Safety of Cryo-Transbronchial Biopsy in Diffuse Lung Diseases: Analysis of Three Hundred Cases

Abstract

Background: Transbronchial biopsy (TBB) which is performed with metal forceps (forceps TBB) has been accepted as a useful technique in establishing diagnoses of diffuse lung diseases (DLDs). The use of cryoprobes to obtain alveolar tissue (cryo-TBB) is a new method which is currently used by our institute as well as others with excellent results. Objectives: To assess the safety of cryo-TBB compared with conventional forceps TBB. Methods: We performed a retrospective data evaluation of 300 consecutive patients who underwent cryo-TBB between January 2012 and April 2014 and compared them with historical cases treated with forceps TBB between 2010 and 2012. The results of both diagnostic modalities were compared based on pathological reports. The major complications (significant bleeding and pneumothorax) were compared, along with postprocedural hospitalization. Results: Pneumothorax was observed in 15 cases (4.95%) treated with cryo-TBB versus 9 cases (3.15%) treated with forceps TBB, with no significant difference (p = 0.303). The insertion of a chest tube was necessary in 6 (2%) and 4 (1.3%) of the cases having undergone cryo-TBB or forceps TBB, respectively (p = 0.8). In the cryo-TBB group, bleeding was encountered in 16 cases (5.2%), and it occurred in 13 cases (4.5%) of the forceps TBB group, with no significant difference in rates (p = 0.706). Also, there was no significant difference in hospital admission rates between the groups [cryo-TBB: 10 (3.3%); forceps TBB: 4 (1.44%); p = 0.181]. The safety profile of cryo- and forceps TBB remained the same even when stratified according to indications for TBB, i.e. immunocompromised hosts, patients after lung transplantation and those with DLDs. Conclusion: In patients with DLDs, cryo-TBB is as safe as forceps TBB.

Safety and Diagnostic Yield of Transbronchial Lung Cryobiopsy in Diffuse Parenchymal Lung Diseases: A Comparative Study versus Video-Assisted Thoracoscopic Lung Biopsy and a Systematic Review of the Literature

“…case reports, review articles); the remaining 37 articles were retrieved for detailed full-text evaluation. Eighteen original studies were included in the present review, and their main characteristics are presented in table 3[7,8,9,19,20,21,22,23,24,25,26,27,28,29,30,31,32]: 15 studies reported data on both DY and safety, 2 on safety only, and 1 on DY only. …”

“…The pooled estimate of 0.12, presented in figure 6, should be interpreted with caution, as the definition of ‘moderate' bleeding was vastly different between the studies, making a reliable summary of the data difficult to accomplish. Moreover, the largest cohort studies were not included in this analysis, since Gershman et al [27] did not distinguish between mild and moderate bleeding (overall rate 5.3%), while the preventive use of a Fogarty balloon in our study was considered a major ‘bias' in the interpretation of the results. Anyhow, the fact that we did not experience any grade 2 bleeding does not mean that this is not a common and potentially serious adverse event related to the procedure; it rather suggests that using a prophylactic bronchial blocker is highly recommended in order to reduce and limit such a complication.…”

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

“…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).…”

“…Severe bleeding (requiring either cessation of the procedure or the use of a bronchial blocker/sealant or surgical 27 Pajares et al 37 Fruchter et al 38 Fruchter et al 39 Kropski et al 40 Yarmus et al 41 Casoni et al 42 Fruchter et al 43 Griff et al 44 Pajares et al 45 Gershman et al 46 Hagmeyer et al 47 Hernández-González et al 48 Pourabdollah et al 49 1. Question/objective sufficiently described ?…”

Transbronchial Lung Cryobiopsy: New Options for a New Reality

“…In some articles, the safety profile is comparable to that of the conventional biopsy forceps, but a higher rate of pneumothoraces and severe haemorrhage has also been described with this technique [3,4,11]. Pajares et al [4], in a randomized trial comparing cryoprobes and forceps in patients with interstitial lung diseases inconsistent with usual interstitial pneumonia, found a higher diagnostic yield in the cryobiopsy group, even after histological findings had been submitted to a multidisciplinary approach.…”