The safety and efficacy of different methods for obtaining transbronchial lung cryobiopsy in diffuse lung diseases

医学 气胸 放射科 透视 支气管镜检查 优势比 回顾性队列研究 置信区间 入射(几何) 外科 内科学 物理 光学
作者
DM Sahajal Dhooria,Ravindra Mehta,DM Arjun Srinivasan,Karan Madan,DM Inderpaul Singh Sehgal,Vallandramam Pattabhiraman,Pavan Yadav,Mahadevan Sivaramakrishnan,Anant Mohan,Amanjit Bal,Mandeep Garg,Ritesh Agarwal
出处
期刊:Clinical Respiratory Journal [Wiley]
卷期号:12 (4): 1711-1720 被引量:56
标识
DOI:10.1111/crj.12734
摘要

Abstract Introduction Most data on transbronchial lung cryobiopsy (TBLC) are from single centers, with little evidence on the outcome of different methods for performing TBLC. Objective To report the diagnostic yield and safety of TBLC with different procedural techniques. Materials and Methods Retrospective 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. Results In 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. Conclusions Transbronchial 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.
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