Sahajal Dhooria1, Ravindra Mehta2, Arjun Srinivasan3, Karan Madan4, Inderpaul Singh Sehgal1, Vallandramam Pattabhiraman3, Pavan Kumar Yadav2, Mahadevan Sivaramakrishnan3, Anant Mohan4, Amanjit Bal5, Mandeep Garg6, Ritesh Agarwal1
1Department of Pulmonary Medicine Postgraduate Institute of Medical Education and Research Chandigarh Punjab India
2Department of Pulmonary, Critical Care and Sleep Medicine Apollo Hospitals Bengaluru Karnataka India
3Department of Pulmonology, Allergy and Sleep Medicine Royal Care Hospital Coimbatore Tamil Nadu India
4Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
5Department of Histopathology Postgraduate Institute of Medical Education and Research Chandigarh Punjab India
6Department of Radiodiagnosis and Imaging Postgraduate Institute of Medical Education and Research Chandigarh Punjab India
Tóm tắt
AbstractIntroductionMost data on transbronchial lung cryobiopsy (TBLC) are from single centers, with little evidence on the outcome of different methods for performing TBLC.ObjectiveTo report the diagnostic yield and safety of TBLC with different procedural techniques.Materials and MethodsRetrospective multicenter study of subjects who underwent TBLC for the diagnosis of diffuse parenchymal lung diseases (DPLDs). The procedure was performed using various methods: flexible or rigid bronchoscopy, with or without the use of fluoroscopy or occlusion balloon.ResultsIn total, 128 subjects (59% women) with a mean age of 48.9 years were included. The overall diagnostic yield of TBLC was 78.1%, with a definite diagnosis on multidisciplinary discussion made in 57 (44.5%) subjects. On a multivariate analysis, the diagnostic yield was associated with the number of biopsies taken {ajdusted odds ratio [AOR] [95% confidence interval (CI)], 2.17 [1.29‐3.67]}. The incidence of pneumothorax was lower in subjects who underwent TBLC with fluoroscopic guidance (5.9% vs 20.9%), [AOR (95% CI), 0.26 (0.07‐0.94)]. Moderate‐to‐severe bleeding occurred less frequently when an occlusion balloon was used [1.8% vs 35.7%; AOR (95% CI), 0.02 (0.001‐0.18)], after adjusting for age, use of fluoroscopy, number of biopsies obtained and number of lobes sampled. Four deaths occurred; 2 because of acute exacerbation of idiopathic pulmonary fibrosis.ConclusionsTransbronchial lung cryobiopsy was found to offer a reasonable yield in the diagnosis of DPLDs. The incidence of pneumothorax and moderate‐to‐severe bleeding was lower with the use of fluoroscopy and an occlusion balloon, respectively.
