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Lung

, Volume 191, Issue 6, pp 619–624 | Cite as

Transbronchial Cryobiopsy in Immunocompromised Patients with Pulmonary Infiltrates: A Pilot Study

  • Oren FruchterEmail author
  • Ludmila Fridel
  • Dror Rosengarten
  • Nader Abed-el Rahman
  • Mordechai R. Kramer
Article

Abstract

Background

In immunocompromised patients with pulmonary infiltrates, transbronchial lung biopsies (TBB) obtained by forceps has been shown to increase the diagnostic yield over simple bronchoalveolar lavage. Cryo-TBB is a novel modality for obtaining lung biopsies. We aimed to evaluate for the first time the efficacy and safety of cryo-TBB in immunocompromised patients.

Methods

Fifteen immunocompromised patients with pulmonary infiltrates underwent cryo-TBB. During the procedure two to three biopsy samples were taken. Procedure characteristics, complications, and the diagnostic yield were retrospectively evaluated.

Results

Most patients (n = 11) were immunocompromised due to hematological malignancies. The remaining four patients were receiving chronic immunosuppressive treatment due to previous solid-organ transplantation (n = 2) or collagen-vascular disease (n = 2). No major complications occurred in the cryo-TBB group. The mean surface area of the specimen taken by cryo-TBB was 9 mm2. The increase in surface area and quality of biopsy samples translated to a high percentage of alveolated tissue (70 %) that enabled a clear histological detection of the following diagnoses: noncaseating granulomatous inflammation (n = 2), acute interstitial pneumonitis consistent with drug reaction (n = 5), nonspecific interstitial pneumonia fibrotic variant (n = 1), diffuse alveolar damage (n = 3), organizing pneumonia (n = 3), and pulmonary cryptococcal pneumonia (n = 1). Diagnostic information obtained by cryo-TBB led to change in the management of 12 patients (80 %).

Conclusion

Cryo-TBB in immunocompromised patients with pulmonary infiltrates provides clinically important diagnostic data with a low complication rate. These advantages should be further compared with traditional forceps TBB in a prospective randomized trial.

Keywords

Bronchoscopy Pathology Infection 

Abbreviations

TBB

Transbronchial biopsy

BAL

Bronchoalveolar lavage

CHOP

Cyclophosphamide–hydroxydaunorubicin–oncovin–prednisone

ABVD

Adriamycin–bleomycin–vinblastine–dacarbazine

BMT

Bone marrow transplantation

Ly

Lymphoma

Notes

Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Oren Fruchter
    • 1
    • 2
    Email author
  • Ludmila Fridel
    • 2
    • 3
  • Dror Rosengarten
    • 1
    • 2
  • Nader Abed-el Rahman
    • 1
    • 2
  • Mordechai R. Kramer
    • 1
    • 2
  1. 1.The Pulmonary DivisionRabin Medical Center, Beilinson HospitalPetah TikvaIsrael
  2. 2.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.The Pathology DivisionRabin Medical CenterPetah TikvaIsrael

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