Cryoprobe Transbronchial Lung Biopsy in Patients After Lung Transplantation

Yarmus, Lonny; Akulian, Jason; Gilbert, Christopher R.; Illei, Peter B.; Shah, Pali D.; Merlo, Christian A.; Orens, J.; Feller‐Kopman, David

doi:10.1378/chest.12-2290

Cited by 117 publications

(114 citation statements)

References 22 publications

Supporting

Mentioning

103

Contrasting

Unclassified

Order By: Relevance

“…In contrast, more than half (16 of 27, 59.3%) of conventional biopsies have diffuse crush artifact/atelectasis, while none of the cryobiopsies show diffuse crush artifact/atelectasis. Similar to our results, Yarmus et al 7 showed a significantly higher percentage of open alveoli in cryobiopsies than in conventional biopsies in a study of 21 lung allograft biopsies, using a 1.9-mm probe. Other authors 6,8,12,22 did not identify any crush artifact or compressed alveoli in the cryobiopsy specimens.…”

Section: Commentsupporting

confidence: 92%

“…Similar to our results, other authors have shown a 2-to 5-fold higher mean diameter 6,13,21 or 3-to 4-fold higher mean specimen areas 7,8,12,21 for cryobiopsies than for conventional biopsies in the setting of interstitial lung disease, lung cancer, immunocompromised hosts, and lung allografts. Although the volume of tissue recovered with cryobiopsy is approximately 4-fold of that recovered with conventional biopsies in our study, the number of alveoli, small airways, and veins and venules is only approximately 2-fold higher in cryobiopsies.…”

Section: Commentsupporting

confidence: 92%

“…4 A few reports [5][6][7][8][9][10] describe the use of cryobiopsies in immunocompromised patients, lung allografts, and endobronchial tumors. Preliminary data suggest that this technique is safe and provides larger specimens with enhanced quality.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Transbronchial Cryobiopsies in the Evaluation of Lung Allografts: Do the Benefits Outweigh the Risks?

Roden¹,

Kern

Aubry³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

View full text Add to dashboard Cite

Context.-Transbronchial cryobiopsy technique yields larger biopsies with enhanced quality. The benefits and safety of cryobiopsies have not been thoroughly studied in lung allografts.Objective.-To compare size, quality, reproducibility of interpretation of rejection and complications of cryobiopsies with those of conventional biopsies from lung allografts.Design.-All cryobiopsies (March 2014-January 2015) of lung allografts performed at Mayo Clinic, Rochester, and medical records were reviewed. For comparison, conventional biopsies from the same patient or, if unavailable, from a random patient, were selected. Two pathologists blinded to outcome reviewed all biopsies. Specimen volume, number of alveoli, small airways, and pulmonary vessels were counted and statistically compared.Results.-Fifty-four biopsies (27 cryobiopsies) from 18 patients (11 men) were reviewed. A median of 3 (range, 2-5) and 10 (range, 6-12) specimens were obtained with cryobiopsies and conventional biopsies, respectively. Cryobiopsies were larger and contained more alveoli (P , .001, both) and small airways (P ¼ .04). Conventional biopsies showed more fresh alveolar hemorrhage (procedural) and crush artifact/atelectasis (P , .001, both). Cryobiopsies contained more pulmonary veins and venules (P , .001). There was no significant difference between the types of biopsies with respect to the reviewers' agreement on grades of rejection. Complications were more frequent in the cryobiopsy group, though the difference was not statistically significant.Conclusions.-Cryobiopsies of lung allografts are larger and have less artifact. However, complications occur and should be considered. Three cryobiopsy specimens appear sufficient for histopathologic evaluation of lung allografts.

show abstract

Section: Commentsupporting

confidence: 92%

Section: Commentsupporting

confidence: 92%

See 1 more Smart Citation

Transbronchial Cryobiopsies in the Evaluation of Lung Allografts: Do the Benefits Outweigh the Risks?

Roden¹,

Kern

Aubry³

et al. 2015

Archives of Pathology &Amp; Laboratory Medicine

View full text Add to dashboard Cite

show abstract

“…1). 27,[37][38][39][40][41][42][43][44][45][46][47][48][49] Nine studies were retrospective, 27 39,41 one in immunocompromised subjects with pulmonary infiltrates, 38 and one including subjects from all 3 categories 46 (Table 1). The studies were generally of good quality (Table 2), with the median (interquartile range) QualSyst score being 18 (17)(18)(19).…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Yield and Safety of Cryoprobe Transbronchial Lung Biopsy in Diffuse Parenchymal Lung Diseases: Systematic Review and Meta-Analysis

et al. 2016

View full text Add to dashboard Cite

BACKGROUND: Transbronchial lung biopsy with flexible forceps is the most commonly used technique in diagnosis of diseases diffusely involving the lung parenchyma. Recently, transbronchial lung biopsy using the flexible cryoprobe (cryo-transbronchial lung biopsy) has also been reported. Herein, we perform a systematic review and meta-analysis describing the efficacy and safety of cryo-transbronchial lung biopsy. METHODS: The PubMed and EMBASE databases were searched for studies reporting the outcomes of cryo-transbronchial lung biopsy in subjects with diffuse parenchymal lung involvement. The quality of individual studies was assessed using the QualSyst tool. The pooled diagnostic yield of cryo-transbronchial lung biopsy was calculated using proportion meta-analysis (random effects model). Heterogeneity was evaluated using the I 2 test and Cochran Q test. Publication bias was determined using both statistical and graphical methods.

show abstract

“…Cryobiopsies are reported to yield significantly larger specimens with more alveoli, bronchioles, veins, and venules, and less procedure-related artifact when compared to traditional forceps transbronchial biopsies ( Figure 1, A and B). [8][9][10] Concern over higher complication rates in patients undergoing cryobiopsy and limited experience with cryobiopsy in the transplant setting have prevented widespread adoption of the technique in the routine workup of lung allograft recipients. However, a recent study 8 did not show a significant difference in complications between cryobiopsies and transbronchial biopsies in the lung allograft setting.…”

mentioning

confidence: 99%

Diagnosis of Acute Cellular Rejection and Antibody-Mediated Rejection on Lung Transplant Biopsies: A Perspective From Members of the Pulmonary Pathology Society

Roden¹,

Aisner²,

Allen³

et al. 2016

Archives of Pathology &Amp; Laboratory Medicine

View full text Add to dashboard Cite

Context.— The diagnosis and grading of acute cellular and antibody-mediated rejection (AMR) in lung allograft biopsies is important because rejection can lead to acute graft dysfunction and/or failure and may contribute to chronic graft failure. While acute cellular rejection is well defined histologically, no reproducible specific features of AMR are currently identified. Therefore, a combination of clinical features, serology, histopathology, and immunologic findings is suggested for the diagnosis of AMR. Objective.— To describe the perspective of members of the Pulmonary Pathology Society (PPS) on the workup of lung allograft transbronchial biopsy and the diagnosis of acute cellular rejection and AMR in lung transplant. Data Sources.— Reports by the International Society for Heart and Lung Transplantation (ISHLT), experience of members of PPS who routinely review lung allograft biopsies, and search of literature database (PubMed). Conclusions.— Acute cellular rejection should be assessed and graded according to the 2007 working formulation of the ISHLT. As currently no specific features are known for AMR in lung allografts, the triple test (clinical allograft dysfunction, donor-specific antibodies, pathologic findings) should be used for its diagnosis. C4d staining might be performed when morphologic, clinical, and/or serologic features suggestive of AMR are identified.

show abstract

Cryoprobe Transbronchial Lung Biopsy in Patients After Lung Transplantation

Cited by 117 publications

References 22 publications

Transbronchial Cryobiopsies in the Evaluation of Lung Allografts: Do the Benefits Outweigh the Risks?

Transbronchial Cryobiopsies in the Evaluation of Lung Allografts: Do the Benefits Outweigh the Risks?

Diagnostic Yield and Safety of Cryoprobe Transbronchial Lung Biopsy in Diffuse Parenchymal Lung Diseases: Systematic Review and Meta-Analysis

Diagnosis of Acute Cellular Rejection and Antibody-Mediated Rejection on Lung Transplant Biopsies: A Perspective From Members of the Pulmonary Pathology Society

Contact Info

Product

Resources

About