Diagnostic approach in parenchymal lung diseases: transbronchial lung biopsy or cryobiopsy?
Diagnostic approach in parenchymal lung diseases: transbronchial lung biopsy or cryobiopsy?
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.
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- 1. Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence- based guidelines for diagnosis and management. American Journal of Respiratory and Critical Care Medicine 2011; 183(6): 788-824.doi: 10.1164/rccm.2009-040GL
- 2. Poletti V, Ravaglia C, Gurioli C, Piciucchi S, Dubini S et al. Invasive diagnostic techniques in idiopathic interstitial pneumonias. Respirology 2016; 21(1): 44-50. doi: 10.111111/ resp.12694
- 3. Strongman H, Kausar I, Maher TM. Incidence, prevalence and survival of patients with idiopathic pulmonary fibrosis in the UK. Advances in Therapy 2018; 35(5): 724-736. doi: 10.1007/ s12325-018-0693-1
- 4. Lamas DJ, Kawut SM, Bagiella E, Philip N, Arcasoy SM et al. Delayed access and survival in idiopathic pulmonary fibrosis: a cohort study. American Journal of Respiratory and Critical Care Medicine 2011; 184(7): 842-847.doi: 10.1164/rccm.201104- 0668OC
- 5. Casoni GL, Tomassetti S, Cavazza A, Colby TV, Dubini A et al. Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases. Plos One 2014; 9(2): e86716. doi: 10.1371/journal.pone.0086716
- 6. Andersen HA, Fontana RS, Harrison EG Jr. Transbronchoscopic lung biopsy for diffuse pulmonary diseases.Diseases of the chest1965; 48(2): 187-192. doi: 10.1177/000348946507400417
- 7. American Thoracic Society, European Respiratory Society. american thoracic society/european respiratory society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. American Journal of Respiratory and Critical Care Medicine 2002; 165: 277-304. doi: 10.1164/ajrccm.165.2ats01
- 8. Travis WD, Costabel U, Hansell DM, King TE Jr, Lynch Da et al. An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. American Journal of Respiratory and Critical Care Medicine 2013; 188(6): 733-748. doi: 10.1164/ rccm.201308-1483ST
- 9. Xaubet A, Ancochea J, Bollo E, Fernandez-Fabrellas E, Franquet T et al. Guidelines for the diagnosis and treatment of idiopathic pulmonary fibrosis. Archivos de Broncopneumologia 2013; 49(8): 343-353. doi: 10.1016/j. arbr.2013.06.003
- 10. Sheth JS, Belperio JA, Fishbein MC, Kazerooni EA, Lagstein A et al. Utility of transbronchial vs surgical lung biopsy in the diagnosis of suspected fibrotic interstitial lung disease. Chest 2017; 151(2): 389-399. doi: 10.1016/j.chest.2016.09.028
- 11. Kebbe J, Abdo T. Interstitial lung disease: the diagnostic role of bronchoscopy. Journal of Thoracic Disease2017; 9(10): 996- 1010.doi: 10.21037/jtd.2017.06.39
- 12. Raparia K, Aisner DL, Allen TC, Beasley MB, Borczuk A et al. Transbronchial lung cryobiopsy for interstitial lung disease diagnosis: a perspective from members of the pulmonary pathology society. The Archives of Pathology & Laboratory Medicine 2016; 140(11): 1281-1284. doi: 10.5858/arpa.2016- 0258-SA
- 13. Babiak A, Hetzel J, Krishna G, Fritz P, Moeller P et al. Transbronchial cryobiopsy: a new tool for lung biopsies. Respiration 2009; 78(2): 203-208. doi: 10.1159/000203987
- 14. Colby TV, Tomassetti S, Cavazza A, Dubini A, Poletti V. Transbronchial cryobiopsy in diffuse lung disease: update for the pathologist. The Archives of Pathology & Laboratory Medicine 2017; 141(7): 891-900. doi: 10.5858/ arpa.2016-0233- RA
- 15. Pajares V, Puzo C, Castillo D, Lerma E, Montero MA et al. Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease:a randomized trial. Respirology 2014; 19(6): 900- 906. doi: 10.1111/resp.12322
- 16. Pajares V, Torrego A, Puzo C, Lerma E, Gil De Bernabe MA et al. Transbronchial lung biopsy using cryoprobes. Archivos de Broncopneumologia2010; 46(3): 111-115. doi: 10.1016/j. arbres.2009.09.012
- 17. Hernández-González F, Lucena CM, Ramírez J, Sanchez M, Jimenez MJ et al. Cryobiopsy in the diagnosis of diffuse interstitial lung disease: yield and cost-effectiveness analysis. Archivos de Broncopneumologia2015; 51(6): 261-267. doi: 10.1016/j.arbr.2015.02.001
- 18. Ganganah O, Guo SL, Chiniah M, Li YS. Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: A systematic reviewandmeta-analysis. Respirology 2016; 21(5): 834-841. doi: 10.1111/resp.12770
- 19. Hetzel J, Eberhardt R, Herth FJ, Petermann C, Reichle G et al. Cryobiopsy increases the diagnostic yield of endobronchial biopsy: a multicentre trial. European Respiratory Journal2012; 39(3): 685-690. doi:10.1183/09031936.00033011
- 20. Gershman E, Fruchter O, Benjamin F, Nader AR, Rosenqarten D et al. Safety of cryo-transbronchial biopsy in diffuse lung diseases: analysis of three hundred cases. Respiration 2015; 90(1): 40-46. doi: 10.1159/000381921
- 21. Bango-Alvarez A, Ariza-Porta M, Torres-Rivas H, FernandezFernandez L, Prieto A et al. Transbronchial cryobiopsy in interstitial lung disease: experience in 106 cases - how to do it. ERJ Open Research 2017; 3(1): 00148-2016. doi: 10.1183/23120541.00148-2016
- 22. Ramaswamy A, Homer R, Killam J, Pisani M, Murphy M et al. Comparison of transbronchial and cryobiopsies in evaluation of diffuse parenchymal lung disease. Journal of Bronchology and Interventional Pulmonology 2016; January; 23(1): 14-21. doi: 10.1097/LBR.0000000000000246