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BMC Pulmonary Medicine Apr 2021The surgical lung biopsy (SLB) is the recommended sampling technique when the pathological analysis of the lung is required in the work-up of an interstitial lung... (Observational Study)
Observational Study
BACKGROUND
The surgical lung biopsy (SLB) is the recommended sampling technique when the pathological analysis of the lung is required in the work-up of an interstitial lung disease (ILD) but trans-bronchial lung cryobiopsy (TBLC) is increasingly recognized as an alternative approach. As TBLCs have lower mortality and morbidity risks than SLB, this study aimed to investigate the safety of TBLCs in patients at higher risk of complications and for whom SLB was not considered as an alternative.
METHOD
This prospective study was conducted in two hospitals in which TBLCs were performed in patients with body mass index (BMI) > 35, and/or older than 75 years, and/or with severely impaired lung function (FVC < 50% or DLCO < 30%), and/or systolic pulmonary artery pressure > 45 mmHg, and/or a clinically significant cardiac disease. Patients with any of these risk factors constituted the high-risk group. Clinical outcomes were compared with those obtained in patients without these risk factors (low-risk group).
RESULTS
Ninety-six patients were included between April 2015 and April 2020, respectively 38 and 58 in the high-risk or the low-risk group. No statistically significant difference was observed between both groups in terms of severity and rate of bleeding, pneumothorax, or duration of hospital stay (p value ranging from 0.419 to 0.914).
CONCLUSION
This preliminary study on a limited number of patients suggests that TBLC appears safe in those in whom lung biopsy is at high-risk of complications according to their age, BMI, lung impairment, and cardiac comorbidities.
Topics: Aged; Biopsy; Bronchi; Cryosurgery; Female; Humans; Lung; Lung Diseases, Interstitial; Male; Middle Aged; Postoperative Complications; Prospective Studies; Risk Factors
PubMed: 33902504
DOI: 10.1186/s12890-021-01503-9 -
Lung Apr 2022Transbronchial lung cryobiopsy (TBLC) is an accepted alternative to surgical lung biopsy (SLB) for diagnosing diffuse parenchymal lung disease (DPLD) that is less...
INTRODUCTION
Transbronchial lung cryobiopsy (TBLC) is an accepted alternative to surgical lung biopsy (SLB) for diagnosing diffuse parenchymal lung disease (DPLD) that is less invasive and results in comparable diagnostic yields. Performing lung biopsies on hospitalized patients, however, has increased risk due to the patient's underlying disease severity. Data evaluating the safety and efficacy of TBLC in hospitalized patients are limited. We present a comparison of TBLC for hospitalized and outpatients and provide the safety and diagnostic yields in these populations.
METHODS
Demographic data, pulmonary function values, chest imaging pattern, procedural information, and diagnosis were recorded from enrolled patients. Complications from the procedure were the primary outcomes and diagnostic yield was the secondary outcome.
RESULTS
77 patients (n = 22 hospitalized vs n = 55 outpatient) underwent TBLC during the study period. Comparing adverse events between hospitalized and outpatients revealed no statistically significant differences in pneumothorax (9%, n = 2 vs 5%,n = 3), tube thoracostomy placement (5%, n = 1 vs 2%, n = 1), grade 2 bleeding (9%, n = 2 vs 0%, n = 0), escalation in level of care (5%, n = 1 vs 0%, n = 0), 30-day mortality (9%, n = 2 vs 2%, n = 1), and 60-day mortality (9%, n = 2 vs 4%, n = 2) (p > 0.05 for all). No deaths were attributed to the procedure. 95% of cases received a multidisciplinary conference diagnosis (hospitalized 100%, n = 22 vs outpatients 93%, n = 51, p = 0.32).
CONCLUSION
Our experience supports that TBLC may be a safe and effective modality for acutely ill-hospitalized patients with DPLD. Further efforts to enhance procedural safety and to determine the impact of an expedited tissue diagnosis on patient outcomes are needed.
Topics: Biopsy; Bronchoscopy; Humans; Lung; Lung Diseases, Interstitial; Pneumothorax
PubMed: 35103841
DOI: 10.1007/s00408-022-00513-6 -
The American Journal of Case Reports May 2022BACKGROUND CT-guided lung biopsy is a routine procedure used to evaluate suspicious pulmonary lesions that may arise from malignancy or infectious etiology. Common...
BACKGROUND CT-guided lung biopsy is a routine procedure used to evaluate suspicious pulmonary lesions that may arise from malignancy or infectious etiology. Common complications such as pneumothorax, bleeding, and rare cases of air embolisms leading to stroke have been documented as well. It is reported that there is a 0.06-0.08% risk of air embolism resulting in stroke in patients undergoing CT-guided lung biopsy. However, other causes of ischemic stroke following lung biopsy should be considered. CASE REPORT A 36-year-old obese man presented with chronic shortness of breath, intermittent fever, and night sweats. Chest CT showed multiple bilateral pulmonary nodules with basilar predominance, and laboratory test results that showed no acute infections, a negative TB QuantiFERON, and a normal transthoracic echocardiogram. Therefore, elective lung biopsy was performed to direct future medical therapy. Shortly after the procedure, the patient reported having right-sided vision loss and decreased sensation on the right half of his face, arms, and legs. Non-contrast CT of the brain showed no hemorrhage and no air intracranially. Therefore, following a Neurology consult, the stroke protocol was initiated, which resulted in tPA being administered. TPA use resolved the patient's symptoms, with no signs of hemorrhage. CONCLUSIONS Air embolisms have commonly been the cause of strokes following CT-guided lung biopsies, which can be detected on CT brain with signs of air intracranially. However, our case presents an ischemic cause of stroke with no evidence of air embolisms intracranially. Multidisciplinary stroke team consultations and consideration of alternative causes of stroke following CT-guided lung biopsy can be lifesaving, as urgent medical therapy can be delayed without proper considerations.
Topics: Adult; Biopsy, Needle; Embolism, Air; Humans; Image-Guided Biopsy; Lung; Male; Stroke
PubMed: 35643928
DOI: 10.12659/AJCR.935587 -
The Clinical Respiratory Journal Apr 2022Transbronchial lung cryobiopsy (TBLC) is a new technique to obtain specimens for diagnosis of interstitial lung disease (ILD) in recent years. The objective of this...
INTRODUCTION
Transbronchial lung cryobiopsy (TBLC) is a new technique to obtain specimens for diagnosis of interstitial lung disease (ILD) in recent years. The objective of this study is to evaluate the safety and the diagnostic accuracy of TBLC in patients of desquamative interstitial pneumonia (DIP).
METHODS
In this study twelve patients confirmed with DIP were selected from January 2019 to December 2020 at the department of pulmonary and critical care medicine in China-Japan Friendship Hospital. All cases underwent TBLC in a hybrid cone beam CT (CBCT) operation room with a single general anesthesia. The definitive diagnosis was made by a multidisciplinary team that involved clinicians, radiologists and pathologists. This study analyzed the biopsy sample surface areas, main complications and the consistency between TBLC pathology and multidisciplinary discussion (MDD) diagnosis for DIP.
RESULTS
An average of 3.1 ± 1.1 specimens were obtained per patient. The mean surface area of the specimen was 23.7 ± 6.1 mm . None of the cases had pneumothorax or massive hemorrhage. Ten cases (83.3%) had no or mild bleeding and two cases (16.7%) had moderate bleeding. All cases had the typical pathologic characteristics of DIP, which was highly consistent with the diagnosis of MDD.
CONCLUSION
TBLC can obtain sufficient samples for the pathological diagnosis of DIP, which has high security and accuracy in experienced specialist centers.
Topics: Biopsy; Bronchoscopy; Hemorrhage; Humans; Lung; Lung Diseases, Interstitial; Pneumothorax
PubMed: 35229474
DOI: 10.1111/crj.13483 -
Respiratory Medicine 2022Surgical lung biopsy remains the standard procedure for the subset of patients with fibrosing interstitial lung disease (F-ILD) who require a lung biopsy to secure a...
Surgical lung biopsy remains the standard procedure for the subset of patients with fibrosing interstitial lung disease (F-ILD) who require a lung biopsy to secure a confident diagnosis. Little is known about the pathologic features of samples obtained via non-intubated/"awake" surgical lung biopsy and the diagnostic accuracy of awake biopsy in patients with F-ILD. Two expert thoracic pathologists blinded to the type of lung biopsy compared the clinical-pathologic features of 120 conventional VATS biopsies with those of 21 consecutive non-intubated/"awake" VATS biopsies. No statistically significant differences between the two procedures were observed with regard to identification of histopathological features. Biopsy length, average of sampled lobes and mean number of slides were similar with the two procedures, while the width of the biopsies was significantly deeper with conventional VATS (31.5 mm versus 25.6 mm; p = 0.01). By contrast, the mean age of patients (69.5 versus 64.5 years; p = 0.02) and the level of diagnostic confidence (100% versus 75%; p = 0.007) were significantly higher among patients undergoing the "awake" procedure. Diagnostic yield was 100% in both groups, with a similar distribution of ILD diagnoses. Non-intubated/"awake" biopsy has the potential to become the standard surgical procedure in patients with F-ILD requiring a histological confirmation of their diagnosis. However, larger prospective studies are needed to validate the safety and diagnostic yield of "awake" compared to conventional VATS.
Topics: Biopsy; Humans; Lung; Lung Diseases, Interstitial; Middle Aged; Retrospective Studies; Thoracic Surgery, Video-Assisted; Wakefulness
PubMed: 35227545
DOI: 10.1016/j.rmed.2022.106777 -
Physiological Reports Jun 2021Patient-derived organoids have revolutionized biomedical research and therapies by "transferring the patient into the Petri dish". In vitro access to human lung...
Patient-derived organoids have revolutionized biomedical research and therapies by "transferring the patient into the Petri dish". In vitro access to human lung organoids representing distal lung tissue, i.e. alveolar organoids, would facilitate research pertaining to a wide range of medical conditions and might open for a future approach to individualized treatment.We propose a protocol to derive a single human lung biopsy towards both alveolar and bronchiolar organoids. By modulating Wnt pathway, we obtained a differential gene expression of the main markers for both subtypes, such as a higher expression of surfactant protein C in alveolar organoids or a higher expression of mucine 5AC in bronchiolar organoids. Although the specific cell enrichment was not complete, the differentiation was observed as early as passage 1 based on morphology, and confirmed by QPCR and histology at passage 2. These results are consistent with a functional specification of lung epithelium towards both alveoli- and bronchi-enriched organoids from first passages.
Topics: Biopsy; Bronchi; Gene Expression Regulation; Humans; Lung; Male; Organoids; Pulmonary Alveoli; Real-Time Polymerase Chain Reaction
PubMed: 34110705
DOI: 10.14814/phy2.14857 -
The Journal of Heart and Lung... Oct 2022Routine monitoring of lung-transplanted patients is crucial for the identification of immunological and non-immunological complications. Determining the etiology of...
BACKGROUND
Routine monitoring of lung-transplanted patients is crucial for the identification of immunological and non-immunological complications. Determining the etiology of acute allograft dysfunction, particularly in alloimmune-mediated disorders, relies heavily on the lung biopsy with histopathologic analysis. Standardization of the pathologic diagnosis of rejection (e.g., cellular and antibody-mediated) is based on consensus statements and guidelines, indicating the importance of a multidisciplinary approach to achieve a definitive etiological diagnosis. In addition to these statements and guidelines, refinements and standardizations are feasible through systematic analysis morphological, immunophenotypic and molecular alterations observed in transbronchial biopsies. This study is to identify key morphologic features to be assessed, select consistent and reproducible terminology for each histological feature, and provide standardized definitions for pathological assessment and grading.
METHODS
A template was created by experts in lung transplantation including pathologists, pulmonologists, immunologists. An initial draft was circulated, followed by discussions and multiple revisions by email and conference calls.
RESULTS
The "lung allograft standardized histological analysis - LASHA" template was created and structured as multiple-choice questions with number of fields to be filled in to allow for standardization of results and easy transfer into a future electronic spreadsheet.
CONCLUSION
This template will help facilitate multicenter studies through a uniform protocol and correlations with new diagnostic modalities. After validation in large-scale studies, an optimized template could be included in routine clinical practice to enhance graft assessment and medical decision-making.
Topics: Allografts; Biopsy; Graft Rejection; Humans; Lung; Lung Transplantation; Transplantation, Homologous
PubMed: 35931644
DOI: 10.1016/j.healun.2022.06.021 -
The British Journal of Radiology May 2022To evaluate the clinical impact of the tract embolization technique using gelatin sponge slurry after percutaneous CT-guided lung biopsy.
Preventive tract embolization with gelatin sponge slurry is safe and considerably reduces pneumothorax after CT-guided lung biopsy with use of large 16-18 coaxial needles.
OBJECTIVE
To evaluate the clinical impact of the tract embolization technique using gelatin sponge slurry after percutaneous CT-guided lung biopsy.
METHODS
We retrospectively compared coaxial needle CT-guided lung biopsies performed without embolization (100 patients) and with the tract embolization technique using a mixture of iodine and gelatin sponge slurry (105 patients) between June 2012 and July 2020. Uni- and multivariate analyses were performed between groups to determine risk factors of pneumothorax.
RESULTS
Patients with gelatin sponge slurry tract embolization had statistically lower rates of pneumothorax ((17.1% 39%, < 0.001). In univariate analysis, tract embolization (OR = 0.32, CI = 0.17-0.61 p<0.001) and nodule size >2 cm (OR = 0.33 CI = 0.14-0.8 = 0.013) had a protective effect on pneumothorax. The puncture path lengths > 2-20 mm and >20 mm were risk factors for pneumothorax (OR = 3.35 IC = 1.44-8.21 = 0.006 and OR = 4.36 CI = 1.98-10.29 p<0.001, respectively). In multivariate regression analysis, tract embolization had a protective effect of pneumothorax (OR = 0.25, CI = 0.12-0.51, < 0.001). The puncture path lengths > 2-20 mm and >20 mm were risk factors for pneumothorax ( = 0.030 and = 0.002, respectively).
CONCLUSIONS
The tract embolization technique using iodinated gelatin sponge slurry is safe and considerably reduces pneumothorax after percutaneous CT-guided lung biopsy. Our results suggest that it could be use in clinical routine.
ADVANCES IN KNOWLEDGE
The systemic use of gelatin sponge slurry is safe and reduces considerably the rate of pneumothorax upon needle removal when CT-guided core biopsies are performed using large 16-18G coaxial needles.
Topics: Gelatin; Humans; Image-Guided Biopsy; Lung; Needles; Pneumothorax; Radiography, Interventional; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed
PubMed: 34986006
DOI: 10.1259/bjr.20210869 -
Cancer Treatment and Research... 2022Small pulmonary nodules (≤1.5 cm) are frequently detected on routine chest imaging and lung cancer screening studies. Our goal was to determine the clinical value of...
Small pulmonary nodules (≤1.5 cm) are frequently detected on routine chest imaging and lung cancer screening studies. Our goal was to determine the clinical value of CT-guided core needle biopsy (CNB) in the evaluation of such nodules. In this single-center study, we retrospectively analyzed patient data (n = 44) for CNBs on lung nodules (≤1.5 cm) performed at our biopsy center between May 2017 and March 2020. We analyzed for the rate of pathology diagnosis, molecular/biomarker analysis, complications, and change in clinical management and outcome over a period ranging up to 60 months after biopsy. A pathology diagnosis of malignancy or benign lesion was obtained in 97.9% of biopsies in this cohort. The rate of complications was low with only 6.8% of patients requiring the insertion of a temporary small profile interventional radiology (IR) pigtail chest tube for pneumothorax. Out of the subset of biopsy specimens that were sent for tissue molecular analysis, 90% had enough tissue preserved after initial pathological analysis to obtain at least one molecular marker. Our data show that CT-guided CNB is safe and reliable, and should be considered for the evaluation of small, suspicious lung nodules found on routine screenings for the early detection and evaluation of malignant lesions.
Topics: Humans; Retrospective Studies; Early Detection of Cancer; Lung Neoplasms; Image-Guided Biopsy; Tomography, X-Ray Computed; Lung
PubMed: 36041372
DOI: 10.1016/j.ctarc.2022.100626 -
Respiration; International Review of... 2018Accurate diagnosis is essential for successful management of diffuse lung disease (DLD). Histopathology may sometimes be necessary. Surgical lung biopsy, the gold...
BACKGROUND
Accurate diagnosis is essential for successful management of diffuse lung disease (DLD). Histopathology may sometimes be necessary. Surgical lung biopsy, the gold standard, carries a risk of morbidity and mortality. Computed tomography (CT) guided transthoracic lung biopsy (CT-TLB) is a minimally invasive method for obtaining lung tissue. However, its diagnostic yield is unknown in DLD.
OBJECTIVE
To assess the diagnostic yield of CT-TLB in DLD according to the predominant high-resolution CT (HRCT) patterns.
METHODS
Between January 2009 and December 2016, we enrolled all consecutive adult patients with suspicion of DLD who underwent CT-guided transthoracic lung biopsy during the diagnostic work-up. All biopsies were performed by a senior interventional radiologist using CT fluoroscopy.
RESULTS
The study included 169 patients (50.3% men) with a mean (±SD) age of 58.3 ± 14 years. Consolidation was the predominant HRCT pattern. A definitive or probable diagnosis was made in 66.3%. The most frequent diagnosis was organizing pneumonia (36.2%). Diagnostic yield was higher when the predominant HRCT pattern was consolidation or nodular. The most common complication was pneumothorax (17.8%); other complications included mild hemoptysis (7.7%), hemothorax (1.2%), and death (0.59%). No acute exacerbation of the underlying condition was observed.
CONCLUSIONS
CT-TLB proved to be accurate and safe for the diagnosis of DLD. The overall diagnostic yield of the procedure was 66.3%. Given its low complication rates, CT-TLB can be an option in patients whose respiratory function is seriously impaired and in those with substantial comorbidities, where more invasive procedures cannot be performed for reasons of safety.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Image-Guided Biopsy; Lung; Lung Diseases; Male; Middle Aged; Radiography, Thoracic; Retrospective Studies; Tomography, X-Ray Computed; Young Adult
PubMed: 30130745
DOI: 10.1159/000489934