Sahajal Dhooria1, Inderpaul Singh Sehgal1, Ashutosh N Aggarwal1, Digambar Behera1, Ritesh Agarwal2. 1. Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 2. Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India. agarwal.ritesh@outlook.in.
Abstract
BACKGROUND: Transbronchial lung biopsy with flexible forceps is the most commonly used technique in diagnosis of diseases diffusely involving the lung parenchyma. Recently, transbronchial lung biopsy using the flexible cryoprobe (cryo-transbronchial lung biopsy) has also been reported. Herein, we perform a systematic review and meta-analysis describing the efficacy and safety of cryo-transbronchial lung biopsy. METHODS: The PubMed and EMBASE databases were searched for studies reporting the outcomes of cryo-transbronchial lung biopsy in subjects with diffuse parenchymal lung involvement. The quality of individual studies was assessed using the QualSyst tool. The pooled diagnostic yield of cryo-transbronchial lung biopsy was calculated using proportion meta-analysis (random effects model). Heterogeneity was evaluated using the I(2) test and Cochran Q test. Publication bias was determined using both statistical and graphical methods. RESULTS: Our search yielded 14 studies (1,183 subjects). The pooled diagnostic yield of cryo-transbronchial lung biopsy was 76.9% (95% CI 67.2-85.3) if only definitive diagnoses were considered and 85.9% (95% CI 78.2-92.2) if both definitive and probable diagnoses were considered. Four studies (321 subjects) the performance of flexible forceps biopsy and cryo-transbronchial lung biopsy. The diagnostic yield of cryo-transbronchial lung biopsy (86.3, 95% CI 80.2-90.8) was significantly higher than that of flexible forceps biopsy (56.5%, 95% CI 27.5-83.2) with an odds ratio of 6.7 (95% CI 3.6-12.4) and a number needed to treat of 4. Lung tissue was obtained in 98% of all samples with cryo-transbronchial lung biopsy and was free of compression artifacts. The size of samples obtained with cryo-transbronchial lung biopsy was significantly bigger compared with flexible forceps biopsy (20.4 vs 4.3 mm(2), P = .005). The complications of cryo-transbronchial lung biopsy included pneumothorax (6.8%), severe bleeding (0.3%), and death (0.1%). Clinical and statistical heterogeneity was present, and there was evidence of publication bias. CONCLUSIONS: Cryo-transbronchial lung biopsy is a relatively safe procedure with good diagnostic yield in diseases diffusely involving the lung parenchyma.
BACKGROUND: Transbronchial lung biopsy with flexible forceps is the most commonly used technique in diagnosis of diseases diffusely involving the lung parenchyma. Recently, transbronchial lung biopsy using the flexible cryoprobe (cryo-transbronchial lung biopsy) has also been reported. Herein, we perform a systematic review and meta-analysis describing the efficacy and safety of cryo-transbronchial lung biopsy. METHODS: The PubMed and EMBASE databases were searched for studies reporting the outcomes of cryo-transbronchial lung biopsy in subjects with diffuse parenchymal lung involvement. The quality of individual studies was assessed using the QualSyst tool. The pooled diagnostic yield of cryo-transbronchial lung biopsy was calculated using proportion meta-analysis (random effects model). Heterogeneity was evaluated using the I(2) test and Cochran Q test. Publication bias was determined using both statistical and graphical methods. RESULTS: Our search yielded 14 studies (1,183 subjects). The pooled diagnostic yield of cryo-transbronchial lung biopsy was 76.9% (95% CI 67.2-85.3) if only definitive diagnoses were considered and 85.9% (95% CI 78.2-92.2) if both definitive and probable diagnoses were considered. Four studies (321 subjects) the performance of flexible forceps biopsy and cryo-transbronchial lung biopsy. The diagnostic yield of cryo-transbronchial lung biopsy (86.3, 95% CI 80.2-90.8) was significantly higher than that of flexible forceps biopsy (56.5%, 95% CI 27.5-83.2) with an odds ratio of 6.7 (95% CI 3.6-12.4) and a number needed to treat of 4. Lung tissue was obtained in 98% of all samples with cryo-transbronchial lung biopsy and was free of compression artifacts. The size of samples obtained with cryo-transbronchial lung biopsy was significantly bigger compared with flexible forceps biopsy (20.4 vs 4.3 mm(2), P = .005). The complications of cryo-transbronchial lung biopsy included pneumothorax (6.8%), severe bleeding (0.3%), and death (0.1%). Clinical and statistical heterogeneity was present, and there was evidence of publication bias. CONCLUSIONS: Cryo-transbronchial lung biopsy is a relatively safe procedure with good diagnostic yield in diseases diffusely involving the lung parenchyma.
Authors: Robert J Lentz; A Christine Argento; Thomas V Colby; Otis B Rickman; Fabien Maldonado Journal: J Thorac Dis Date: 2017-07 Impact factor: 2.895
Authors: Frédéric Rivière; Aurélie Cazes; Olivier Bylicki; Hervé Le Floch; Wanda Gaspard; Marie Alice Cornetto; France Charton; Jacques Margery; Frédéric Grassin Journal: Indian J Thorac Cardiovasc Surg Date: 2022-01-23