The safety profile of a protocolized transbronchial cryobiopsy program utilizing a 2.4 mm cryoprobe for interstitial lung disease

Oh, Scott; Ronaghi, Reza; He, Tao; Oberg, Catherine L.; Channick, Colleen; Susanto, Irawan; Carroll, Mathew; Weight, Stephen; Sayah, David M.; Dolinay, Tamás; Chung, Augustine; Fishbein, Michael; Lynch, Joseph P.; Belperio, John A.

doi:10.1016/j.rmed.2022.106913

Cited by 3 publications

(3 citation statements)

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“…It was then inserted through the robotic working channel, its location confirmed via fluoroscopy, and the confirmed freezing time applied, typically 4–5 s. The sample was removed through the working channel, leaving the robotic catheter in place for mechanical hemostatic tamponade, if needed, as well as repeat biopsy without the need to renavigate. Of note, given the size of the biopsies these procedures were done through an 8.5-mm endotracheal tube and no balloon occlusion device was placed prophylactically as has been described for cryobiopsy in ILD [ 13 ]. Figure 1 shows a frozen and a thawed cryobiopsy specimen as well as a gross comparison of needle aspirate tissue, forceps biopsies, and cryobiopsies.…”

Section: Methodsmentioning

confidence: 99%

Novel Robotic-Assisted Cryobiopsy for Peripheral Pulmonary Lesions

Oberg

Folch

et al. 2022

Lung

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Purpose Tissue acquisition in lung cancer is vital for multiple reasons. Primary reasons reported for molecular testing failure in lung cancer biopsy specimens include insufficient amount of tumor cells provided and inadequate tissue quality. Robotic bronchoscopy is a new tool enabling peripheral pulmonary lesion sampling; however, diagnostic yield remains imperfect possibly due to the location of nodules adjacent to or outside of the airway. The 1.1-mm cryoprobe is a novel diagnostic tool and accesses tissue in a 360-degree manner, thus potentially sampling eccentric/adjacent lesions. This study examines the diagnostic yield of the cryoprobe compared to standard needle aspiration and forceps biopsy. It additionally evaluates yield for molecular markers in cases of lung cancer. Methods This is a retrospective analysis of 112 patients with 120 peripheral pulmonary lesions biopsied via robotic bronchoscopy using needle aspirate, forceps, and cryobiopsy. Results The overall diagnostic yield was 90%. Nearly 18% of diagnoses were made exclusively from the cryobiopsy sample. Molecular analysis was adequate on all cryobiopsy samples sent. Digital imaging software confirmed an increase in quantity and quality of samples taken via cryobiopsy compared to needle aspirate and traditional forceps biopsy. Conclusion Using the 1.1-mm cryoprobe to biopsy PPN combined with the Ion robotic bronchoscopy system is safe, feasible, and provides more diagnostic tissue than needle aspirates or traditional forceps biopsies. The combination of cryobiopsy with robotic-assisted bronchoscopy increased diagnostic yield, likely due to its 360-degree tissue acquisition which is beneficial when targeting extraluminal lesions adjacent to the airway.

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Section: Methodsmentioning

confidence: 99%

Novel Robotic-Assisted Cryobiopsy for Peripheral Pulmonary Lesions

Oberg

Folch

et al. 2022

Lung

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“…There is a paucity of studies examining bleeding following TBLC using the NBS. Oh et al reported a prospective cohort of 201 subjects undergoing TBLC for undifferentiated ILD using a 2.4 mm cryoprobe and prophylactic endobronchial balloon 24 . Goel et al reported a retrospective cohort of 326 patients with diffuse and localized lung disease undergoing TBLC using a 1.9 mm cryoprobe with prophylactic balloon blockade used in 75% of cases 25 .…”

Section: Discussionmentioning

confidence: 99%

“…Oh et al reported a prospective cohort of 201 subjects undergoing TBLC for undifferentiated ILD using a 2.4 mm cryoprobe and prophylactic endobronchial balloon. 24 326 patients with diffuse and localized lung disease undergoing TBLC using a 1.9 mm cryoprobe with prophylactic balloon blockade used in 75% of cases. 25 The rates of significant bleeding were only 0.5% and 0.92%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Low bleeding rates following transbronchial lung cryobiopsy in unclassifiable interstitial lung disease

Taverner,

Lucena,

Garner

et al. 2024

Respirology

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Background and ObjectiveBronchoscopic transbronchial lung cryobiopsy (TBLC) is a guideline‐endorsed alternative to surgical lung biopsy for tissue diagnosis in unclassifiable interstitial lung disease (ILD). The reported incidence of post‐procedural bleeding has varied widely. We aimed to characterize the incidence, severity and risk factors for clinically significant bleeding following TBLC using an expert‐consensus airway bleeding scale, in addition to other complications and diagnostic yield.MethodsA retrospective cohort study of consecutive adult outpatients with unclassifiable ILD who underwent TBLC following multidisciplinary discussion at a single centre in the UK between July 2016 and December 2021. TBLC was performed under general anaesthesia with fluoroscopic guidance and a prophylactic endobronchial balloon.ResultsOne hundred twenty‐six patients underwent TBLC (68.3% male; mean age 62.7 years; FVC 86.2%; DLCO 54.5%). Significant bleeding requiring balloon blocker reinflation for >20 min, admission to ICU, packed red blood cell transfusion, bronchial artery embolization, resuscitation or procedural abandonment, occurred in 10 cases (7.9%). Significant bleeding was associated with traction bronchiectasis on HRCT (OR 7.1, CI 1.1–59.1, p = 0.042), a TBLC histological pattern of UIP (OR 4.0, CI 1.1–14, p = 0.046) and the presence of medium‐large vessels on histology (OR 37.3, CI 6.5–212, p < 0.001). BMI ≥30 (p = 0.017) and traction bronchiectasis on HRCT (p = 0.025) were significant multivariate predictors of longer total bleeding time (p = 0.017). Pneumothorax occurred in nine cases (7.1%) and the 30‐day mortality was 0%. Diagnostic yield was 80.6%.ConclusionTBLC has an acceptable safety profile in experienced hands. Radiological traction bronchiectasis and obesity increase the risk of significant bleeding following TBLC.

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Cryoprobe biopsy versus mechanical biopsies in pulmonary diagnostics

Ueoka,

Ronaghi,

Khauli

et al. 2024

Current Opinion in Pulmonary Medicine

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Purpose of review Biopsy tools have been essential in improving the diagnostic accuracy of bronchoscopic procedures. Of these tools, cryobiopsy has emerged as a promising technique for diagnosing thoracic diseases. This review summarizes the existing data comparing cryobiopsies to other mechanical biopsy methods for sampling endobronchial, parenchymal, and mediastinal targets. Recent findings Initially adopted for managing airway stenoses, the use of cryoprobes has expanded to diagnosing endobronchial lesions, parenchymal opacities, and mediastinal lymph node pathologies. Studies have demonstrated that cryobiopsy offers a higher diagnostic yield than forceps biopsy alone. By leveraging the Joule-Thomson effect to freeze and collect larger tissue samples compared to traditional methods, cryobiopsy improves diagnostic accuracy and helps in better characterizing the nature of the lesions. While the risk of complications, such as pneumothorax and hemorrhage are comparable to, or higher than traditional biopsy methods, cryobiopsy's enhanced diagnostic capabilities make it a valuable tool in the assessment of pulmonary disease. Summary Compared with other mechanical biopsy techniques, cryoprobe biopsies significantly enhance the diagnostic yield for endobronchial lesions, interstitial lung disease, pulmonary nodules, and mediastinal lymph nodes.

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The safety profile of a protocolized transbronchial cryobiopsy program utilizing a 2.4 mm cryoprobe for interstitial lung disease

Cited by 3 publications

References 56 publications

Novel Robotic-Assisted Cryobiopsy for Peripheral Pulmonary Lesions

Novel Robotic-Assisted Cryobiopsy for Peripheral Pulmonary Lesions

Low bleeding rates following transbronchial lung cryobiopsy in unclassifiable interstitial lung disease

Cryoprobe biopsy versus mechanical biopsies in pulmonary diagnostics

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