Lung cryobiopsies

A paradigm shift in diagnostic bronchoscopy?

Venerino Poletti, Gian Luca Casoni, Carlo Gurioli, Jay H Ryu, Sara Tomassetti

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

In 1963, the first bronchoscopic lung biopsy was performed. Less than 10 years later, the technique of transbronchial lung biopsy using a flexible bronchoscope was introduced into clinical practice, significantly reducing the rate of major complications and the rate of surgical lung biopsies in patients with diffuse parenchymal lung diseases. The diagnostic yield of transbronchial lung biopsy varies among various parenchymal lung diseases. In pulmonary sarcoidosis and lymphangitis carcinomatosa, a diagnosis can be obtained in up to 80% of patients. This method is considered inadequate, however, in identifying more complex histological patterns such as usual interstitial pneumonitis or nonspecific interstitial pneumonitis. Introduction of the 'jumbo forceps' and of a more 'surgically oriented' procedural setting (patients deeply sedated and intubated) allowed larger and more numerous lung specimens to be obtained without a significant increase of complications such as pneumothorax or bronchial bleeding. However, the possibility to obtain enough parenchymal tissue for a morphological diagnosis of complex patterns remained unmet. Recently, the use of cryoprobes has achieved a significant impact on this issue allowing to obtain large quantity of tissue. Recent studies document that with transbronchial cryobiopsies the diagnosis of usual interstitial pneumonitis can be made confidently by pathologists with a good inter-observer agreement. Pneumothorax is the main complication (reported in up to one fourth of cases in some series); bronchial bleeding is easily controlled using Fogarty balloon. Transbronchial cryobiopsy is a promising new technique that may become a valid alternative to surgical lung biopsy in the near feature.

Original languageEnglish (US)
Pages (from-to)645-654
Number of pages10
JournalRespirology
Volume19
Issue number5
DOIs
StatePublished - 2014

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Bronchoscopy
Lung
Biopsy
Idiopathic Pulmonary Fibrosis
Interstitial Lung Diseases
Pneumothorax
Lymphangitis
Hemorrhage
Pulmonary Sarcoidosis
Bronchoscopes
Surgical Instruments
Lung Diseases

Keywords

  • biopsy
  • cryobiopsy
  • interstitial lung disease
  • pneumothorax
  • transbronchial biopsy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Poletti, V., Casoni, G. L., Gurioli, C., Ryu, J. H., & Tomassetti, S. (2014). Lung cryobiopsies: A paradigm shift in diagnostic bronchoscopy? Respirology, 19(5), 645-654. https://doi.org/10.1111/resp.12309

Lung cryobiopsies : A paradigm shift in diagnostic bronchoscopy? / Poletti, Venerino; Casoni, Gian Luca; Gurioli, Carlo; Ryu, Jay H; Tomassetti, Sara.

In: Respirology, Vol. 19, No. 5, 2014, p. 645-654.

Research output: Contribution to journalArticle

Poletti, V, Casoni, GL, Gurioli, C, Ryu, JH & Tomassetti, S 2014, 'Lung cryobiopsies: A paradigm shift in diagnostic bronchoscopy?', Respirology, vol. 19, no. 5, pp. 645-654. https://doi.org/10.1111/resp.12309
Poletti, Venerino ; Casoni, Gian Luca ; Gurioli, Carlo ; Ryu, Jay H ; Tomassetti, Sara. / Lung cryobiopsies : A paradigm shift in diagnostic bronchoscopy?. In: Respirology. 2014 ; Vol. 19, No. 5. pp. 645-654.
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