Radial Probe Ultrasound-Guided Cryobiopsy
Fluoroscopy-guided transbronchial forceps biopsy has a low diagnostic yield in patients with radiographic suspicion of interstitial lung disease. Cryobiopsy has a higher diagnostic yield likely due to preserved lung architecture and larger biopsies; however, there is an increased risk of major airway bleeding and pneumothorax. Simultaneous use of endobronchial balloon blocker allows for containment of bleeding after cryobiopsy to the affected lobe. In the current article we describe use of radial ultrasound in identification of a target lung parenchyma without a major blood vessel adjacent to distal bronchi. After fluoroscopic marking of the selected airway a 3 second cryobiopsy was performed after localization of cryoprobe. Simultaneous use of radial ultrasound and fluoroscopy can possibly decrease bleeding complication associated with cryobiopsy in patients with suspected interstitial lung disease.
AbstractIdiopathic pulmonary fibrosis (IPF) is a progressive lung disease associated with significant morbidity and mortality. The diagnosis of IPF involves a combination of clinical history, radiological imaging and examination of histopathological samples in appropriate cases. Historically, transbronchial biopsy (TBB) has been used to obtain histological samples; however this lacks diagnostic accuracy. At present, surgical lung biopsy (SLB) is the gold standard technique for obtaining specimen samples; however this carries a significant mortality risk. Transbronchial lung cryobiopsy (TBLC) is a new technique that has bee...
CONCLUSION: A prospective randomized study is needed to evaluate the technique in France in order to specify its diagnostic performance and its safety profile in comparison to SLB. PMID: 31005425 [PubMed - as supplied by publisher]
Conclusions: In the real-world setting, cTBB has a meaningful diagnostic value in the context of a MDT approach and may enable histopathological assessment even in patients with more advanced disease unsuitable for SLB.Respiration
Conclusion: Cryobiopsy is safe procedure with low incidence of serious complications (major bleeding or pneumothorax) even when it is performed without fluoroscopy. Results in our study showed lower proportion of definitive diagnosis established after cryobiopsy which can be partly explained with the lack of pathologist's experience when we started the study.
Conclusions: In fibrosing ILD, TCB contributes to a conclusive clinical diagnosis in about 70%. In case of inconclusive findings SLB remains an optional step up procedure leading to a conclusive diagnosis in nearly all cases. Modifications of the TCB procedure can reduce complication rates. There may be a relevant risk of procedure-associate exacerbations with potentially lethal outcome.
Conclusions: CLE seems a promising alternative to fluoroscopy as a guidance tool for TBCB procedures.Respiration
CONCLUSION: Practitioners should recognize that while cryobiopsies are a high-yield, safe, and cost-effective alternative to surgical lung biopsy, not all procedures carry the same risk profiles. Hospitalized patients may have a greater propensity for pneumothorax, persistent air leak, transfer to the ICU, and 30-day mortality. PMID: 29957284 [PubMed - in process]
Conclusions: In the real world setting, cTBB has a meaningful diagnostic value in the context of a multidisciplinary team and may also enable histopathogical assessment in more advanced disease.
Introduction: Transbronchial lung cryobiopsy (TBC) has emerged as an alternative to surgical lung biopsy in interstitial lung disease (ILD). Besides its less invasive nature, some associated complications have been described.Objective: To evaluate complications of TBC and associated factors.Methods: Prospective evaluation of all patients with ILD submitted to TBC in our Center.Results: Ninety patients were included (mean age 60±13 years; 58,9% male). Twenty-two patients presented pneumothorax [18 (81.8%) patients treated with chest tube drainage; median air leak time=1 day (IQR=2)]. Factors related to pneumothorax w...
Introduction: Interstitial lung disease (ILD) is a heterogenous group of respiratory disorders with over 150 causes. Some diagnoses can be made confidently without histopathology, however there are some that are unclassifiable. International guidelines state that surgical lung biopsy is the gold standard for diagnosis of ILD. Over the last decade, transbronchial lung cryobiopsy (TBLC) in addition to forceps transbronchial biopsy (FTBB), has been increasingly utilised in diagnosing ILD. We aimed to analyse and compare diagnostic yield and complications derived from application of TBLC versus tradiational FTBB in patients wi...