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Complications of Transbronchial Cryobiopsy

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Transbronchial cryobiopsy in diffuse parenchymal lung disease

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Abstract

Safety profile of transbronchial lung cryobiopsy (TLCB) is characterized by significant variability in the literature, mostly due to the rapid spread of the technique around the world and the variability of the procedure itself in different centers. Pneumothorax seems to be the most common complication occurring after TLCB, being influenced by patient-related factors (radiological fibrotic score and UIP pattern on biopsy) or procedure-related factors (type of sedation/airway control, distance from the pleura, size of the probe and freezing time, sampling strategy, skill level of operator). Another common complication of cryobiopsy is bleeding, although generally readily controlled endoscopically by the use of bronchial blockers (Fogarty balloon or other tools) and/or the use of rigid bronchoscopy; no bleeding-related deaths have been reported after cryobiopsy. Other complications are anecdotal and can comprise transient respiratory failure, neurological manifestations, pneumomediastinum, prolonged air leak, and pulmonary abscess. Regarding mortality, current data are showing that TLCB appears to be safer than surgical lung biopsy and no age limit has been suggested for TLCB, as it has been performed safely in a wide age range of patients, which need to be carefully evaluated in terms of comorbidities and fitness for anesthesia.

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References

  1. Hetzel J, Maldonado F, Ravaglia C, et al. 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. 2018;95:188–200.

    Article  Google Scholar 

  2. Babiak A, Hetzel J, Krishna G, et al. Tranbronchial cryobiopsy: a new tool for lung biopsies. Respiration. 2009;78:203–8.

    Article  Google Scholar 

  3. Kropski JA, Pritchett JM, Mason WR, et al. Bronchoscopic cryobiopsy for the diagnosis of diffuse parenchymal lung disease. PLoS One. 2013;12:e78674.

    Article  Google Scholar 

  4. Fruchter O, Fridel L, Rosengarten D, et al. Transbronchial cryobiopsy in immunocompromised patients with pulmonary infiltrates: a pilot study. Lung. 2013;91:619–24.

    Article  Google Scholar 

  5. Yarmus L, Akulian J, Gilbert C, et al. Cryoprobe transbronchial lung biopsy in patients after lung transplantation: a pilot safety study. Chest. 2013;143:621–6.

    Article  Google Scholar 

  6. Pajares V, Puzo C, Castillo D, et al. Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: a randomized trial. Respirology. 2014;19:900–6.

    Article  Google Scholar 

  7. Fruchter O, Fridel L, El Raouf BA, et al. Histological diagnosis of interstitial lung diseases by cryo-transbronchial biopsy. Respirology. 2014;19:683–38.

    Article  Google Scholar 

  8. Pourabdollah M, Shamaei M, Karimi S, et al. Transbronchial lung biopsy: the pathologist’s point of view. Clin Respir J. 2016;10:211–6.

    Article  Google Scholar 

  9. Griff S, Schönfeld N, Ammenwerth W, et al. Diagnostic yield of transbronchial cryobiopsy in non-neoplastic lung disease: a retrospective case series. BMC Pulm Med. 2014;14:171.

    Article  Google Scholar 

  10. Hernández-González F, Lucena CM, Ramírez J, et al. Cryobiopsy in the diagnosis of diffuse interstitial lung disease: yield and cost- effectiveness analysis (in English, Spanish). Arch Bronconeumol. 2015;6:261–7.

    Google Scholar 

  11. Hagmeyer L, Theegarten D, Wohlschläger J, et al. The role of transbronchial cryobiopsy and surgical lung biopsy in the diagnostic algorithm of interstitial lung disease. Clin Respir J. 2016;10:589–95.

    Article  Google Scholar 

  12. Gershman E, Fruchter O, Benjamin F, et al. Safety of cryo-transbronchial biopsy in diffuse lung diseases: analysis of three hundred cases. Respiration. 2015;90:40–6.

    Article  Google Scholar 

  13. Ramaswamy A, Homer R, Killam J, et al. Comparison of transbronchial and cryobiopsies in evaluation of diffuse parenchymal lung disease. J Bronchology Interv Pulmonol. 2016;23:14–21.

    Article  Google Scholar 

  14. Echevarria-Uraga JJ, Pèerez-Izquierdo J, Garcìa-Garai N, et al. Usefulness of an angioplasty balloon as selective bronchial blockade device after transbronchial cryobiopsy. Respirology. 2016;21:1094–9.

    Article  Google Scholar 

  15. Ravaglia C, Bonifazi M, Wells AU, et al. 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. 2016;91:215–27.

    Article  Google Scholar 

  16. Ussavarungsi K, Kern RM, Roden AC, et al. Transbronchial cryobiopsy in diffuse parenchymal lung disease: retrospective analysis of 74 cases. Chest. 2017;151:400–8.

    Article  Google Scholar 

  17. DiBardino DM, Haas AR, Lanfranco AR, et al. High complication rate after introduction of transbronchial cryobiopsy into clinical practice at an Academic Medical Center. Ann Am Thorac Soc. 2017;14:851–7.

    Article  Google Scholar 

  18. Bango-Alvarez A, Ariza-Prota M, Torres-Rivas H, et al. Transbronchial cryobiopsy in interstitial lung disease: experience in 106 cases—how to do it. ERJ Open Res. 2017;3:00148-2016.

    Article  Google Scholar 

  19. Kronborg-White S, Folkersen B, Rasmussen TR, et al. Introduction of cryobiopsies in the diagnostics of interstitial lung diseases—experiences in a referral center. Eur Clin Respir J. 2017;4:1274099.

    Article  Google Scholar 

  20. Sriprasart T, Aragaki A, Baughman R, et al. A single US center experience of transbronchial lung cryobiopsy for diagnosing interstitial lung disease with a 2-scope technique. J Bronchology Interv Pulmonol. 2017;24:131–5.

    Article  Google Scholar 

  21. Ravaglia C, Wells AU, Tomassetti S, et al. Transbronchial lung cryobiopsy in diffuse parenchymal lung disease: comparison between biopsy from 1 segment and biopsy from 2 segments—diagnostic yield and complications. Respiration. 2017;93:285–92.

    Article  Google Scholar 

  22. Wall CP, Gaensler EA, Carrington CB, et al. Comparison of transbronchial and open biopsies in chronic infiltrative lung diseases. Am Rev Respir Dis. 1981;123:280–5.

    CAS  PubMed  Google Scholar 

  23. O’Brien JD, Ettinger NA, Shevlin D, et al. Safety and yield of transbronchial biopsy in mechanically ventilated patients. Crit Care Med. 1997;25:440–6.

    Article  Google Scholar 

  24. Berbescu EA, Katzenstein AL, Snow JL, et al. Transbronchial biopsy in usual interstitial pneumonia. Chest. 2006;129:1126–31.

    Article  Google Scholar 

  25. Casoni GL, Tomassetti S, Cavazza A, et al. Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases. PLoS One. 2014;9:e86716.

    Article  Google Scholar 

  26. Facciolongo N, Patelli M, Gasparini S, et al. Incidence of complications in bronchoscopy. Multicentre prospective study of 20,986 bronchoscopies. Monaldi Arch Chest Dis. 2009;71:8–14.

    CAS  PubMed  Google Scholar 

  27. Tomassetti S, Piciucchi S, Tantalocco P, et al. The multidisciplinary approach in the diagnosis of idiopathic pulmonary fibrosis: a patient case-based review. Eur Respir Rev. 2015;24:69–773.

    Article  Google Scholar 

  28. Sheth JS, Belperio JA, Fishbein MC, et al. Utility of transbronchial versus surgical lung biopsy in the diagnosis of suspected fibrotic interstitial lung disease. Chest. 2017;151:389–99.

    Article  Google Scholar 

  29. Rena O, Casadio C, Leo F, et al. Videothoracoscopic lung biopsy in the diagnosis of interstitial lung disease. Eur J Cardiothorac Surg. 1999;16:624–7.

    Article  CAS  Google Scholar 

  30. Kreider ME, Hansen-Flaschen J, Ahmad NN, et al. Complications of video-assisted thoracoscopic lung biopsy in patients with interstitial lung disease. Ann Thorac Surg. 2007;83:1140–4.

    Article  Google Scholar 

  31. Zhang D, Liu Y. Surgical lung biopsies in 418 patients with suspected interstitial lung disease in China. Intern Med. 2010;49:1097–102.

    Article  Google Scholar 

  32. Fibla JJ, Molins L, Blanco A, et al. Video-assisted thoracoscopic lung biopsy in the diagnosis of interstitial lung disease: a prospective, multi-center study in 224 patients. Arch Bronconeumol. 2012;48:81–5.

    Article  Google Scholar 

  33. Blackhall V, Asif M, Renieri A, et al. The role of surgical lung biopsy in the management of interstitial lung disease: experience from a single institution in the UK. Interact Cardiovasc Thorac Surg. 2013;17:253–7.

    Article  Google Scholar 

  34. Morris D, Zamvar V. The efficacy of video-assisted thoracoscopic surgery lung biopsies in patients with interstitial lung disease: a retrospective study of 66 patients. J Cardiothorac Surg. 2014;9:45.

    Article  Google Scholar 

  35. Rotolo N, Imperatori A, Dominioni L, et al. Efficacy and safety of surgical lung biopsy for interstitial disease. Experience of 161 consecutive patients from a single institution in Italy. Sarcoidosis Vasc Diffuse Lung Dis. 2015;32:251–8.

    PubMed  Google Scholar 

  36. Hutchinson JP, McKeever TM, Fogarty AW, et al. Surgical lung biopsy for the diagnosis of interstitial lung disease in England: 1997–2008. Eur Respir J. 2016;48:1453–61.

    Article  Google Scholar 

  37. Hutchinson JP, Fogarty AW, McKeever TM, et al. In-hospital mortality after surgical lung biopsy for interstitial lung disease in the United States. 2000 to 2011. Am J Respir Crit Care Med. 2016;193:1161–7.

    Article  CAS  Google Scholar 

  38. Lieberman S, Gleason JB, Ilyas MIM, et al. Assessing the safety and clinical impact of thoracoscopic lung biopsy in patients with interstitial lung disease. J Clin Diagn Res. 2017;11:OC57–9.

    PubMed  PubMed Central  Google Scholar 

  39. Patel RR, Utz JP. Bronchoscopic lung biopsy. In: Wang K-P, Metha AC, Turner Jr JF, editors. Flexible bronchoscopy. Chichester: Wiley-Blackwell; 2011. p. 117–31.

    Google Scholar 

  40. Griff S, Ammenwerth W, Schönfeld N, et al. Morphometrical analysis of transbronchial cryobiopsies. Diagn Pathol. 2011;6:53.

    Article  Google Scholar 

  41. Iftikhar IH, Alghothani L, Sardi A, et al. Transbronchial lung cryobiopsy and video-assisted thoracoscopic lung biopsy in the diagnosis of diffuse parenchymal lung disease: a meta-analysis of diagnostic test accuracy. Ann Am Thorac Soc. 2017;14:1197–211.

    PubMed  Google Scholar 

  42. O’Donovan JP, Khan KA, Burke L, et al. Bronchoscopic cryobiopsy: initial experience in an interstitial lung disease centre. Irish J Med Sci. 2014;183(11 Suppl 1):S515–6.

    Google Scholar 

  43. Sharp C, McCabe M, Adamali H, et al. Use of transbronchial cryobiopsy in the diagnosis of interstitial lung disease-a systematic review and cost analysis. QJM. 2017;110:207–14.

    Article  CAS  Google Scholar 

  44. Ball CG, Kirkpatrick AW, Laupland KB, et al. Factors related to the failure of radiographic recognition of occult post traumatic pneumothoraces. Am J Surg. 2005;189:541.

    Article  Google Scholar 

  45. Ebrahimi A, Yousefifard M, Mohammad Kazemi H, et al. Diagnostic accuracy of chest ultrasonography versus chest radiography for identification of pneumothorax: a systematic review and meta-analysis. Tanaffos. 2014;13:29–40.

    PubMed  PubMed Central  Google Scholar 

  46. Husain LF, Hagopian L, Wayman D, et al. Sonographic diagnosis of pneumothorax. J Emerg Trauma Shock. 2012;5:76–81.

    Article  Google Scholar 

  47. Viglietta L, Inchingolo R, Pavano C, et al. Ultrasonography for the diagnosis of pneumothorax after transbronchial lung cryobiopsy in diffuse cryobiopsy in diffuse parenchymal lung diseases. Respiration. 2017;94:232–6.

    Article  Google Scholar 

  48. Poletti V, Hetzel J. Transbronchial cryobiopsy in diffuse parenchymal lung disease: need for procedural standardization. Respiration. 2015;90:275–8.

    Article  Google Scholar 

  49. Hagmeyer L, Theegarten D, Treml M, et al. Validation of transbronchial cryobiopsy in interstitial lung disease—interim analysis of a prospective trial and critical review of the literature. Sarcoidosis Vasc Diffuse Lung Dis. 2016;33:2–9.

    PubMed  Google Scholar 

  50. Linhas R, Marçôa R, Oliveira A, et al. Transbronchial lung cryobiopsy: associated complications. Rev Port Pneumol (2006). 2017;23:331–7.

    CAS  Google Scholar 

  51. Chan JWM, Yeung YC, Sin KM, et al. Guidelines of procedural and sedation safety in flexible bronchoscopy and pleuroscopy. Hong Kong Thoracic Society, American College of Chest Physicians (Hong Kong and Macau Chapter), Hong Kong Lung Foundation. 2016.

    Google Scholar 

  52. Skalski JH, Kern RM, Midthun DE, et al. Pulmonary abscess as a complication of transbronchial lung cryobiopsy. J Bronchology Interv Pulmonol. 2016;23:63–6.

    Article  Google Scholar 

  53. Tomic R, Cortes-Puentes GA, Murugan P, et al. Acute exacerbation of interstitial lung disease after cryobiopsy. J Bronchology Interv Pulmonol. 2017;24:319–22.

    Article  Google Scholar 

  54. Ernst A, Eberhardt R, Wahidi M. Effect of routine clopidogrel use on bleeding complications after transbronchial biopsy in humans. Chest. 2006;129:734–7.

    Article  Google Scholar 

  55. Utz JP, Ryu JH, Douglas WW, et al. High short-term mortality following lung biopsy for usual interstitial pneumonia. Eur Respir J. 2001;17:175–9.

    Article  CAS  Google Scholar 

  56. Qiu M, Chen Y, Ye Q. Risk factors for acute exacerbation of idiopathic pulmonary fibrosis: a systematic review and meta-analysis. Clin Respir J. 2018;12:1084–92.

    Article  CAS  Google Scholar 

  57. Fujimoto K, Taniguchi H, Johkoh T, et al. Acute exacerbation of idiopathic pulmonary fibrosis: high resolution CT scores predict mortality. Eur Radiol. 2012;22:83–92.

    Article  Google Scholar 

  58. Latsi PI, du Bois RM, Nicholson AG, et al. Fibrotic idiopathic interstitial pneumonia: the prognostic value of longitudinal functional trends. Am J Respir Crit Care Med. 2003;168:531–7.

    Article  Google Scholar 

  59. King TE Jr, Bradford WZ, Castro-Bernardini S, et al. A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis. N Engl J Med. 2014;370:2083–92.

    Article  Google Scholar 

  60. Richeldi L, du Bois RM, Raghu G, et al. Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis. N Engl J Med. 2014;370:2071–82.

    Article  Google Scholar 

  61. Harari S, Caminati A, Albera C, et al. Efficacy of pirfenidone for idiopathic pulmonary fibrosis: an Italian real life study. Respir Med. 2015;109:904–13.

    Article  CAS  Google Scholar 

  62. Martinez FJ, Flaherty KR. Comprehensive and individualized patient care in idiopathic pulmonary fibrosis: refining approaches to diagnosis, prognosis, and treatment. Chest. 2017;151:1173–4.

    Article  Google Scholar 

  63. Lee SH, Shim HS, Cho SH, et al. Prognostic factors for idiopathic pulmonary fibrosis: clinical, physiologic, pathologic, and molecular aspects. Sarcoidosis Vasc Diffuse Lung Dis. 2011;28:102–12.

    CAS  PubMed  Google Scholar 

  64. Munoz Fernandez AM, Pajares V, Lucena C, et al. Safety of transbronchial lung criobiopsy in mechanically ventilated patients in critical care. Multicenter study. European Respiratory Congress. 2016.

    Google Scholar 

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Authors and Affiliations

  1. Department of Diseases of the Thorax, Pulmonology Unit, GB Morgagni – L Pierantoni Hospital, Forlì, Italy

    Claudia Ravaglia

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  1. Claudia Ravaglia
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  1. Department of Diseases of the Thorax, Ospedale Morgagni-Pierantoni, Forlì, Italy

    Venerino Poletti

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Ravaglia, C. (2019). Complications of Transbronchial Cryobiopsy. In: Poletti, V. (eds) Transbronchial cryobiopsy in diffuse parenchymal lung disease. Springer, Cham. https://doi.org/10.1007/978-3-030-14891-1_6

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  • DOI: https://doi.org/10.1007/978-3-030-14891-1_6

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