Learning curve for transbronchial lung cryobiopsy in diffuse lung disease

Almeida, Leonor; Lima, Bruno; Mota, Patrícia Caetano; Melo, Natália; Magalhães, Adriana; Pereira, José Miguel; Moura, Conceição Souto; Guimarães, Susana; Morais, António

doi:10.1016/j.rppnen.2017.09.005

Cited by 31 publications

(31 citation statements)

References 26 publications

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“…In relation to the determination of committee composition, Castillo et al [24] recently reviewed criteria regarding standardization of the necessary professional experience. As for experience, it has been demonstrated that diagnostic yield reflect the TBCB learning curve [25]. Our results reflect TBCB diagnostic yield variability, documented as between 50.6% and 100% in the recently published expert consensus [7].…”

Section: Plos Onesupporting

confidence: 80%

Transbronchial biopsy results according to diffuse interstitial lung disease classification. Cryobiopsy versus forceps: MULTICRIO study

et al. 2020

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Background In recent years, transbronchial cryobiopsy (TBCB) has come to be increasingly used in interventional pulmonology units as it obtains larger and better-quality samples than conventional transbronchial lung biopsy (TBLB) with forceps. No multicenter studies have been performed, however, that analyse and compare TBCB and TBLB safety and yield according to the interstitial lung disease (ILD) classification. Objectives We compared the diagnostic yield and safety of TBCB with cryoprobe sampling versus conventional TBLB forceps sampling in the same patient. Method Prospective multicenter clinical study of patients with ILD indicated for lung biopsy. Airway management with orotracheal tube, laryngeal mask and rigid bronchoscope was according to the protocol of each centre. All procedures were performed using fluoroscopy and an occlusion balloon. TBLB was followed by TBCB. Complications were recorded after both TBLB and TBCB. Results Included were 124 patients from 10 hospitals. Airway management was orotracheal intubation in 74% of cases. Diagnostic yield according to multidisciplinary committee results for

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Section: Plos Onesupporting

confidence: 80%

Transbronchial biopsy results according to diffuse interstitial lung disease classification. Cryobiopsy versus forceps: MULTICRIO study

et al. 2020

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“…However, the presence of pleura does not necessarily mean that the patient will develop a pneumothorax, although the risk is higher. [152857] Thirdly, inadvertent proximal sampling in the absence of fluoroscopy may lead to disruption of major bronchial vessels, resulting in significant bleeding. Finally, fluoroscopic guidance may help in screening for pneumothorax immediately after each biopsy.…”

Section: Methodsmentioning

confidence: 99%

“…Chest radiograph is required to detect a pneumothorax in the postoperative period (generally 2–3 h after the procedure). [175779] Chest ultrasound performed by trained pulmonologists for the detection of pneumothorax following BLC has a sensitivity and specificity of 90% and 94%, respectively,[79] and is superior to a chest radiograph. [80] In a meta-analysis, chest ultrasonography had a pooled sensitivity and specificity of 78.6% (95% CI, 68.1–98.1) and 98.4% (95% CI, 97.3–99.5), respectively, for the detection of pneumothorax; while the sensitivity and specificity of chest radiography was 39.8% (95% CI, 29.4–50.3) and 99.3% (95% CI, 98.4–100), respectively.…”

Section: Methodsmentioning

confidence: 99%

“…If the BLC procedure is uncomplicated (no or mild bleeding, no postprocedure hypoxemia, and the absence of pneumothorax), the patient can be discharged after 4–6 h.[20545657] A follow-up by a phone call at 24 h has been described in one study. [54] In case of a complication (moderate-severe bleeding, intra- or post-procedure hypoxemia, pneumothorax), the patient requires a longer observation with monitoring of vital parameters and appropriate management.…”

Section: Methodsmentioning

confidence: 99%

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Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement

et al. 2019

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Background: Bronchoscopic lung cryobiopsy (BLC) is a novel technique for obtaining lung tissue for the diagnosis of diffuse parenchymal lung diseases. The procedure is performed using several different variations of technique, resulting in an inconsistent diagnostic yield and a variable risk of complications. There is an unmet need for standardization of the technical aspects of BLC. Methodology: This is a position statement framed by a group comprising experts from the fields of pulmonary medicine, thoracic surgery, pathology, and radiology under the aegis of the Indian Association for Bronchology. Sixteen questions on various technical aspects of BLC were framed. A literature search was conducted using PubMed and EMBASE databases. The expert group discussed the available evidence relevant to each question through e-mail and a face-to-face meeting, and arrived at a consensus. Results: The experts agreed that patients should be carefully selected for BLC after weighing the risks and benefits of the procedure. Where appropriate, consideration should be given to perform alternate procedures such as conventional transbronchial biopsy or subject the patient directly to a surgical lung biopsy. The procedure is best performed after placement of an artificial airway under sedation/general anesthesia. Fluoroscopic guidance and occlusion balloon should be utilized for positioning the cryoprobe to reduce the risk of pneumothorax and bleeding, respectively. At least four tissue specimens (with at least two of adequate size, i.e., ≥5 mm) should be obtained during the procedure from different lobes or different segments of a lobe. The histopathological findings of BLC should be interpreted by an experienced pulmonary pathologist. The final diagnosis should be made after a multidisciplinary discussion. Finally, there is a need for structured training for performing BLC. Conclusion: This position statement is an attempt to provide practical recommendations for the performance of BLC in DPLDs.

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“…Ravaglia et al [21] proposed a positive correlation of the incidence of pneumothorax with the bronchoscopist’s learning curve. To our knowledge, the only study that investigated how many procedures are necessary to gain a proficiency in TBLC is by Almeida et al [22]. They suggest that a mastery in TBLC is gained after 70 procedures, in terms of sample size, better diagnostic yield, and fewer complications.…”

Section: Learning Curve: How To Learn Tblcmentioning

confidence: 99%

Transbronchial Lung Cryobiopsy in Interstitial Lung Diseases: Best Practice

et al. 2018

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The lung biopsy in interstitial lung disease (ILD) represents an important diagnostic step when the clinical and radiological data are insufficient for a firm diagnosis. A growing body of evidence suggests the utility of transbronchial lung cryobiopsy (TBLC) in the diagnostic algorithm of ILD as it allows, compared to transbronchial lung biopsy with conventional forceps, a better identification of complex histological patterns – such as usual interstitial pneumonia – and can provide information which has a clinical impact on the multidisciplinary discussion similar to that provided by surgical lung biopsy. Performed correctly, it appears to have a better safety profile than surgery. The decision to perform a lung biopsy should be a multidisciplinary decision process where it is felt that there is sufficient diagnostic doubt after a careful clinical evaluation including review of the computed tomograms of the thorax. The presence of severe pulmonary hypertension (> 50 mm Hg), poor lung function (FVC < 50%), or dismissed gas transfer (DLCO of < 35%) are considered relative contraindications for TBLC. Anticoagulants and antiplatelet drugs should be discontinued for the minimum period required for the specific drugs. The greatest consideration should be given to ensure the biopsy is performed safely and we recommend the use of either an endotracheal tube or rigid bronchoscopy. Deep sedation or general anesthesia allow better control of the procedure and a better patient experience. Prophylactic balloon blockers should be used to tamponade any bleeding and also to prevent overspill of blood from the segment that is being sampled. The procedure should be performed under fluoroscopy to ensure that samples are ideally obtained about 10 mm from the pleural edge. The cryoprobe is activated for about 5 s for the first biopsy and then adjusted according to the sample size obtained. With a careful standardized approach it is possible to obtain good-quality lung specimens for diagnosis in a safe manner.

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Learning curve for transbronchial lung cryobiopsy in diffuse lung disease

Abstract: Our findings suggest that proficiency in TBLC is achieved at approximately the 70th procedure; however they need to be validated in more series and cohorts.

Cited by 31 publications

References 26 publications

Transbronchial biopsy results according to diffuse interstitial lung disease classification. Cryobiopsy versus forceps: MULTICRIO study

Transbronchial biopsy results according to diffuse interstitial lung disease classification. Cryobiopsy versus forceps: MULTICRIO study

Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement

Transbronchial Lung Cryobiopsy in Interstitial Lung Diseases: Best Practice

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