scholarly journals P16‐45: Efficacy of multidisciplinary discussion (MDD) with transbronchial lung cryobiopsy

Respirology ◽  
2021 ◽  
Vol 26 (S3) ◽  
pp. 467-467
Keyword(s):  
Transbronchial Lung Cryobiopsy

scholarly journals S2K Guideline for Diagnosis of Idiopathic Pulmonary Fibrosis

Respiration ◽  
2021 ◽  
pp. 1-34
Author(s):  
Jürgen Behr ◽  
Andreas Günther ◽  
Francesco Bonella ◽  
Julien Dinkel ◽  
Ludger Fink ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Disease Diagnosis ◽  
Diagnostic Process ◽  
High Resolution Computed Tomography ◽  
Cellular Analysis ◽  
Golden Standard ◽  
Technical Advances ◽  
Transbronchial Lung Cryobiopsy ◽  
Effective Diagnosis

Idiopathic pulmonary fibrosis (IPF) is a severe and often fatal disease. Diagnosis of IPF requires considerable expertise and experience. Since the publication of the international IPF guideline in the year 2011 and the update 2018 several studies and technical advances have occurred, which made a new assessment of the diagnostic process mandatory. The goal of this guideline is to foster early, confident, and effective diagnosis of IPF. The guideline focusses on the typical clinical context of an IPF patient and provides tools to exclude known causes of interstitial lung disease including standardized questionnaires, serologic testing, and cellular analysis of bronchoalveolar lavage. High-resolution computed tomography remains crucial in the diagnostic workup. If it is necessary to obtain specimens for histology, transbronchial lung cryobiopsy is the primary approach, while surgical lung biopsy is reserved for patients who are fit for it and in whom a bronchoscopic diagnosis did not provide the information needed. After all, IPF is a diagnosis of exclusion and multidisciplinary discussion remains the golden standard of diagnosis.

scholarly journals Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems

2020 ◽  
Author(s):  
Emanuela Barisione ◽  
Federica Grillo ◽  
Lorenzo Ball ◽  
Rita Bianchi ◽  
Marco Grosso ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Diffuse Alveolar Damage ◽  
Ground Glass Opacity ◽  
Post Mortem ◽  
Mechanically Ventilated ◽  
Illness Duration ◽  
Transbronchial Lung Cryobiopsy ◽  
Histopathologic Analysis ◽  
Lung Lobes

Abstract Data on the pathology of COVID-19 are scarce; available studies show diffuse alveolar damage; however, there is scarce information on the chronologic evolution of COVID-19 lung lesions. The primary aim of the study is to describe the chronology of lung pathologic changes in COVID-19 by using a post-mortem transbronchial lung cryobiopsy approach. Our secondary aim is to correlate the histologic findings with computed tomography patterns. SARS-CoV-2-positive patients, who died while intubated and mechanically ventilated, were enrolled. The procedure was performed 30 min after death, and all lung lobes sampled. Histopathologic analysis was performed on thirty-nine adequate samples from eight patients: two patients (illness duration < 14 days) showed early/exudative phase diffuse alveolar damage, while the remaining 6 patients (median illness duration—32 days) showed progressive histologic patterns (3 with mid/proliferative phase; 3 with late/fibrotic phase diffuse alveolar damage, one of which with honeycombing). Immunohistochemistry for SARS-CoV-2 nucleocapsid protein was positive predominantly in early-phase lesions. Histologic patterns and tomography categories were correlated: early/exudative phase was associated with ground-glass opacity, mid/proliferative lesions with crazy paving, while late/fibrous phase correlated with the consolidation pattern, more frequently seen in the lower/middle lobes. This study uses an innovative cryobiopsy approach for the post-mortem sampling of lung tissues from COVID-19 patients demonstrating the progression of fibrosis in time and correlation with computed tomography features. These findings may prove to be useful in the correct staging of disease, and this could have implications for treatment and patient follow-up.

scholarly journals Learning curve for transbronchial lung cryobiopsy in diffuse lung disease

Pulmonology ◽  
2018 ◽  
Vol 24 (1) ◽  
pp. 23-31 ◽  
Author(s):  
L.M. Almeida ◽  
B. Lima ◽  
P.C. Mota ◽  
N. Melo ◽  
A. Magalhães ◽  
...  
Keyword(s):  
Learning Curve ◽  
Lung Disease ◽  
Diffuse Lung Disease ◽  
Transbronchial Lung Cryobiopsy ◽  
Diffuse Lung

Transbronchial Lung Cryobiopsy With 2 Bronchoscopes

2018 ◽  
Vol 25 (1) ◽  
pp. e11-e12 ◽  
Author(s):  
Sahajal Dhooria ◽  
Inderpaul S. Sehgal ◽  
Kuruswamy T. Prasad ◽  
Ritesh Agarwal
Keyword(s):  
Transbronchial Lung Cryobiopsy

The Role of Ultrasonography in the Diagnosis and Decision Algorithm for the Management of Pneumothorax after Transbronchial Lung Cryobiopsy

Respiration ◽  
2021 ◽  
pp. 1-9
Author(s):  
David Barros Coelho ◽  
Rita Boaventura ◽  
Leonor Meira ◽  
Susana Guimarães ◽  
Conceição Souto Moura ◽  
...  
Keyword(s):  
Clinical Status ◽  
Treatment Strategies ◽  
Final Diagnosis ◽  
Decision Algorithm ◽  
Chest X Ray ◽  
Transbronchial Lung Cryobiopsy ◽  
Ionizing Radiation Exposure ◽  
Point Projection ◽  
Lung Point

<b><i>Background:</i></b> Pneumothorax is one of the main complications of transbronchial lung cryobiopsy (TBLC). Chest ultrasound (CUS) is a radiation-free alternative method for pneumothorax detection. <b><i>Objective:</i></b> We tested CUS diagnostic accuracy for pneumothorax and assessed its role in the decision algorithm for pneumothorax management. Secondary objectives were to evaluate the post-procedure pneumothorax occurrence and risk factors. <b><i>Methods:</i></b> Eligible patients underwent TBLC, followed by chest X-ray (CXR) evaluation 2 h after the procedure, as our standard protocol. Bedside CUS was performed within 30 min and 2 h after TBLC. Pneumothorax by CUS was defined by the absence of lung sliding and comet-tail artefacts and confirmed with the stratosphere sign on M-mode. Pneumothorax size was determined through lung point projection on CUS and interpleural distance on CXR and properly managed according to clinical status. <b><i>Results:</i></b> Sixty-seven patients were included. Nineteen pneumothoraces were detected at 2 h after the procedure, of which 8 (42.1%) were already present at the first CUS evaluation. All CXR-detected pneumothoraces had a positive CUS detection. There were 3 discordant cases (κ = 0.88, 95% CI: 0.76–1.00, <i>p</i> &#x3c; 0.001), which were detected by CUS but not by inspiration CXR. We calculated a specificity of 97.5% (95% CI: 86.8–99.9) and a sensitivity of 100% (95% CI: 87.2–100) for CUS. Pneumothorax rate was higher when biopsies were taken in 2 lobes and if histology had pleural representation. Final diagnosis was achieved in 79.1% of patients, with the most frequent diagnosis being hypersensitivity pneumonitis. Regarding patients with large-volume pneumothorax needing drainage, the rate of detection was similar between CUS and CRX. <b><i>Conclusion:</i></b> CUS can replace CXR in detecting the presence of pneumothorax after TBLC, and the lung point site can reliably indicate its size. This useful method optimizes time spent at the bronchology unit and allows immediate response in symptomatic patients, helping to choose optimal treatment strategies, while preventing ionizing radiation exposure.

scholarly journals Diagnostic approach in parenchymal lung diseases: transbronchial lung biopsy or cryobiopsy?

2020 ◽  
Vol 50 (6) ◽  
pp. 1535-1539
Author(s):  
Ali Kadri ÇIRAK ◽  
Nuran KATGI ◽  
Onur Fevzi ERER ◽  
Pınar ÇİMEN ◽  
Fatma Fevziye TUKSAVUL ◽  
...  
Keyword(s):  
Lung Biopsy ◽  
Lung Diseases ◽  
Interstitial Lung Diseases ◽  
Massive Hemorrhage ◽  
Open Lung Biopsy ◽  
Transbronchial Lung Biopsy ◽  
Diffuse Parenchymal Lung Diseases ◽  
Training And Research ◽  
Transbronchial Lung Cryobiopsy ◽  
Parenchymal Lung

Background/aim: Diagnosis of interstitial lung diseases requires a multidisciplinary approach, and a gold standard for histological diagnosis is open lung biopsy. Transbronchial lung biopsy (TBLB) and in recent years an alternative method, cryobiopsy (TBLC), are used for the diagnosis of parenchymal lung lesions. The aim of this study is to compare the efficacy of concomitant conventional TBLB and TBLC.Materials and methods: A total of 82 patients who underwent TBLC for diagnosis of diffuse parenchymal lung diseases at Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital between 2015 and 2018 were screened retrospectively and included in the study. Of the patients, 53.7% (n: 44) were male, and 46.4% (n:38) of them were female. The mean age was 58.37 (±9.33) years. First TBLB and then TBLC were performed to all patients in the same session and their diagnostic performances were compared.Results: Although both procedures were done in the same session, 45 patients (54.9%) were diagnosed with TBLB and 75 patients (91.5%) were diagnosed with TBLC (P ˂ 0.001). Hemorrhage was observed in 39 patients (47.6%), but only one had a massive hemorrhage. Pneumothorax was observed in 6 patients (7.3%) and none of them required tube drainage.Conclusion: Transbronchial lung cryobiopsy is a promising technique for the diagnosis of parenchymal lung diseases compared to transbronchial lung biopsy.

scholarly journals Concordance between sequential transbronchial lung cryobiopsy and surgical lung biopsy in patients with diffuse interstitial lung disease

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Yoshiaki Zaizen ◽  
Yasuo Kohashi ◽  
Kishio Kuroda ◽  
Kazuhiro Tabata ◽  
Yuka Kitamura ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Lung Disease ◽  
Lung Biopsy ◽  
Usual Interstitial Pneumonia ◽  
Airway Disease ◽  
Surgical Lung Biopsy ◽  
High Concordance ◽  
Transbronchial Lung Cryobiopsy

Abstract Background Increasing evidence indicates the utility of transbronchial lung cryobiopsy (TBLC) for the diagnosis of interstitial lung disease (ILD). However, only one study has compared TBLC and surgical lung biopsy (SLB) performed on the same patients. Methods We identified seven patients with ILD with TBLC and SLB. We evaluated the clinical characteristics and made a pathological diagnosis based on the official ATS/ERS/JRS/ALAT clinical practice guideline of idiopathic pulmonary fibrosis with both TBLC and SLB. Results Six cases were diagnosed as Usual interstitial pneumonia (UIP) in both TBLC and SLB. One case was diagnosed as indeterminate for UIP with TBLC and probable UIP with SLB. Etiological diagnosis with TBLC and SLB were concordant in 2 cases of idiopathic pulmonary fibrosis (IPF) but discordant for other diagnoses. Major histological findings of UIP including dense fibrosis, peripheral distribution, and fibroblastic foci showed high concordance between TBLC and SLB, which implies that TBLC can reliably detect these features. In contrast, loose fibrosis, cellular infiltration, and airway disease showed poor concordance between the two methods. Conclusion Our study showed that TBLC is useful for UIP diagnosis but not for other ILD. With a multidisciplinary approach, diagnosis of IPF may be determined by TBLC, whereas ILD other than IPF may require SLB.

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