Transbronchial cryobiopsy in diffuse lung disease

Torrego, Alfons; Pajares, Virginia

doi:10.1007/s13665-013-0070-0

Cited by 3 publications

(7 citation statements)

References 38 publications

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“…Bronchoscopy-guided transbronchial biopsy is associated with a low rate of iatrogenic complications, [2][3][4] but the usefulness of this technique is limited given its low diagnostic yield. 5 Surgical biopsy, on the other hand, provides high-quality samples but may lead to serious complications such as bronchopleural fistulae, severe worsening of existing lung disease and even death. [6][7][8] In this context, it is of great interest to develop new biopsy techniques that provide representative samples with a low risk of complications.…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13] The most common complications related to TBCB are pneumothorax and pulmonary haemorrhage. 5,11,14 Despite relatively few publications on the safety of TBCB, its practice is recommended under fluoroscopic guidance to reduce the risk of pneumothorax and with use of devices for blocking the airway to prevent and treat pulmonary haemorrhage. 5,11,12 Although Fogarty balloons have been used to achieve a lobar blockade, a more distal segmental blockade could reduce the gas exchange surface affected in cases of substantial bleeding and could therefore be especially useful in patients with altered lung function.…”

Section: Introductionmentioning

confidence: 99%

“…5,11,14 Despite relatively few publications on the safety of TBCB, its practice is recommended under fluoroscopic guidance to reduce the risk of pneumothorax and with use of devices for blocking the airway to prevent and treat pulmonary haemorrhage. 5,11,12 Although Fogarty balloons have been used to achieve a lobar blockade, a more distal segmental blockade could reduce the gas exchange surface affected in cases of substantial bleeding and could therefore be especially useful in patients with altered lung function. In our institution, we perform fluoroscopically guided TBCB, and we use percutaneous transluminal angioplasty (PTA) balloon catheters to selectively isolate the biopsied bronchus.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of an angioplasty balloon as selective bronchial blockade device after transbronchial cryobiopsy

et al. 2016

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Background and objective: Transbronchial cryobiopsy (TBCB) is a technique in which frozen samples of lung are obtained using a probe inserted through a bronchoscope. We performed a retrospective study to assess the performance of the TBCB procedure complemented by segmental bronchial blockade using an angioplasty balloon, in terms of diagnostic yield and safety in diffuse parenchymal lung disease (DPLD). Methods: Data from 100 patients with suspected DPLD (clinical and radiological findings), who underwent TBCB in our institution to establish a definitive diagnosis, were reviewed. In our institution, TBCB is monitored with fluoroscopy and performed under general anaesthesia by a multidisciplinary team (an anaesthesiologist, a pulmonologist and an interventional radiologist). In each patient, four samples were collected using a 2.4-mm distal diameter cryoprobe. To control bleeding, the biopsied segmental bronchus was blocked with a 6-mm diameter angioplasty balloon, inserted over a 0.035-inch angled hydrophilic guidewire. After the cryoextraction, the balloon was inflated for 3 min intervals until bleeding stopped. Results: Overall, 98% of samples had diagnostic value. In 85% of cases, DPLD was confirmed, while in 7%, cancer was diagnosed. Complications were observed in 16% of the patients: 13 patients developed moderate haemorrhage, and 3 developed pneumothorax. Conclusion: Transbronchial cryobiopsy had a high diagnostic yield for DPLD. Performing the procedure under fluoroscopy guidance and using angioplasty balloon for selective bronchial blockade achieved a low rate of iatrogenic complications directly associated with the technique.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Usefulness of an angioplasty balloon as selective bronchial blockade device after transbronchial cryobiopsy

et al. 2016

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“…Through the cryoadhesive effect, large specimens that demonstrate unaltered and artefact-free morphology can be obtained [3,4,5,6,7]. Transbronchial cryobiopsy is a promising technique because both biopsy size and quality contribute to diagnostic value [8].…”

Section: Introductionmentioning

confidence: 99%

“…Transbronchial cryobiopsy is a promising technique because both biopsy size and quality contribute to diagnostic value [8]. Early studies suggest that transbronchial cryobiopsy has a higher diagnostic yield with similar safety profiles to transbronchial forceps biopsies in interstitial lung disease [4,6,7,9,10,11,12,13], lung transplantation rejection [14,15] and transbronchial malignancy [16]. …”

Section: Introductionmentioning

confidence: 99%

Evaluation of Transbronchial Lung Cryobiopsy Size and Freezing Time: A Prognostic Animal Study

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Oliver²,

Oliver³

et al. 2016

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Background: Transbronchial lung biopsy using a cryoprobe is a novel way of sampling lung parenchyma. Correlation of freezing time with biopsy size and complications has not been evaluated in vivo. Objectives: The primary aim of the study is to evaluate the correlation between transbronchial cryobiopsy freezing time and size. The secondary aims are to evaluate histological quality of the biopsy and evaluate procedure-associated complications. Methods: Transbronchial lung cryobiopsies were obtained from two anaesthetised sheep using a 1.9-mm cryoprobe inserted into a flexible bronchoscope under fluoroscopic guidance. Freezing times ranged from 1 to 6 s (n = 49). The cryobiopsies were evaluated histologically with respect to their size and quality. Complications of bleeding and pneumothorax were recorded. Results: The mean cross-sectional area of the cryobiopsy ranged from 4.7 ± 2.1 to 15.7 ± 15.3 mm². There was a significant positive correlation between increasing freezing time and cryobiopsy cross-sectional area (p = 0.028). All biopsies contained lung tissue with preserved parenchyma. Crush and freeze artefacts were not observed and tissue architecture was intact in all specimens. Small blood vessels and terminal bronchioles were observed in 88% of specimens. All cryobiopsies caused nil or mild haemorrhage with the exception of only 1 episode of severe haemorrhage at 6 s freezing time. Pneumothoraces occurred at 2, 5 and 6 s freezing time and required chest tube insertion. The most significant haemorrhage and pneumothoraces occurred at 5 and 6 s. Our results suggest an initial freezing time of 3 s can provide the maximal biopsy size while minimising major complications. Conclusion: The optimal transbronchial cryobiopsy freezing time is initially 3 s. This time is associated with minimal complications and large artefact-free biopsies.

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