Top

Irish Journal of Medical Science (1971 -)

Published in:

01-11-2021 | Hypersensitivity Pneumonitis | Original Article

Transbronchial lung cryobiopsy (TBLC) in the diagnosis of interstitial lung disease: experience of first 100 cases performed under conscious sedation with flexible bronchoscope

Authors: Anne M. O’Mahony, Louise Burke, Alberto Cavazza, Michael M. Maher, Marcus P. Kennedy, Michael T. Henry

Published in: Irish Journal of Medical Science (1971 -) | Issue 4/2021

Abstract

Background

Diagnosing the aetiology of interstitial lung disease (ILD) may require histology via a surgical lung biopsy (SLB). SLB is associated with significant complications. Transbronchial lung cryobiopsy (TBLC) can provide large, adequate biopsies with fewer complications offering a potential alternative to SLB.

Aims

This study evaluated the safety, diagnostic yield and impact of TBLC on diagnostic certainty in the multidisciplinary diagnosis (MDD) of ILD within routine clinical practice.

Methods

A retrospective study of all TBLC performed in a tertiary institute from March 2014 to December 2016 was performed. Procedures were performed using a flexible bronchoscope and cryoprobe without fluoroscopic guidance.

Results

One hundred procedures were performed on 85 patients. A total of 272 cryobiopsies were obtained with a mean biopsy diameter of 5.9 ± 3.2 mm. Ninety-seven percent contained alveolated lung tissue. Diagnosis based against MDD gold standard was confirmed using TBLC in 67.1% of patients and in 72/100 procedures. Three patients proceeded to SLB. The addition of histological information changed the clinic-radiological diagnosis in twelve patients. The most common diagnosis based on clinical-radiologic-pathologic correlation at MDD was idiopathic pulmonary fibrosis (IPF) (51.2%) and hypersensitivity pneumonitis (15.9%). Moderate bleeding occurred in 18% of cases and five patients (5%) developed pneumothorax requiring intervention. Eleven patients required admission, with a mean length of stay of 1.3 ± 0.9 days.

Conclusion

TBLC aids the diagnosis of ILD in the appropriate patient and may be an acceptable alternative to SLB with fewer complications. Further work on standardizing the procedure is required.

Travis WD, Costabel U, Hansell DM, King TE Jr, Lynch DA, Nicholson AG, Ryerson CJ, Ryu JH, Selman M, Wells AU, Behr J, Bouros D, Brown KK, Colby TV, Collard HR, Cordeiro CR, Cottin V, Crestani B, Drent M, Dudden RF, Egan J, Flaherty K, Hogaboam C, Inoue Y, Johkoh T, Kim DS, Kitaichi M, Loyd J, Martinez FJ, Myers J, Protzko S, Raghu G, Richeldi L, Sverzellati N, Swigris J, Valeyre D (2013) An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 188(6):733–748. https://doi.org/10.1164/rccm.201308-1483STCrossRefPubMedPubMedCentral

Raghu G, Remy-Jardin M, Myers JL, Richeldi L, Ryerson CJ, Lederer DJ, Behr J, Cottin V, Danoff SK, Morell F, Flaherty KR, Wells A, Martinez FJ, Azuma A, Bice TJ, Bouros D, Brown KK, Collard HR, Duggal A, Galvin L, Inoue Y, Jenkins RG, Johkoh T, Kazerooni EA, Kitaichi M, Knight SL, Mansour G, Nicholson AG, Pipavath SNJ, Buendía-Roldán I, Selman M, Travis WD, Walsh S, Wilson KC (2018) Diagnosis of idiopathic pulmonary fibrosis. An official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med 198(5):e44–e68. https://doi.org/10.1164/rccm.201807-1255STCrossRefPubMed

Fisher JH, Shapera S, To T, Marras TK, Gershon A, Dell S (2019) Procedure volume and mortality after surgical lung biopsy in interstitial lung disease. Eur Respir J 53(2). https://doi.org/10.1183/13993003.01164-2018

Han Q, Luo Q, Xie JX, Wu LL, Liao LY, Zhang XX, Chen RC (2015) Diagnostic yield and postoperative mortality associated with surgical lung biopsy for evaluation of interstitial lung diseases: a systematic review and meta-analysis. J Thorac Cardiovasc Surg 149(5):1394–1401. e1391. https://doi.org/10.1016/j.jtcvs.2014.12.057CrossRefPubMed

Hutchinson JP, Fogarty AW, McKeever TM, Hubbard RB (2016) In-hospital mortality after surgical lung biopsy for interstitial lung disease in the United States. 2000 to 2011. Am J Respir Crit Care Med 193(10):1161–1167. https://doi.org/10.1164/rccm.201508-1632OCCrossRefPubMed

Kondoh Y, Taniguchi H, Kitaichi M, Yokoi T, Johkoh T, Oishi T, Kimura T, Nishiyama O, Kato K, du Bois RM (2006) Acute exacerbation of interstitial pneumonia following surgical lung biopsy. Respir Med 100(10):1753–1759. https://doi.org/10.1016/j.rmed.2006.02.002CrossRefPubMed

Ensminger SA, Prakash UB (2006) Is bronchoscopic lung biopsy helpful in the management of patients with diffuse lung disease? Eur Respir J 28(6):1081–1084. https://doi.org/10.1183/09031936.06.00013106CrossRefPubMed

Babiak A, Hetzel J, Krishna G, Fritz P, Moeller P, Balli T, Hetzel M (2009) Transbronchial cryobiopsy: a new tool for lung biopsies. Respiration 78(2):203–208. https://doi.org/10.1159/000203987CrossRefPubMed

Griff S, Schönfeld N, Ammenwerth W, Blum TG, Grah C, Bauer TT, Grüning W, Mairinger T, Wurps H (2014) Diagnostic yield of transbronchial cryobiopsy in non-neoplastic lung disease: a retrospective case series. BMC Pulm Med 14:171. https://doi.org/10.1186/1471-2466-14-171CrossRefPubMedPubMedCentral

10.

Gershman E, Fruchter O, Benjamin F, Nader AR, Rosengarten D, Rusanov V, Fridel L, Kramer MR (2015) Safety of cryo-transbronchial biopsy in diffuse lung diseases: analysis of three hundred cases. Respiration 90(1):40–46. https://doi.org/10.1159/000381921CrossRefPubMed

11.

Kropski JA, Pritchett JM, Mason WR, Sivarajan L, Gleaves LA, Johnson JE, Lancaster LH, Lawson WE, Blackwell TS, Steele MP, Loyd JE, Rickman OB (2013) Bronchoscopic cryobiopsy for the diagnosis of diffuse parenchymal lung disease. PLoS One 8(11):e78674. https://doi.org/10.1371/journal.pone.0078674CrossRefPubMedPubMedCentral

12.

Casoni GL, Tomassetti S, Cavazza A, Colby TV, Dubini A, Ryu JH, Carretta E, Tantalocco P, Piciucchi S, Ravaglia C, Gurioli C, Romagnoli M, Gurioli C, Chilosi M, Poletti V (2014) Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases. PLoS One 9(2):e86716. https://doi.org/10.1371/journal.pone.0086716CrossRefPubMedPubMedCentral

13.

Fruchter O, Fridel L, El Raouf BA, Abdel-Rahman N, Rosengarten D, Kramer MR (2014) Histological diagnosis of interstitial lung diseases by cryo-transbronchial biopsy. Respirology 19(5):683–688. https://doi.org/10.1111/resp.12296CrossRefPubMed

14.

Sethi J, Ali MS, Mohananey D, Nanchal R, Maldonado F, Musani A (2019) Are Transbronchial cryobiopsies ready for prime time? A systematic review and meta-analysis. J Bronchology Interv Pulmonol 26(1):22–32. https://doi.org/10.1097/lbr.0000000000000519CrossRefPubMed

15.

Tomassetti S, Wells AU, Costabel U, Cavazza A, Colby TV, Rossi G, Sverzellati N, Carloni A, Carretta E, Buccioli M, Tantalocco P, Ravaglia C, Gurioli C, Dubini A, Piciucchi S, Ryu JH, Poletti V (2016) Bronchoscopic lung cryobiopsy increases diagnostic confidence in the multidisciplinary diagnosis of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 193(7):745–752. https://doi.org/10.1164/rccm.201504-0711OCCrossRefPubMed

16.

Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S, Mandal S, Martin J, Mills J, Navani N, Rahman NM, Wrightson JM, Munavvar M (2013) British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax 68(Suppl 1):i1–i44. https://doi.org/10.1136/thoraxjnl-2013-203618CrossRefPubMed

17.

Ronan N, Bennett DM, Khan KA, McCarthy Y, Dahly D, Bourke L, Chelliah A, Cavazza A, O’Regan K, Moloney F, Plant BJ, Henry MT (2018) Tissue andbronchoalveolar lavage biomarkers in idiopathic pulmonary fibrosis patients on pirfenidone. Lung 196(5):543–552. https://doi.org/10.1007/s00408-018-0140-8CrossRefPubMed

18.

Ravaglia C, Bonifazi M, Wells AU, Tomassetti S, Gurioli C, Piciucchi S, Dubini A, Tantalocco P, Sanna S, Negri E, Tramacere I, Ventura VA, Cavazza A, Rossi A, Chilosi M, La Vecchia C, Gasparini S, Poletti V (2016) Safety and diagnostic yield of transbronchial lung cryobiopsy in diffuse parenchymal lung diseases: a comparative study versus video-assisted thoracoscopic lung biopsy and a systematic review of the literature. Respiration 91(3):215–227. https://doi.org/10.1159/000444089CrossRefPubMed

19.

Lentz RJ, Taylor TM, Kropski JA, Sandler KL, Johnson JE, Blackwell TS, Maldonado F, Rickman OB (2018) Utility of flexible bronchoscopic cryobiopsy for diagnosis of diffuse parenchymal lung diseases. J Bronchology Interv Pulmonol 25(2):88–96. https://doi.org/10.1097/lbr.0000000000000401CrossRefPubMedPubMedCentral

20.

Ravaglia C, Wells AU, Tomassetti S, Gurioli C, Gurioli C, Dubini A, Cavazza A, Colby TV, Piciucchi S, Puglisi S, Bosi M, Poletti V (2019) Diagnostic yield and risk/benefit analysis of trans-bronchial lung cryobiopsy in diffuse parenchymal lung diseases: a large cohort of 699 patients. BMC Pulm Med 19(1):16. https://doi.org/10.1186/s12890-019-0780-3CrossRefPubMedPubMedCentral

21.

Echevarria-Uraga JJ, Pérez-Izquierdo J, García-Garai N, Gómez-Jiménez E, Aramburu-Ojembarrena A, Tena-Tudanca L, Miguélez-Vidales JL, Capelastegui-Saiz A (2016) Usefulness of an angioplasty balloon as selective bronchial blockade device after transbronchial cryobiopsy. Respirology 21(6):1094–1099. https://doi.org/10.1111/resp.12827CrossRefPubMed

22.

Dalvi PKG, Clum S, Markow M, DiNuoscio D, Rumbak M, Mangar D, Camporesi E (2016) Transbronchial lung cryobiopsy (TBLC) at a tertiary referral hospital: a two-year experience. Pulm Crit Care Med 1(4):2–4. https://doi.org/10.15761/PCCM.1000122CrossRef

23.

Bango-Álvarez A, Ariza-Prota M, Torres-Rivas H, Fernández-Fernández L, Prieto A, Sánchez I, Gil M, Pando-Sandoval A (2017) Transbronchial cryobiopsy in interstitial lung disease: experience in 106 cases - how to do it. ERJ Open Res 3(1). https://doi.org/10.1183/23120541.00148-2016

24.

Ussavarungsi K, Kern RM, Roden AC, Ryu JH, Edell ES (2017) Transbronchial cryobiopsy in diffuse parenchymal lung disease: retrospective analysis of 74 cases. Chest 151(2):400–408. https://doi.org/10.1016/j.chest.2016.09.002CrossRefPubMed

25.

Sriprasart T, Aragaki A, Baughman R, Wikenheiser-Brokamp K, Khanna G, Tanase D, Kirschner M, Benzaquen S (2017) A single US center experience of transbronchial lung cryobiopsy for diagnosing interstitial lung disease with a 2-scope technique. J Bronchology Interv Pulmonol 24(2):131–135. https://doi.org/10.1097/lbr.0000000000000366CrossRefPubMedPubMedCentral

26.

Wälscher J, Groß B, Eberhardt R, Heussel CP, Eichinger M, Warth A, Lasitschka F, Herth FJF, Kreuter M (2019) Transbronchial cryobiopsies for diagnosing interstitial lung disease: real-life experience from a tertiary referral center for interstitial lung disease. Respiration 97(4):348–354. https://doi.org/10.1159/000493428CrossRefPubMed

27.

Dhooria S, Mehta RM, Srinivasan A, Madan K, Sehgal IS, Pattabhiraman V, Yadav P, Sivaramakrishnan M, Mohan A, Bal A, Garg M, Agarwal R (2018) The safety and efficacy of different methods for obtaining transbronchial lung cryobiopsy in diffuse lung diseases. Clin Respir J 12(4):1711–1720. https://doi.org/10.1111/crj.12734CrossRefPubMed

28.

Poletti V, Benzaquen S (2014) Transbronchial cryobiopsy in diffuse parenchymal lung disease. A new star in the horizon. Sarcoidosis Vasc Diffuse Lung Dis 31(3):178–181PubMed

29.

Hetzel J, Maldonado F, Ravaglia C, Wells AU, Colby TV, Tomassetti S, Ryu JH, Fruchter O, Piciucchi S, Dubini A, Cavazza A, Chilosi M, Sverzellati N, Valeyre D, Leduc D, Walsh SLF, Gasparini S, Hetzel M, Hagmeyer L, Haentschel M, Eberhardt R, Darwiche K, Yarmus LB, Torrego A, Krishna G, Shah PL, Annema JT, Herth FJF, Poletti V (2018) Transbronchial cryobiopsies for the diagnosis of diffuse parenchymal lung diseases: expert statement from the cryobiopsy working group on safety and utility and a call for standardization of the procedure. Respiration 95(3):188–200. https://doi.org/10.1159/000484055CrossRefPubMed

30.

Hetzel J, Eberhardt R, Petermann C, Gesierich W, Darwiche K, Hagmeyer L, Muche R, Kreuter M, Lewis R, Ehab A, Boeckeler M, Haentschel M (2019) Bleeding risk of transbronchial cryobiopsy compared to transbronchial forceps biopsy in interstitial lung disease - a prospective, randomized, multicentre cross-over trial. Respir Res 20(1):140. https://doi.org/10.1186/s12931-019-1091-1CrossRefPubMedPubMedCentral

31.

Deasy KF, Walsh LJ, Henry MT (2019) Endobronchial balloon blockers. A retrospective review of their implementation at Cork University Hospital for use in transbronchial lung cryobiopsy under conscious sedation. European Respiratory Journal 54(suppl 63):PA3103. https://doi.org/10.1183/13993003.congress-2019.PA3103CrossRef

32.

Maldonado F, Danoff SK, Wells AU, Colby TV, Ryu JH, Liberman M, Wahidi MM, Frazer L, Hetzel J, Rickman OB, Herth FJF, Poletti V, Yarmus LB (2020) Transbronchial cryobiopsy for the diagnosis of interstitial lung diseases: CHEST guideline and expert panel report. Chest 157(4):1030–1042. https://doi.org/10.1016/j.chest.2019.10.048CrossRefPubMed

33.

Sharp C, McCabe M, Adamali H, Medford AR (2017) Use of transbronchial cryobiopsy in the diagnosis of interstitial lung disease-a systematic review and cost analysis. Qjm 110(4):207–214. https://doi.org/10.1093/qjmed/hcw142CrossRefPubMed

34.

Poletti V, Hetzel J (2015) Transbronchial cryobiopsy in diffuse parenchymal lung disease: need for procedural standardization. Respiration 90(4):275–278. https://doi.org/10.1159/000439313CrossRefPubMed

35.

Colby TV, Tomassetti S, Cavazza A, Dubini A, Poletti V (2017) Transbronchial cryobiopsy in diffuse lung disease: update for the pathologist. Arch Pathol Lab Med 141(7):891–900. https://doi.org/10.5858/arpa.2016-0233-RACrossRefPubMed

36.

Flaherty KR, Travis WD, Colby TV, Toews GB, Kazerooni EA, Gross BH, Jain A, Strawderman RL, Flint A, Lynch JP, Martinez FJ (2001) Histopathologic variability in usual and nonspecific interstitial pneumonias. Am J Respir Crit Care Med 164(9):1722–1727. https://doi.org/10.1164/ajrccm.164.9.2103074CrossRefPubMed

37.

Takemura T, Akashi T, Kamiya H, Ikushima S, Ando T, Oritsu M, Sawahata M, Ogura T (2012) Pathological differentiation of chronic hypersensitivity pneumonitis from idiopathic pulmonary fibrosis/usual interstitial pneumonia. Histopathology 61(6):1026–1035. https://doi.org/10.1111/j.1365-2559.2012.04322.xCrossRefPubMed

38.

Flaherty KR, Wells AU, Cottin V, Devaraj A, Walsh SLF, Inoue Y, Richeldi L, Kolb M, Tetzlaff K, Stowasser S, Coeck C, Clerisme-Beaty E, Rosenstock B, Quaresma M, Haeufel T, Goeldner RG, Schlenker-Herceg R, Brown KK (2019) Nintedanib in progressive fibrosing interstitial lung diseases. N Engl J Med 381(18):1718–1727. https://doi.org/10.1056/NEJMoa1908681CrossRefPubMed

39.

Romagnoli M, Colby TV, Berthet JP, Gamez AS, Mallet JP, Serre I, Cancellieri A, Cavazza A, Solovei L, Dell’Amore A, Dolci G, Guerrieri A, Reynaud P, Bommart S, Zompatori M, Dalpiaz G, Nava S, Trisolini R, Suehs CM, Vachier I, Molinari N, Bourdin A (2019) Poor concordance between sequential transbronchial lung cryobiopsy and surgical lung biopsy in the diagnosis of diffuse interstitial lung diseases. Am J Respir Crit Care Med 199(10):1249–1256. https://doi.org/10.1164/rccm.201810-1947OCCrossRefPubMed

40.

Troy LK, Grainge C, Corte TJ, Williamson JP, Vallely MP, Cooper WA, Mahar A, Myers JL, Lai S, Mulyadi E, Torzillo PJ, Phillips MJ, Jo HE, Webster SE, Lin QT, Rhodes JE, Salamonsen M, Wrobel JP, Harris B, Don G, Wu PJC, Ng BJ, Oldmeadow C, Raghu G, Lau EMT (2020) Diagnostic accuracy of transbronchial lung cryobiopsy for interstitial lung disease diagnosis (COLDICE): a prospective, comparative study. Lancet Respir Med 8(2):171–181. https://doi.org/10.1016/s2213-2600(19)30342-xCrossRefPubMed

Title: Transbronchial lung cryobiopsy (TBLC) in the diagnosis of interstitial lung disease: experience of first 100 cases performed under conscious sedation with flexible bronchoscope
Authors: Anne M. O’Mahony
Louise Burke
Alberto Cavazza
Michael M. Maher
Marcus P. Kennedy
Michael T. Henry
Publication date: 01-11-2021
Publisher: Springer International Publishing
Keywords: Hypersensitivity Pneumonitis
Idiopathic Pulmonary Fibrosis
Pneumothorax
Pneumothorax
Pneumothorax
Pneumonia
Published in: Irish Journal of Medical Science (1971 -) / Issue 4/2021
Print ISSN: 0021-1265
Electronic ISSN: 1863-4362
DOI: https://doi.org/10.1007/s11845-020-02453-7

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Aims

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2021

Consequences of FFP3 mask usage on venous blood gases

Irish cancer patients and survivors have a positive view of the role of nutritional care in cancer management from diagnosis through survivorship

Collection and storage of forensic evidence to enable subsequent reporting of a sexual crime to the police “Option 3”—an Irish experience

Chemotherapy in the Covid-19 era: the patient’s perception

Active vitamin D supplementation and COVID-19 infections: review

A randomized trial to compare procalcitonin and C-reactive protein in assessing severity of sepsis and in guiding antibacterial therapy in Egyptian critically ill patients

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage