Utility of Flexible Bronchoscopic Cryobiopsy for Diagnosis of Diffuse Parenchymal Lung Diseases

Lentz, Robert J.; Taylor, Trevor; Kropski, Jonathan A.; Sandler, Kim L.; Johnson, Joyce E.; Blackwell, Timothy S.; Maldonado, Fabien; Rickman, Otis B.

doi:10.1097/lbr.0000000000000401

Cited by 46 publications

(41 citation statements)

References 28 publications

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“…setting of suspected small airway disease, and one small series has reported preliminary success diagnosing constrictive bronchiolitis with the 1.9 mm probe activated approximately 2 cm from the pleura (56). When specifically reported, high rates of bronchiole representation in cryobiopsy samples have been found with probe-to-pleura distances of 1-2 cm (32,64) and, in an animal model, at 1 cm (58). The major risk of more proximal sampling is major hemorrhage.…”

Section: A B C Dmentioning

confidence: 96%

“…The lower lobes are most commonly biopsied, with current studies evenly split between sampling a single segment or multiple segments. Biopsy of multiple lobes has been less commonly reported (29,30,35,37,(44)(45)(46)50,64) but is of potential interest given SLB data suggesting interlobar histopathological discordance is common (65).…”

Section: Biopsy Target Selection and Biopsy Numbermentioning

confidence: 99%

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Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges

Lentz¹,

Argento²,

et al. 2017

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Transbronchial lung biopsy with a cryoprobe, or cryobiopsy, is a promising new bronchoscopic biopsy technique capable of obtaining larger and better-preserved samples than previously possible using traditional biopsy forceps. Over two dozen case series and several small randomized trials are now available describing experiences with this technique, largely for the diagnosis of diffuse parenchymal lung disease (DPLD), in which the reported diagnostic yield is typically 70% to 80%. Cryobiopsy technique varies widely between centers and this predominantly single center-based retrospective literature heterogeneously defines diagnostic yield and complications, limiting the degree to which this technique can be compared between centers or to surgical lung biopsy (SLB). This review explores the broad range of cryobiopsy techniques currently in use, their rationale, the current state of the literature, and suggestions for the direction of future study into this promising but unproven procedure.

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Section: A B C Dmentioning

confidence: 96%

Section: Biopsy Target Selection and Biopsy Numbermentioning

confidence: 99%

Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges

Lentz¹,

Argento²,

et al. 2017

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“…This is particularly relevant to patient #1, where more peripheral sampling may not have demonstrated pathologic abnormalities. More central airway sampling is suggested to allow examination of small caliber airways [7], though interestingly, presence of bronchiolar airways in cryobiopsy specimens has been reported by multiple authors even following sampling approximately 2 cm from the pleura [18,24]. The ability of CT-fluoroscopy to confirm the position of cryoprobe may have been instrumental in achieving a diagnosis in this patient -adjacent lung parenchyma demonstrated only normal findings, and biopsy performed more peripherally may not have retrieved diagnostic tissue.…”

Section: Discussionmentioning

confidence: 99%

“…Transbronchial cryobiopsy continues to gain acceptance as an important technique for the evaluation of patients with DPLD. Studies suggest that diagnostic performance may be comparable to surgical lung biopsy [1,15,16], with significantly favorable morbidity/mortality [17,18]. Isolated reports have expressed concerns regarding the safety of transbronchial cryobiopsy [19], and diagnostic performance remains variable [1,17].…”

Section: Discussionmentioning

confidence: 99%

CT-Fluoroscopic Guidance for Performance of Targeted Transbronchial Cryobiopsy: A Preliminary Report

et al. 2018

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Background: Bronchoscopic transbronchial cryobiopsy is increasingly used for the histological assessment of diffuse parenchymal lung disease. Diagnostic performance may be improved by more accurate targeting of biopsy to radiologic abnormalities, and complication rates may be reduced by avoiding biopsy of pleura or larger vessels. Objectives: To report the preliminary experience of using CT-fluoroscopic guidance for accurate targeting of bronchoscopic transbronchial cryobiopsy. Methods: Bronchoscopic cryobiopsy was performed in a hybrid CT theatre. 3D CT images were acquired following positioning of the cryoprobe in a distal airway segment. Where cryoprobe position was observed to be too close to the chest wall/diaphragm pleura, or not within the region of interest within the lung parenchyma, re-positioning of probe was undertaken and repeat 3D images were acquired to confirm positioning prior to cryobiopsy. Results: CT-fluoroscopic transbronchial cryobiopsy was successfully performed in 4 patients: 3 patients with interstitial lung infiltrates, and one with an enlarging left upper lobe mass. Images were reviewed following each acquisition to accurately assess the probe position within the lung parenchyma, and relative to other thoracic structures. Intra-procedural imaging was of sufficient quality to allow the accurate positioning of the cryoprobe tip with respect to both the parenchymal region of interest and pleural surfaces. No complications were experienced, and all procedures yielded diagnostic specimens. Conclusions: Our preliminary experience confirms the feasibility of performing transbronchial cryobiopsy under CT-fluoroscopic guidance. Accurate targeting of transbronchial cryobiopsy may be achieved using CT-fluoroscopic guidance. Positioning of the probe tip, both with respect to parenchymal region of interest and to pleural surfaces, can be established with high accuracy.

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“…Surgical lung biopsy has the highest yield, but bronchoscopic cryobiopsy, which provides larger biopsy specimens compared with traditional forceps biopsy, may find an increasing role in this regard. 18 Bronchoalveolar lavage is neither diagnostic nor specific but may be used to rule out other processes, such as infection or hemorrhage. Distinguishing IPF-UIP from a CTD-ILD whenever possible has significant therapeutic implications.…”

Section: Clinical Approach To Ctd-ildmentioning

confidence: 99%

Interstitial Lung Disease and Other Pulmonary Manifestations in Connective Tissue Diseases

Mira-Avendano

Abril

Burger

et al. 2019

Mayo Clinic Proceedings

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Utility of Flexible Bronchoscopic Cryobiopsy for Diagnosis of Diffuse Parenchymal Lung Diseases

Cited by 46 publications

References 28 publications

Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges

Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges

CT-Fluoroscopic Guidance for Performance of Targeted Transbronchial Cryobiopsy: A Preliminary Report

Interstitial Lung Disease and Other Pulmonary Manifestations in Connective Tissue Diseases

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