Bryan S Benn1, Arthur Oliver Romero2,3, Hasnain Bawaadam2, Nathaniel Ivanick2,4, Mendy Lum5, Ganesh Krishna2,6. 1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank, Milwaukee, WI, 53226, USA. bbenn@mcw.edu. 2. Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, CA, USA. 3. Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA. 4. Department of Pulmonary Medicine, Roswell Park Cancer Center, Buffalo, NY, USA. 5. Respiratory Care Services, El Camino Health, Mountain View, CA, USA. 6. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Palo Alto Medical Foundation, Palo Alto, CA, USA.
Abstract
INTRODUCTION: Determining the cause of diffuse parenchymal lung disease (DPLD) is challenging. While surgical lung biopsy has been the standard approach, transbronchial lung cryobiopsy (TBLC) represents a minimally invasive alternative with an acceptable safety profile and reasonable accuracy. In this study, we prospectively assessed whether the use of cone beam CT (CBCT) coupled with a novel bronchoscope holder and prophylactic administration of vasoconstricting medications decreases potential complications and improves diagnostic accuracy when performing TBLC. METHODS: 33 patients presenting for evaluation of newly diagnosed DPLD were enrolled. Demographic data, pulmonary function values, chest imaging pattern, procedural information, and diagnosis were recorded. RESULTS: Mean patient age was 67, with the majority Caucasian (n = 26, 79%) and male (n = 20, 61%). Mean pulmonary function values revealed restrictive lung disease (76 ± 14% predicted) and diffusing capacity impairment (52 ± 16%). A non-usual interstitial pneumonia imaging pattern was commonly seen (n = 20, 61%). CBCT guided TBLC was performed in one lobe (n = 29, 88%) or two lobes (n = 4, 12%) with mean probe-to-pleura distance of 4.2 ± 1.3 mm. No peri or post procedural complications occurred. 32 patients (97%) received a histological diagnosis with a final multidisciplinary conference diagnosis possible for 32 (97%). CONCLUSION: CBCT guided TBLC coupled with a novel articulating scope holder and prophylactic phenylephrine administration has the potential to increase safety and diagnostic yield for patients with newly identified DPLD. Future studies comparing different aspects of this approach in isolation and with other modalities have the potential to refine this procedure to improve patient care.
INTRODUCTION: Determining the cause of diffuse parenchymal lung disease (DPLD) is challenging. While surgical lung biopsy has been the standard approach, transbronchial lung cryobiopsy (TBLC) represents a minimally invasive alternative with an acceptable safety profile and reasonable accuracy. In this study, we prospectively assessed whether the use of cone beam CT (CBCT) coupled with a novel bronchoscope holder and prophylactic administration of vasoconstricting medications decreases potential complications and improves diagnostic accuracy when performing TBLC. METHODS: 33 patients presenting for evaluation of newly diagnosed DPLD were enrolled. Demographic data, pulmonary function values, chest imaging pattern, procedural information, and diagnosis were recorded. RESULTS: Mean patient age was 67, with the majority Caucasian (n = 26, 79%) and male (n = 20, 61%). Mean pulmonary function values revealed restrictive lung disease (76 ± 14% predicted) and diffusing capacity impairment (52 ± 16%). A non-usual interstitial pneumonia imaging pattern was commonly seen (n = 20, 61%). CBCT guided TBLC was performed in one lobe (n = 29, 88%) or two lobes (n = 4, 12%) with mean probe-to-pleura distance of 4.2 ± 1.3 mm. No peri or post procedural complications occurred. 32 patients (97%) received a histological diagnosis with a final multidisciplinary conference diagnosis possible for 32 (97%). CONCLUSION: CBCT guided TBLC coupled with a novel articulating scope holder and prophylactic phenylephrine administration has the potential to increase safety and diagnostic yield for patients with newly identified DPLD. Future studies comparing different aspects of this approach in isolation and with other modalities have the potential to refine this procedure to improve patient care.
Authors: Maurizio Bernasconi; Coenraad F N Koegelenberg; Angela Koutsokera; Adam Ogna; Alessio Casutt; Laurent Nicod; Alban Lovis Journal: ERJ Open Res Date: 2017-06-21
Authors: S Sato; H Yamakawa; T Takemura; T Nakamura; T Nishizawa; T Oba; R Kawabe; K Akasaka; M Amano; H Matsushima Journal: BMC Pulm Med Date: 2022-10-18 Impact factor: 3.320