Shelley She1, Daniel P Steinfort2,3, Alvin J Ing4,5, Jonathan P Williamson4,6, Paul Leong7, Louis B Irving2,3, Barton R Jennings7, Tajalli Saghaie4,5. 1. School of Medicine, The University of Sydney. 2. Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital. 3. Department of Medicine, University of Melbourne. 4. MQ Health Respiratory and Sleep, Faculty of Medicine and Health Sciences, Macquarie University. 5. Department of Thoracic Medicine, Concord Hospital. 6. Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, NSW. 7. Monash Lung and Sleep, Monash Health, Melbourne, Vic., Australia.
Abstract
BACKGROUND: Transbronchial lung cryobiopsy (TBCB) plays an increasing role in the evaluation of diffuse parenchymal lung disease with acceptable diagnostic yield and safety profile compared with that of video-assisted thoracoscopic surgical lung biopsy on most reports. However, published outcomes with regard to safety and complication rates vary. We aim to determine the safety profile of TBCB when performed using a standardized protocol consistent with recently published expert guidelines. MATERIALS AND METHODS: We reviewed prospectively maintained databases from 5 Australian tertiary referral centers. The procedures were performed in accordance with a recent expert statement recommending standardization of TBCB procedures, in particular with fluoroscopy, a secured airway, and prophylactic bronchial blockers. Periprocedural complications were assessed along with clinical outcomes. RESULTS: A total of 121 patients underwent TBCB between August 2013 and August 2017 following a standardized protocol using general anesthesia. Of them, 84 patients (66.7%) were discharged on the day of the procedure. Pneumothorax occurred in 18 patients (14.9%), 13 (10.7%) of whom required chest tube drainage. Moderate bleeding occurred in 15 patients (13.2%) and severe bleeding in 1 (0.83%). Histopathologic diagnosis was made in 80 patients (66.1%). CONCLUSION: Pooled outcomes from Australian tertiary centers indicate that TBCB is safe when performed in a protocolized fashion. Active measures to anticipate and manage bleeding and to direct biopsy position result in low rates of major complications.
BACKGROUND: Transbronchial lung cryobiopsy (TBCB) plays an increasing role in the evaluation of diffuse parenchymal lung disease with acceptable diagnostic yield and safety profile compared with that of video-assisted thoracoscopic surgical lung biopsy on most reports. However, published outcomes with regard to safety and complication rates vary. We aim to determine the safety profile of TBCB when performed using a standardized protocol consistent with recently published expert guidelines. MATERIALS AND METHODS: We reviewed prospectively maintained databases from 5 Australian tertiary referral centers. The procedures were performed in accordance with a recent expert statement recommending standardization of TBCB procedures, in particular with fluoroscopy, a secured airway, and prophylactic bronchial blockers. Periprocedural complications were assessed along with clinical outcomes. RESULTS: A total of 121 patients underwent TBCB between August 2013 and August 2017 following a standardized protocol using general anesthesia. Of them, 84 patients (66.7%) were discharged on the day of the procedure. Pneumothorax occurred in 18 patients (14.9%), 13 (10.7%) of whom required chest tube drainage. Moderate bleeding occurred in 15 patients (13.2%) and severe bleeding in 1 (0.83%). Histopathologic diagnosis was made in 80 patients (66.1%). CONCLUSION: Pooled outcomes from Australian tertiary centers indicate that TBCB is safe when performed in a protocolized fashion. Active measures to anticipate and manage bleeding and to direct biopsy position result in low rates of major complications.
Authors: Steven Bozinovski; Amanda Vannitamby; Kanishka Rangamuwa; Savreet Aujla; Hao Wang; Christian Aloe; Louis Irving; Tracy T Leong; Daniel P Steinfort Journal: Transl Lung Cancer Res Date: 2021-06