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Lung India. 2019 Jan-Feb;36(1):48-59. doi: 10.4103/lungindia.lungindia_75_18.

Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement.

Author information

1
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
2
Department of Respiratory Medicine, Jaipur Golden Hospital and Rajiv Gandhi Cancer Institute, New Delhi, India.
3
Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India.
4
Department of Respiratory Medicine, Bombay Hospital and Fortis Hiranandani Hospital, Mumbai, India.
5
Department of Respiratory Medicine, Nanavati Super Speciality Hospital, Mumbai, India.
6
Department of Respiratory Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India.
7
Department of Chest Diseases, SMS Medical College, Jaipur, Rajasthan, India.
8
Department of Respiratory Medicine, Century Hospital, Hyderabad, Telangana, India.
9
Department of Respiratory Medicine, Royal Care Hospital, Coimbatore, India.
10
Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
11
Department of Respiratory Medicine, Indraprastha Apollo Hospital, New Delhi, India.
12
India and Lung Care and Sleep Centre, Institute of Pulmonology, Medical Research and Development, Mumbai, India.
13
Department of Respiratory Medicine, Sir Ganga Ram Hospital, New Delhi, India.
14
Department of Respiratory Medicine, Fortis Hospital Anandapur, Kolkata, West Bengal, India.
15
Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
16
Department of Respiratory Medicine, Maharaja Agrasen Hospital, New Delhi, India.
17
Department of Respiratory, Medicine, Narayana Health City, Bengaluru, Karnataka, India.
18
Department of Pulmonary Medicine, Christian Medical College, Vellore, India.
19
Department of Respiratory Medicine, Jindal Chest Clinic, Chandigarh, India.
20
Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
21
Department of Respiratory Medicine, Max Hospital, New Delhi, India.
22
Department of Internal and Pulmonary Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
23
Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, New Delhi, India.
24
Fortis Hospital, Mohali, Punjab, India.
25
Department of Respiratory Medicine, Apollo Hospital, Bengaluru, Karnataka, India.
26
Department of Respiratory Medicine, Fortis Hospital, New Delhi, India.
27
Department of Respiratory Medicine, BLK Super Speciality Hospital, New Delhi, India.
28
Department of Respiratory Medicine, City Clinic and Bhailal Amin General Hospital, Vadodara, Gujarat, India.
29
Department of Respiratory Medicine, Apollo Hospital, Chennai, Tamil Nadu, India.
30
Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, United States of America.
31
Department of Respiratory Medicine, Asthma Bhawan, Jaipur, Rajasthan, India.
32
Department of Respiratory Medicine, Getwell Hospital and Research Institute, Nagpur, Maharashtra, India.
33
Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh, India.

Abstract

Background:

Bronchoscopic lung cryobiopsy (BLC) is a novel technique for obtaining lung tissue for the diagnosis of diffuse parenchymal lung diseases. The procedure is performed using several different variations of technique, resulting in an inconsistent diagnostic yield and a variable risk of complications. There is an unmet need for standardization of the technical aspects of BLC.

Methodology:

This is a position statement framed by a group comprising experts from the fields of pulmonary medicine, thoracic surgery, pathology, and radiology under the aegis of the Indian Association for Bronchology. Sixteen questions on various technical aspects of BLC were framed. A literature search was conducted using PubMed and EMBASE databases. The expert group discussed the available evidence relevant to each question through e-mail and a face-to-face meeting, and arrived at a consensus.

Results:

The experts agreed that patients should be carefully selected for BLC after weighing the risks and benefits of the procedure. Where appropriate, consideration should be given to perform alternate procedures such as conventional transbronchial biopsy or subject the patient directly to a surgical lung biopsy. The procedure is best performed after placement of an artificial airway under sedation/general anesthesia. Fluoroscopic guidance and occlusion balloon should be utilized for positioning the cryoprobe to reduce the risk of pneumothorax and bleeding, respectively. At least four tissue specimens (with at least two of adequate size, i.e., ≥5 mm) should be obtained during the procedure from different lobes or different segments of a lobe. The histopathological findings of BLC should be interpreted by an experienced pulmonary pathologist. The final diagnosis should be made after a multidisciplinary discussion. Finally, there is a need for structured training for performing BLC.

Conclusion:

This position statement is an attempt to provide practical recommendations for the performance of BLC in DPLDs.

KEYWORDS:

Bronchoscopy; hypersensitivity pneumonitis; idiopathic pulmonary fibrosis; interstitial lung disease; interventional pulmonology; lung biopsy; sarcoidosis; video-assisted thoracoscopic surgery

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