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Bronchoscopic lung cryobiopsy: An Indian Association for Bronchology position statement

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 comp...

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Autores principales: Dhooria, Sahajal, Agarwal, Ritesh, Sehgal, Inderpaul Singh, Aggarwal, Ashutosh Nath, Goyal, Rajiv, Guleria, Randeep, Singhal, Pratibha, Shah, Shirish P, Gupta, Krishna B, Koolwal, Suresh, Akkaraju, Jayachandra, Annapoorni, Shankar, Bal, Amanjit, Bansal, Avdhesh, Behera, Digambar, Chhajed, Prashant N, Dhamija, Amit, Dhar, Raja, Garg, Mandeep, Gopal, Bharat, Hibare, Kedar R, James, Prince, Jindal, Aditya, Jindal, Surinder K, Khan, Ajmal, Kishore, Nevin, Koul, Parvaiz A, Kumar, Arvind, Kumar, Raj, Lall, Ajay, Madan, Karan, Mandal, Amit, Mehta, Ravindra M, Mohan, Anant, Nangia, Vivek, Nath, Alok, Nayar, Sandeep, Patel, Dharmesh, Pattabhiraman, Vallandaramam, Raghupati, Narasimhan, Sarkar, Pralay K, Singh, Virendra, Sivaramakrishnan, Mahadevan, Srinivasan, Arjun, Swarnakar, Rajesh, Talwar, Deepak, Thangakunam, Balamugesh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330795/
https://www.ncbi.nlm.nih.gov/pubmed/30604705
http://dx.doi.org/10.4103/lungindia.lungindia_75_18
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author Dhooria, Sahajal
Agarwal, Ritesh
Sehgal, Inderpaul Singh
Aggarwal, Ashutosh Nath
Goyal, Rajiv
Guleria, Randeep
Singhal, Pratibha
Shah, Shirish P
Gupta, Krishna B
Koolwal, Suresh
Akkaraju, Jayachandra
Annapoorni, Shankar
Bal, Amanjit
Bansal, Avdhesh
Behera, Digambar
Chhajed, Prashant N
Dhamija, Amit
Dhar, Raja
Garg, Mandeep
Gopal, Bharat
Hibare, Kedar R
James, Prince
Jindal, Aditya
Jindal, Surinder K
Khan, Ajmal
Kishore, Nevin
Koul, Parvaiz A
Kumar, Arvind
Kumar, Raj
Lall, Ajay
Madan, Karan
Mandal, Amit
Mehta, Ravindra M
Mohan, Anant
Nangia, Vivek
Nath, Alok
Nayar, Sandeep
Patel, Dharmesh
Pattabhiraman, Vallandaramam
Raghupati, Narasimhan
Sarkar, Pralay K
Singh, Virendra
Sivaramakrishnan, Mahadevan
Srinivasan, Arjun
Swarnakar, Rajesh
Talwar, Deepak
Thangakunam, Balamugesh
author_facet Dhooria, Sahajal
Agarwal, Ritesh
Sehgal, Inderpaul Singh
Aggarwal, Ashutosh Nath
Goyal, Rajiv
Guleria, Randeep
Singhal, Pratibha
Shah, Shirish P
Gupta, Krishna B
Koolwal, Suresh
Akkaraju, Jayachandra
Annapoorni, Shankar
Bal, Amanjit
Bansal, Avdhesh
Behera, Digambar
Chhajed, Prashant N
Dhamija, Amit
Dhar, Raja
Garg, Mandeep
Gopal, Bharat
Hibare, Kedar R
James, Prince
Jindal, Aditya
Jindal, Surinder K
Khan, Ajmal
Kishore, Nevin
Koul, Parvaiz A
Kumar, Arvind
Kumar, Raj
Lall, Ajay
Madan, Karan
Mandal, Amit
Mehta, Ravindra M
Mohan, Anant
Nangia, Vivek
Nath, Alok
Nayar, Sandeep
Patel, Dharmesh
Pattabhiraman, Vallandaramam
Raghupati, Narasimhan
Sarkar, Pralay K
Singh, Virendra
Sivaramakrishnan, Mahadevan
Srinivasan, Arjun
Swarnakar, Rajesh
Talwar, Deepak
Thangakunam, Balamugesh
author_sort Dhooria, Sahajal
collection PubMed
description 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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spelling pubmed-63307952019-04-17 Bronchoscopic lung cryobiopsy: An Indian Association for Bronchology position statement Dhooria, Sahajal Agarwal, Ritesh Sehgal, Inderpaul Singh Aggarwal, Ashutosh Nath Goyal, Rajiv Guleria, Randeep Singhal, Pratibha Shah, Shirish P Gupta, Krishna B Koolwal, Suresh Akkaraju, Jayachandra Annapoorni, Shankar Bal, Amanjit Bansal, Avdhesh Behera, Digambar Chhajed, Prashant N Dhamija, Amit Dhar, Raja Garg, Mandeep Gopal, Bharat Hibare, Kedar R James, Prince Jindal, Aditya Jindal, Surinder K Khan, Ajmal Kishore, Nevin Koul, Parvaiz A Kumar, Arvind Kumar, Raj Lall, Ajay Madan, Karan Mandal, Amit Mehta, Ravindra M Mohan, Anant Nangia, Vivek Nath, Alok Nayar, Sandeep Patel, Dharmesh Pattabhiraman, Vallandaramam Raghupati, Narasimhan Sarkar, Pralay K Singh, Virendra Sivaramakrishnan, Mahadevan Srinivasan, Arjun Swarnakar, Rajesh Talwar, Deepak Thangakunam, Balamugesh Lung India General Perspective 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. Medknow Publications & Media Pvt Ltd 2019 /pmc/articles/PMC6330795/ /pubmed/30604705 http://dx.doi.org/10.4103/lungindia.lungindia_75_18 Text en Copyright: © 2018 Indian Chest Society http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle General Perspective
Dhooria, Sahajal
Agarwal, Ritesh
Sehgal, Inderpaul Singh
Aggarwal, Ashutosh Nath
Goyal, Rajiv
Guleria, Randeep
Singhal, Pratibha
Shah, Shirish P
Gupta, Krishna B
Koolwal, Suresh
Akkaraju, Jayachandra
Annapoorni, Shankar
Bal, Amanjit
Bansal, Avdhesh
Behera, Digambar
Chhajed, Prashant N
Dhamija, Amit
Dhar, Raja
Garg, Mandeep
Gopal, Bharat
Hibare, Kedar R
James, Prince
Jindal, Aditya
Jindal, Surinder K
Khan, Ajmal
Kishore, Nevin
Koul, Parvaiz A
Kumar, Arvind
Kumar, Raj
Lall, Ajay
Madan, Karan
Mandal, Amit
Mehta, Ravindra M
Mohan, Anant
Nangia, Vivek
Nath, Alok
Nayar, Sandeep
Patel, Dharmesh
Pattabhiraman, Vallandaramam
Raghupati, Narasimhan
Sarkar, Pralay K
Singh, Virendra
Sivaramakrishnan, Mahadevan
Srinivasan, Arjun
Swarnakar, Rajesh
Talwar, Deepak
Thangakunam, Balamugesh
Bronchoscopic lung cryobiopsy: An Indian Association for Bronchology position statement
title Bronchoscopic lung cryobiopsy: An Indian Association for Bronchology position statement
title_full Bronchoscopic lung cryobiopsy: An Indian Association for Bronchology position statement
title_fullStr Bronchoscopic lung cryobiopsy: An Indian Association for Bronchology position statement
title_full_unstemmed Bronchoscopic lung cryobiopsy: An Indian Association for Bronchology position statement
title_short Bronchoscopic lung cryobiopsy: An Indian Association for Bronchology position statement
title_sort bronchoscopic lung cryobiopsy: an indian association for bronchology position statement
topic General Perspective
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330795/
https://www.ncbi.nlm.nih.gov/pubmed/30604705
http://dx.doi.org/10.4103/lungindia.lungindia_75_18
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