Feasibility and safety of transbronchial lung cryobiopsy and mediastinal lymph node cryobiopsy: Experience from a resource-limited African setting
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Abstract
Background. Transbronchial lung cryobiopsy (TBLC) is a relatively new technique recommended for sampling of lung parenchyma in patients with suspected interstitial lung disease (ILD) and as an alternative to surgical lung biopsy. A more recently introduced technique is endobronchial ultrasound-guided transbronchial mediastinal lymph node lymph node cryobiopsy (EBUS-TMC) to enable tissue biopsy of mediastinal lymph nodes. However, there are no data on the feasibility of implementing these techniques in a resource-limited African setting, where there is a chronic bed shortage and same-day discharges are preferable.
Objectives. To determine the feasibility and diagnostic yield of TBLC and EBUS-TMC in a resource-limited African setting.
Methods. We performed an audit of lung and lymph node cryobiopsy procedures performed at the E16 Respiratory Clinic at Groote Schuur Hospital, Cape Town, South Africa. Indications, diagnostic performance outcomes and lessons learned were documented and analysed.
Results. Sixteen patients underwent 19 cryobiopsy procedures that were performed under general anaesthesia (n=11 TBLC, n=8 EBUS- TMC, including 3 patients in whom both TBLC and EBUS-TMC were concurrently performed). The main indications were evaluation of ILD and suspected lymph node malignancy. The diagnostic yield was 63.6% for TBLC (n=7/11; 2 nonspecific interstitial pneumonia, 2 sarcoidosis, 1 espiratory bronchiolitis-ILD, 1 organising pneumonia, 1 nonspecific chronic inflammation) and 50.0% for EBUS-TMC (n=4/8; 1 plasmacytoma, 1 lymphoma, 1 cryptococcus infection, 1 patient with both cryptococcus infection and tuberculosis). Of the patients, 2 had moderate bleeding and 3 had mild bleeding, and 14 were discharged on the day of the procedure.
Conclusion. TBLC and EBUS-TMC, with avoidance of surgical lung biopsy in most patients and same-day discharge in most patients, are feasible in an African setting. These data inform clinical practice and programme implementation in resource-limited settings.
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References
1. Sheth JS, Belperio JA, Fishbein MC, et al. Utility of transbronchial vs surgical lung biopsy in the diagnosis of suspected fibrotic interstitial lung disease. Chest 2017;151(2):389-399. https://doi.org/10.1016/j.chest.2016.09.028
2. Berbescu EA, Katzenstein A-LA, Snow JL, Zisman DA. Transbronchial biopsy in usual interstitial pneumonia. Chest 2006;129(5):1126-1131. https://doi.org/10.1378/ chest.129.5.1126
3. Shim HS, Park MS, Park IK. Histopathologic findings of transbronchial biopsy in usual interstitial pneumonia. Pathol Int 2010;60(5):373-377. https://doi.org/10.1111/ j.1440-1827.2010.02528.x
4. HuoYR,ChanMV,HabibAR,LuiI,RidleyL.PneumothoraxratesinCT-guidedlung biopsies: A comprehensive systematic review and meta-analysis of risk factors. Br J Radiol 2020;93(1108):20190866. https://doi.org/10.1259/bjr.20190866
5. Peng M, Xu W-b, Shi J-h, et al. [The diagnostic value of CT-guided percutaneous needle lung biopsy in diffuse parenchymal lung diseases]. Zhonghua Jie He He Hu Xi Za Zhi 2012;35(3):171-175.
6. BlackhallV,AsifM,RenieriA,etal.Theroleofsurgicallungbiopsyinthemanagement of interstitial lung disease: Experience from a single institution in the UK. Interact Cardiovasc Thorac Surg 2013;17(2):253-257. https://doi.org/10.1093/icvts/ivt217
7. Nguyen W, Meyer KC. Surgical lung biopsy for the diagnosis of interstitial lung disease: A review of the literature and recommendations for optimizing safety and efficacy. Sarcoidosis Vasc Diffuse Lung Dis 2013;30(1):3-16.
8. Madan K, Mittal S, Hadda V, Mohan A. Cryoprobe transbronchial lung biopsy with flexible bronchoscope using Arndt endobronchial blocker. Lung India 2019;36(3):241- 243. https://doi.org/10.4103/lungindia.lungindia_35_18
9. Lentz RJ, Argento AC, Colby TV, Rickman OB, Maldonado F. Transbronchial cryobiopsy for diffuse parenchymal lung disease: A state-of-the-art review of procedural techniques, current evidence, and future challenges. J Thorac Dis 2017;9(7):2186-2203. https://doi.org/10.21037/jtd.2017.06.96
10. Rodrigues I, Estêvão Gomes R, Coutinho LM, et al. Diagnostic yield and safety of transbronchial lung cryobiopsy and surgical lung biopsy in interstitial lung diseases: A systematic review and meta-analysis. Eur Respir Rev 2022;31(166):210280. https:// doi.org/10.1183/16000617.0280-2021
11. Korevaar DA, Colella S, Fally M, et al. European Respiratory Society guidelines on transbronchial lung cryobiopsy in the diagnosis of interstitial lung diseases. Eur Respir J 2022;60(5):2200425. https://doi.org/10.1183/13993003.00425-2022
12. Ariza-Prota M, Pérez-Pallarés J, Fernández-Fernández A, et al. Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lesions: Safety, feasibility and diagnostic yield – experience in 50 cases. ERJ Open Res 2023;9(2):00448-2022. https://doi.org/10.1183/23120541.00448-2022
13. Troy LK, Williamson JP. Mediastinal cryobiopsy: Safe and effective but in whom and when? Lancet Respir Med 2023;11(3):217-219. https://doi.org/10.1016/S2213- 2600(22)00410-6
14. Katgi N, Çimen P, Çirak AK, et al. Complication and cost analysis of transbronchial lung cryobiopsy and awake video-assisted thoracic surgery in diagnosis of interstitial lung disease. Sarcoidosis Vasc Diffuse Lung Dis 2022;39(1):e2022005. https://doi. org/10.36141/svdld.v39i1.12293
15. Leslie KO, Gruden JF, Parish JM, Scholand MB. Transbronchial biopsy interpretation in the patient with diffuse parenchymal lung disease. Arch Pathol Lab Med 2007;131(3):407-423. https://doi.org/10.5858/2007-131-407-TBIITP
16. Thiboutot J, Illei PB, Maldonado F, et al. Safety and feasibility of a sheath cryoprobe for bronchoscopic transbronchial biopsy: The FROSTBITE trial. Respiration 2022;101(12):1131-1138. https://doi.org/10.1159/000526876
17. Khot MS, Chakraborti A, Saini JK, et al. Comparison of the diagnostic yield of transbronchial lung biopsies by forceps and cryoprobe in diffuse parenchymal lung disease. Afr J Thorac Crit Care Med 2023;29(3):e799. https://doi.org/10.7196/ AJTCCM.2023.v29i3.799