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Lung Cryobiopsy Outside of the Operating Room: A Safe Alternative to Surgical Biopsy

OBJECTIVE: Transbronchial lung cryobiopsy (TBLC) is a promising technique that can provide a histologic diagnosis in interstitial lung diseases (ILD) and is an alternative to surgical lung biopsy. The main concerns with the procedure are safety and diagnostic accuracy. The technique is applicable in...

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Autores principales: Menezes, Vanessa, Molina, Juan Carlos, Pollock, Clare, Romeo, Philippe, Morisset, Julie, Ferraro, Pasquale, Lafontaine, Edwin, Martin, Jocelyne, Nasir, Basil, Leduc, Charles, Liberman, Moishe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8637350/
https://www.ncbi.nlm.nih.gov/pubmed/34338070
http://dx.doi.org/10.1177/15569845211034506
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author Menezes, Vanessa
Molina, Juan Carlos
Pollock, Clare
Romeo, Philippe
Morisset, Julie
Ferraro, Pasquale
Lafontaine, Edwin
Martin, Jocelyne
Nasir, Basil
Leduc, Charles
Liberman, Moishe
author_facet Menezes, Vanessa
Molina, Juan Carlos
Pollock, Clare
Romeo, Philippe
Morisset, Julie
Ferraro, Pasquale
Lafontaine, Edwin
Martin, Jocelyne
Nasir, Basil
Leduc, Charles
Liberman, Moishe
author_sort Menezes, Vanessa
collection PubMed
description OBJECTIVE: Transbronchial lung cryobiopsy (TBLC) is a promising technique that can provide a histologic diagnosis in interstitial lung diseases (ILD) and is an alternative to surgical lung biopsy. The main concerns with the procedure are safety and diagnostic accuracy. The technique is applicable in patients unable to undergo surgical biopsy due to severe comorbidities or when patient transport to the operating room is dangerous. This study reports the initial experience with TBLC on a thoracic surgical service as a first attempt at diagnosis in patients with diffuse parenchymal lung diseases (DPLD). METHODS: Between May 2018 and July 2020, 32 patients underwent TBLC using bedside flexible bronchoscopy for suspected ILD on a thoracic surgical endoscopy service. Retrospective evaluation of the procedure details, complications, and diagnostic yield were analyzed and reported. RESULTS: A total of 89 pathological samples were obtained (mean 2.8 per patient). Pneumothorax and minor bleeding occurred in 25% and 16.7% of patients, respectively. Sixty-seven percent of complications occurred with use of the 2.4 mm cryoprobe (P = 0.036). Concordance between the histologic diagnosis and final clinical diagnosis was observed in 62.5% of patients and the pathology guided the final treatment in 71% (P = 0.027) with Kappa-concordance of 0.60 (P < 0.001). CONCLUSIONS: Cryobiopsy is becoming part of the diagnostic evaluation in patients with indeterminate DPLD or hypoxemic respiratory failure. TBLC is easy to perform and has a favorable safety profile. Thoracic specialists should consider adding TBLC to their procedural armamentarium as a first option for patients with indeterminate PLD.
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spelling pubmed-86373502021-12-03 Lung Cryobiopsy Outside of the Operating Room: A Safe Alternative to Surgical Biopsy Menezes, Vanessa Molina, Juan Carlos Pollock, Clare Romeo, Philippe Morisset, Julie Ferraro, Pasquale Lafontaine, Edwin Martin, Jocelyne Nasir, Basil Leduc, Charles Liberman, Moishe Innovations (Phila) Original Articles OBJECTIVE: Transbronchial lung cryobiopsy (TBLC) is a promising technique that can provide a histologic diagnosis in interstitial lung diseases (ILD) and is an alternative to surgical lung biopsy. The main concerns with the procedure are safety and diagnostic accuracy. The technique is applicable in patients unable to undergo surgical biopsy due to severe comorbidities or when patient transport to the operating room is dangerous. This study reports the initial experience with TBLC on a thoracic surgical service as a first attempt at diagnosis in patients with diffuse parenchymal lung diseases (DPLD). METHODS: Between May 2018 and July 2020, 32 patients underwent TBLC using bedside flexible bronchoscopy for suspected ILD on a thoracic surgical endoscopy service. Retrospective evaluation of the procedure details, complications, and diagnostic yield were analyzed and reported. RESULTS: A total of 89 pathological samples were obtained (mean 2.8 per patient). Pneumothorax and minor bleeding occurred in 25% and 16.7% of patients, respectively. Sixty-seven percent of complications occurred with use of the 2.4 mm cryoprobe (P = 0.036). Concordance between the histologic diagnosis and final clinical diagnosis was observed in 62.5% of patients and the pathology guided the final treatment in 71% (P = 0.027) with Kappa-concordance of 0.60 (P < 0.001). CONCLUSIONS: Cryobiopsy is becoming part of the diagnostic evaluation in patients with indeterminate DPLD or hypoxemic respiratory failure. TBLC is easy to perform and has a favorable safety profile. Thoracic specialists should consider adding TBLC to their procedural armamentarium as a first option for patients with indeterminate PLD. SAGE Publications 2021-08-01 2021-09 /pmc/articles/PMC8637350/ /pubmed/34338070 http://dx.doi.org/10.1177/15569845211034506 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Creative Commons Non Commercial CC BY This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Articles
Menezes, Vanessa
Molina, Juan Carlos
Pollock, Clare
Romeo, Philippe
Morisset, Julie
Ferraro, Pasquale
Lafontaine, Edwin
Martin, Jocelyne
Nasir, Basil
Leduc, Charles
Liberman, Moishe
Lung Cryobiopsy Outside of the Operating Room: A Safe Alternative to Surgical Biopsy
title Lung Cryobiopsy Outside of the Operating Room: A Safe Alternative to Surgical Biopsy
title_full Lung Cryobiopsy Outside of the Operating Room: A Safe Alternative to Surgical Biopsy
title_fullStr Lung Cryobiopsy Outside of the Operating Room: A Safe Alternative to Surgical Biopsy
title_full_unstemmed Lung Cryobiopsy Outside of the Operating Room: A Safe Alternative to Surgical Biopsy
title_short Lung Cryobiopsy Outside of the Operating Room: A Safe Alternative to Surgical Biopsy
title_sort lung cryobiopsy outside of the operating room: a safe alternative to surgical biopsy
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8637350/
https://www.ncbi.nlm.nih.gov/pubmed/34338070
http://dx.doi.org/10.1177/15569845211034506
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