/0970-2113.177463
Bango-Álvarez A, Ariza-Prota M, Torres-Rivas H, et al. Transbronchial cryobiopsy in interstitial lung disease: experience in 106 cases - how to do it. ERJ Open Res 2017;3:00148-2016.
DOI: https://doi.org/10.1183/23120541.00148-2016
Du Rand IA, Blaikley J, Booton R, et al. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax 2013;68:i1-44.
DOI: https://doi.org/10.1136/thoraxjnl-2013-203618
Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011;183:788-824.
DOI: https://doi.org/10.1164/rccm.2009-040GL
Kaarteenaho R. The current position of surgical lung biopsy in the diagnosis of idiopathic pulmonary fibrosis. Respir Res 2013;14:43.
DOI: https://doi.org/10.1186/1465-9921-14-43
Korevaar DA, Colella S, Fally M, et al. European Respiratory Society guidelines on transbronchial lung cryobiopsy in the diagnosis of interstitial lung diseases. Eur Respir J 2022;60:2200425.
DOI: https://doi.org/10.1183/13993003.00425-2022
Ravaglia C, Wells AU, Tomassetti S, et al. Diagnostic yield and risk/benefit analysis of trans-bronchial lung cryobiopsy in diffuse parenchymal lung diseases: a large cohort of 699 patients. BMC Pulm Med 2019;19:16.
DOI: https://doi.org/10.1186/s12890-019-0780-3
Babiak A, Hetzel J, Krishna G, et al. Transbronchial cryobiopsy: a new tool for lung biopsies. Respiration 2009;78:203-8.
DOI: https://doi.org/10.1159/000203987
Griff S, Ammenwerth W, Schönfeld N, et al. Morphometrical analysis of transbronchial cryobiopsies. Diagn Pathol 2011;6:53.
DOI: https://doi.org/10.1186/1746-1596-6-53
Chou CL, Wang CW, Lin SM, et al. Role of flexible bronchoscopic cryotechnology in diagnosing endobronchial masses. Ann Thorac Surg 2013;95:982-6.
DOI: https://doi.org/10.1016/j.athoracsur.2012.11.044
Pajares V, Puzo C, Castillo D, et al. Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: a randomized trial. Respirology 2014;19:900-6.
DOI: https://doi.org/10.1111/resp.12322
Fruchter O, Fridel L, El Raouf BA, et al. Histological diagnosis of interstitial lung diseases by cryo-transbronchial biopsy. Respirology 2014;19:683-8.
DOI: https://doi.org/10.1111/resp.12296
Khot MS, Chakraborti A, Saini JK, et al. Comparison of the diagnostic yield of transbronchial lung biopsies by forceps and cryoprobe in diffuse parenchymal lung disease. Afr J Thorac Crit Care Med 2023;29:10.7196/AJTCCM.2023.v29i3.799.
DOI: https://doi.org/10.7196/AJTCCM.2023.v29i3.799
Vinay V, Abdullah Y, Garg A, et al. The master impersonator: pulmonary tuberculosis mimicking diffuse cystic lung disease – a mini case series of a rare presentation. J Family Med Prim Care 2022;11:6590-2.
DOI: https://doi.org/10.4103/jfmpc.jfmpc_331_22
Colby T V., Tomassetti S, Cavazza A, et al. Transbronchial cryobiopsy in diffuse lung disease update for the pathologist. Arch Pathol Lab Med 2017;141:891-900.
DOI: https://doi.org/10.5858/arpa.2016-0233-RA
Casoni GL, Tomassetti S, Cavazza A, et al. Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases. PLoS One 2014;9:e86716.
DOI: https://doi.org/10.1371/journal.pone.0086716
Loor K, Culebras M, Sansano I, et al. Lung allograft transbronchial cryobiopsy for critical ventilated patients: a randomised trial. Eur Respir J 2023;61:2102354.
DOI: https://doi.org/10.1183/13993003.02354-2021
Dhooria S, Mehta RM, Srinivasan A, et al. The safety and efficacy of different methods for obtaining transbronchial lung cryobiopsy in diffuse lung diseases. Clin Respir J 2018;12:1711-20.
DOI: https://doi.org/10.1111/crj.12734
Tomassetti S, Wells AU, Costabel U, et al. Bronchoscopic lung cryobiopsy increases diagnostic confidence in the multidisciplinary diagnosis of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2016;193:745-52.
DOI: https://doi.org/10.1164/rccm.201504-0711OC
Hetzel J, Eberhardt R, Petermann C, et al. Bleeding risk of transbronchial cryobiopsy compared to transbronchial forceps biopsy in interstitial lung disease - a prospective, randomized, multicentre cross-over trial. Respir Res 2019;20:140.
DOI: https://doi.org/10.1186/s12931-019-1091-1
Johannson KA, Marcoux VS, Ronksley PE, Ryerson CJ. Diagnostic yield and complications of transbronchial lung cryobiopsy for interstitial lung disease: a systematic review and metaanalysis. Ann Am Thorac Soc 2016;13:1828-38.
DOI: https://doi.org/10.1513/AnnalsATS.201606-461SR
Giri M, Huang G, Puri A, et al. Efficacy and safety of cryobiopsy vs. forceps biopsy for interstitial lung diseases, lung tumors, and peripheral pulmonary lesions: an updated systematic review and meta-analysis. Front Med (Lausanne) 2022;9:840702.
DOI: https://doi.org/10.3389/fmed.2022.840702
Hagmeyer L, Theegarten D, Treml M, et al. Validation of transbronchial cryobiopsy in interstitial lung disease - Interim analysis of a prospective trial and critical review of the literature. Sarcoidosis Vasc Diffuse Lung Dis 2016;33:2-9.
Deasy KF, Walsh LJ, Kennedy MP, Henry MT. Endobronchial balloon blockers: a retrospective analysis of their implementation for use in transbronchial cryobiopsy under conscious sedation. Lung 2021;199:187-93.
DOI: https://doi.org/10.1007/s00408-021-00424-y
Chen X, Luo J, Yang L, et al. The diagnostic value of transbronchial lung cryobiopsy combined with rapid on-site evaluation in diffuse lung diseases: a prospective and self-controlled study. BMC Pulm Med 2022;22:124.
DOI: https://doi.org/10.1186/s12890-022-01898-z
Safety of a sheath cryoprobe bronchoscopic transbronchial biopsy technique (FROSTBITE). 2022. Available from: https://clinicaltrials.gov/ct2/show/study/NCT04486560.
Ethics Approval
This study was extended in conjunction with the research project labeled as Office letter no: NITRD/PGEC/2017/6109, obtained from the Institutional Research and Ethical Committee.How to Cite
Sharma, Deepak, Vinay V, Jitendra Kumar Saini, Prabhpreet Sethi, Lokender Kumar, and Praveen Kumar Dubey. 2024. “Assessing the Effectiveness and Safety of Transbronchial Lung Cryobiopsy Utilizing a Flexible Bronchoscope With an Endobronchial Blocker in Diffuse Parenchymal Lung Lesions”. Monaldi Archives for Chest Disease, March. https://doi.org/10.4081/monaldi.2024.2887.
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