Transbronchial Cryobiopsies for the Diagnosis of Diffuse Parenchymal Lung Diseases: Expert Statement from the Cryobiopsy Working Group on Safety and Utility and a Call for Standardization of the Procedure

Respiration - Tập 95 Số 3 - Trang 188-200 - 2018
Jürgen Hetzel1, Fabien Maldonado2, Claudia Ravaglia3, Athol U. Wells4, Thomas V. Colby5, Sara Tomassetti3, Jay H. Ryu6, Oren Fruchter7, Sara Piciucchi8, Alessandra Dubini9, Alberto Cavazza10, Marco Chilosi11, Nicola Sverzellati12, Dominique Valeyre13, Dimitri Leduc14, Simon P. Hart15, Stefano Gasparini16, M Hetzel17, Lars Hagmeyer18, Maik Häntschel1, Ralf Eberhardt19, Kaid Darwiche20, Lonny Yarmus21, Alfonso Torrego22, Ganesh Krishna23, Pallav L. Shah24, Jouke T. Annema25, Felix J.F. Herth19, Venerino Poletti3,26
1Department of Hematology, Oncology, Rheumatology, Immunology and Pulmonology, University of Tübingen, Tübingen, Germany
2Division of Pulmonary and Critical Care, Vanderbilt University, Nashville, TN, USA
3Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy
4Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
5Department of Pathology, Mayo Clinic, Scottsdale, AZ, USA
6Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
7Pulmonary Division, Wolfson Medical Center and Tel Aviv University, Tel Aviv, Israel
8Department of Radiology, Ospedale GB Morgagni, Forlì, Italy
9Department of Pathology, Ospedale GB Morgagni, Forlì, Italy
10Department of Pathology, S. Maria Nuova Hospital-I.R.C.C.S, Reggio Emilia, Italy
11Department of Pathology, Verona University, Verona, Italy
12Division of Radiology, Department of Clinical Sciences, University of Parma, Parma, Italy
13Assistance Publique-Hôpitaux de Paris, Avicenne University Hospital, Bobigny, France
14Department of Chest Medicine, Erasme University Hospital, Free University of Brussels, Brussels, Belgium
15King’s College Hospital Foundation Trust, London, UK
16Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, and Pulmonary Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, Ancona, Italy
17Krankenhaus vom Roten Kreuz, Stuttgart, Germany
18Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany
19Department of Pneumology and Critical Care Medicine, Thoraxklinik, Translational Lung Research Center Heidelberg, German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
20Department of Interventional Pulmonology, Ruhrlandklinik, University Hospital, University Duisburg-Essen, Essen, Germany
21Johns Hopkins University School of Medicine, Baltimore, MD USA
22Bronchoscopy Unit, Respiratory Department, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
23Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, El Camino Hospital, Mountain View, CA, USA
24The National Institute for Health Research, Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, and Imperial College, London, UK
25Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands
26Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark

Tóm tắt

Transbronchial cryobiopsies (TBCB) have recently been introduced as a promising and safer alternative to surgical lung biopsy in the diagnostic approach to diffuse parenchymal lung diseases (DPLD). Despite a substantial and expanding body of literature, the technique has not yet been standardized and its place in the diagnostic algorithm of DPLD remains to be defined. In part, this reflects concerns over the diagnostic yield and safety of the procedure, together with the rapid spread of the technique without competency and safety standards; furthermore, there is a substantial procedural variability among centers and interventional pulmonologists. We report this expert statement proposed during the third international conference on “Transbronchial Cryobiopsy in Diffuse Parenchymal Lung Disease” (Ravenna, October 27–28, 2016), which formulates evidence- and expert-based suggestions on the indications, contraindications, patient selection, and procedural aspects of the procedure. The following 5 domains were reviewed: (1) what is the role of TBCB in the diagnostic evaluation of DPLD: patient selection; (2) pathological considerations; (3) contraindications and safety considerations; (4) how should TBCB be performed and in what procedural environment; and (5) who should perform TBCB. Finally, the existence of white paper recommendations may also reassure local hospital credentialing committees tasked with endorsing an adoption of the technique.

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Respiration

Tập 95 Số 3

188-200

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