open access

Vol 88, No 2 (2020)
ORIGINAL PAPERS
Published online: 2020-04-30
Submitted: 2019-11-17
Accepted: 2020-02-29
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Transbronchial lung cryobiopsy guided by radial mini-probe endobronchial ultrasound in interstitial lung diseases — a multicenter prospective study

Maciej Gnass, Anna Filarecka, Artur Bartczak, Małgorzata Szołkowska, Agnieszka Knapczyk, Monika Lis, Monika Skrobot, Jerzy Soja, Magadlena Misiaszek, Łukasz Barszczok, Damian Czyżewski, Artur Szlubowski
DOI: 10.5603/ARM.2020.0086
·
Pubmed: 32383463
·
Adv Respir Med 2020;88(2):123-128.

open access

Vol 88, No 2 (2020)
ORIGINAL PAPERS
Published online: 2020-04-30
Submitted: 2019-11-17
Accepted: 2020-02-29

Abstract

Introduction: Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). A general anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing it’s safety could result in wider use.
Prospective, observational study was conducted in three Polish pulmonology centers to evaluate safety and diagnostic yield of TBLC under conscious sedation, without intubation and bronchial blockers and with radial-EBUS guidance instead of fluoroscopy. Material and methods: In patients suspected of ILD, in accordance with high resolution computer tomography (HRCT) selected lung segments were examined with radial-EBUS mini probe without a guide sheath. If the lung infiltrations were visible this locations were preferred. If not, specimens were taken from two different segments of the same lobe. Two to five biopsies with freezing time 5–8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels.
Results: From March 2017 to September 2019 — 114 patients (M: 59, F: 55) of mean (SD) age 54 (14) years were included to the study on the basis of medical history and HRCT. Histopathology was conclusive in 90 (79%) patients and included 16 different diagnoses (sarcoidosis, EAA, COP predominantly). 24 inconclusive biopsies of unclassifiable pulmonary fibrosis were followed up. Complications included five cases (4.4%) of pneumothorax requiring a chest tube drainage and a minor and moderate bleeding in few cases. There was no need for use of balloon bronchial blockers.
Conclusions: TBLC under conscious sedation guided by radial EBUS mini-probe is novel, reasonable and safe technique for histological diagnosis of ILDs.

Abstract

Introduction: Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). A general anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing it’s safety could result in wider use.
Prospective, observational study was conducted in three Polish pulmonology centers to evaluate safety and diagnostic yield of TBLC under conscious sedation, without intubation and bronchial blockers and with radial-EBUS guidance instead of fluoroscopy. Material and methods: In patients suspected of ILD, in accordance with high resolution computer tomography (HRCT) selected lung segments were examined with radial-EBUS mini probe without a guide sheath. If the lung infiltrations were visible this locations were preferred. If not, specimens were taken from two different segments of the same lobe. Two to five biopsies with freezing time 5–8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels.
Results: From March 2017 to September 2019 — 114 patients (M: 59, F: 55) of mean (SD) age 54 (14) years were included to the study on the basis of medical history and HRCT. Histopathology was conclusive in 90 (79%) patients and included 16 different diagnoses (sarcoidosis, EAA, COP predominantly). 24 inconclusive biopsies of unclassifiable pulmonary fibrosis were followed up. Complications included five cases (4.4%) of pneumothorax requiring a chest tube drainage and a minor and moderate bleeding in few cases. There was no need for use of balloon bronchial blockers.
Conclusions: TBLC under conscious sedation guided by radial EBUS mini-probe is novel, reasonable and safe technique for histological diagnosis of ILDs.

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Keywords

cryobiopsy; interstital lung diseases; endoscopy; endobronchial ultrasound; bronchoscopy

About this article
Title

Transbronchial lung cryobiopsy guided by radial mini-probe endobronchial ultrasound in interstitial lung diseases — a multicenter prospective study

Journal

Advances in Respiratory Medicine

Issue

Vol 88, No 2 (2020)

Pages

123-128

Published online

2020-04-30

DOI

10.5603/ARM.2020.0086

Pubmed

32383463

Bibliographic record

Adv Respir Med 2020;88(2):123-128.

Keywords

cryobiopsy
interstital lung diseases
endoscopy
endobronchial ultrasound
bronchoscopy

Authors

Maciej Gnass
Anna Filarecka
Artur Bartczak
Małgorzata Szołkowska
Agnieszka Knapczyk
Monika Lis
Monika Skrobot
Jerzy Soja
Magadlena Misiaszek
Łukasz Barszczok
Damian Czyżewski
Artur Szlubowski

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