Transbronchial Lung Cryobiopsy for Diffuse and Localized Peripheral Pulmonary Lesions: A Retrospective Review of Our Early Experience
Keywords:Cryobiopsy, Peripheral lung lesion, Transbronchial lung cryobiopsy, Interventional Pulmonology, Lung Cancer, Interstitial lung disease
Background: Transbronchial lung cryobiopsy (TBLC) is an emerging technique for obtaining lung biopsy. This retrospective study aimed to evaluate the performance and safety of TBLC performed on diffuse peripheral pulmonary lesions (DPPL) and localized peripheral pulmonary lesions (LPPL).
Methods: 58 patients underwent TBLC. They were divided into two groups (DPPL and LPPL) based on radiological findings. The patients’ demographic data, procedural details, complications, and radiological and pathologic diagnostic results were analyzed.
Results: The overall diagnostic yield for TBLC was 72.4%. In the subgroup analysis, the diagnostic yield was 74.3% for DPPL and 69.6% for LPPL. For LPPL, the overall diagnostic yield was 87.5% and 12.5% for lesions with positive and negative bronchus signs, respectively (P = 0.01). In both groups, the success of TBLC was not influenced by the size, number, or location of the biopsy. Thirty-two (82%) patients had mild bleeding, while six (15.4%) had moderate bleeding. Pneumothorax occurred in four (6.9%) patients, with three patients requiring chest tube drainage. The mean duration of hospital stay was longer for patients who either bled or developed pneumothorax compared to those who did not (5.64 days vs. 3.47 days; P = 0.014) and (14.25 days vs. 4.24 days; P = 0.035) respectively.
Conclusion: TBLC provided an acceptable diagnostic yield for DPPL and LPPL under fluoroscopy guidance without the use of ancillary devices such as radial endobronchial ultrasound or guide sheath. The safety profile of TBLC corresponded with a low incidence of pneumothorax and manageable bleeding complications with the routine use of an endobronchial balloon.
Raghu G, Remy-Jardin M, Myers JL, Richeldi L, Ryerson CJ, Lederer DJ, et al. Diagnosis of idiopathic pulmonary fibrosis. An official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med 2018 Sep 1;198(5):e44-68.
Lettieri CJ, Veerappan GR, Helman DL, Mulligan CR, Shorr AF. Outcomes and safety of surgical lung biopsy for interstitial lung disease. Chest 2005;127(5):1600-5
Bradley B, Branley HM, Egan JJ, Greaves MS, Hansell DM, Harrison NK, et al. Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. Thorax 2008;63 Suppl 5:v1-58
Hutchinson JP, Fogarty AW, McKeever TM, Hubbard RB. In-hospital mortality after surgical lung biopsy for interstitial lung disease in the United States. 2000 to 2011. Am J Respir Crit Care Med 2016;193(10):1161-7
Schumann C, Hetzel J, Babiak AJ, Merk T, Wibmer T, Möller P, et al. Cryoprobe biopsy increases the diagnostic yield in endobronchial tumor lesions. J Thorac Cardiovasc Surg 2010;140(2):417-21
Pajares V, Puzo C, Castillo D, Lerma E, Montero MA, Ramos-Barbón D, et al. Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: a randomized trial. Respirology 2014;19(6):900-6
Casoni GL, Tomassetti S, Cavazza A, Colby TV, Dubini A, Ryu JH, et al. Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases. PLoS One 2014;9(2):e86716
Babiak A, Hetzel J, Krishna G, Fritz P, Moeller P, Balli T, et al. Transbronchial cryobiopsy: a new tool for lung biopsies. Respiration 2009;78:203-8
Tomassetti S, Wells AU, Costabel U, Cavazza A, Colby TV, Rossi G, et al. Bronchoscopic lung cryobiopsy increases diagnostic confidence in the multidisciplinary diagnosis of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2016;193(7):745-52
Dhooria S, Sehgal IS, Aggarwal AN, Behera D, Agarwal R. Diagnostic yield and safety of cryoprobe transbronchial lung biopsy in diffuse parenchymal lung diseases: systematic review and meta-analysis. Respir Care 2016 May 1;61(5):700-12
Ganganah O, Guo SL, Chiniah M, Li YS. Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: a systematic review and meta‐analysis. Respirology 2016 Jul;21(5):834-41
Maldonado F, Danoff SK, Wells AU, Colby TV, Ryu JH, Liberman M, et al. Transbronchial cryobiopsy for the diagnosis of interstitial lung diseases: CHEST guideline and expert panel report. Chest 2020 April 1;157(4):1030-42
Travis WD, King TE, Bateman ED, Lynch DA, Capron F, Center D, et al. American Thoracic Society/European Respiratory Society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 2002 Jan 15;165(2):277-304.
Raghu G, Remy-Jardin M, Ryerson CJ, Myers JL, Kreuter M, Vasakova M, et al. Diagnosis of hypersensitivity pneumonitis in adults. An official ATS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med 2020 Aug 1;202(3):e36-69.
Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008 Mar;246(3):697-722.
Gaeta M, Pandolfo I, Volta S, Russi EG, Bartiromo G, Girone G, et al. Bronchus sign on CT in peripheral carcinoma of the lung: value in predicting results of transbronchial biopsy. AJR Am J Roentgenol 1991; 157: 1181-1185
Kurimoto N, Morita K. Bronchial branch tracing. Springer Nature; 2020 Feb 27.
Kho SS, Nyanti LE, Chai CS, Chan SK, Tie ST. Feasibility of manual bronchial branch reading technique in navigating conventional rEBUS bronchoscopy in the evaluation of peripheral pulmonary lesion. Clin Respir J 2020 October 28
Du Rand IA, Barber PV, Goldring J, Lewis RA, Mandal S, Munavvar M, et al. British Thoracic Society guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults. Thorax 2011 Nov 1;66(Suppl 3):iii1-21
Madan K, Mittal S, Gupta N, Hadda V, Mohan A, Guleria R. Cryoprobe transbronchial lung biopsy: how we do it? Lung India 2018;35(6):520-522
Sethi J, Ali MS, Mohananey D, Nanchal R, Maldonado F, Musani A. Are transbronchial cryobiopsies ready for prime time? A systematic review and meta-analysis. J Bronchol Interv Pulmonol 2019;26(1):22-32
Sryma PB, Mittal S, Madan NK, Tiwari P, Hadda V, Mohan A, et al. Efficacy of radial endobronchial ultrasound (R-EBUS) guided transbronchial cryobiopsy for peripheral pulmonary lesions (PPL’s): a systematic review and meta-analysis. Pulmonology 2021 January 10
Ali MS, Sethi J, Taneja A, Musani A, Maldonado F. Computed tomography bronchus sign and the diagnostic yield of guided bronchoscopy for peripheral pulmonary lesions. A systematic review and meta-analysis. Ann Thorac Surg 2018 Aug;15(8):978-87
Nasu S, Okamoto N, Suzuki H, Shiroyama T, Tanaka A, Samejima Y, et al. Comparison of the utilities of cryobiopsy and forceps biopsy for peripheral lung cancer. Anticancer Res 2019;39(10):5683
Udagawa H, Kirita K, Naito T, Nomura S, Ishibashi M, Matsuzawa R, et al. Feasibility and utility of transbronchial cryobiopsy in precision medicine for lung cancer: prospective single‐arm study. Cancer Sci 2020 Jul;111(7):2488
Linhas R, Marçôa R, Oliveira A, Almeida J, Neves S, Campainha S. Transbronchial lung cryobiopsy: associated complications. Rev Port de Pneumol (English Edition) 2017 Nov 1;23(6):331-7.
Nakai T, Watanabe T, Kaimi Y, Ogawa K, Matsumoto Y, Sawa K, et al. Safety profile and risk factors for bleeding in transbronchial cryobiopsy using a two-scope technique for peripheral pulmonary lesions. BMC Pulm Med 2022 Dec;22(1):1-1.
Hetzel J, Eberhardt R, Petermann C, Gesierich W, Darwiche K, Hagmeyer L, 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 Dec;20(1):140
Ravaglia C, Wells AU, Tomassetti S, Gurioli C, Gurioli C, Dubini A, 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 Dec;19(1):16
Ravaglia C, Wells AU, Tomassetti S, Dubini A, Cavazza A, Piciucchi S, et al. Transbronchial lung cryobiopsy in diffuse parenchymal lung disease: comparison between biopsy from 1 segment and biopsy from 2 segments-diagnostic yield and complications. Respiration 2017;93(4):285-92
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