Transbronchial Lung Biopsy In Patients Research Articles

Observational findings of transbronchial lung biopsy in patients with interstitial lung disease: a retrospective study in Aleppo University Hospital.

This retrospective cohort research was done between 1 January 2020 and 18 April 2022 at the pulmonary department of Aleppo University Hospital, Syria, using patient records. In our study, 174 patients were examined. We included patients over the age of 18 who were referred or admitted to our department at Aleppo University Hospital after being diagnosed with diffuse parenchymal lung disease based on high-resolution computed tomography and clinical symptoms, while excluding other respiratory diseases such as tuberculosis and coronavirus disease 2019. Patients in the research were 53±7.1 years old on average. Cough and dyspnea were the most common clinical complaints among the patients, which accounted for 79.12 and 78.16%, respectively. A significant fraction of ground-glass opacity was detected on the high-resolution computed tomography, amounting to 102 (58.62%) and 74 (42.53%) for the reticular lesions, respectively. As a complication there were 40 patients with bleeding, of whom 24 had moderate bleeding, and 11 had major bleeding. We also had three patients with pneumothorax. The diagnostic yield of the TBLB in our ILD patients was 66.66%. An adequate diagnostic accuracy (66.66%) was detected in the TBLB in confirming the diagnosis of ILD; in addition, the bleeding was the most prevalent complication of this procedure. More interventional studies are needed to compare the diagnostic accuracy of this procedure with other invasive and noninvasive diagnostic methodologies of ILD.

A Survey of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) practices in India.

Background:There is a lack of data on the prevalent practices of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in India.Aim:To study the current practices of EBUS-TBNA in India.Methods:This survey was an online questionnaire designed on the Google forms interface. The survey included various questions related to demographics, sedation, analgesia and anesthesia, technical aspects, and infection control related to the procedure of EBUS-TBNA.Results:Data from 134 respondents (mean age: 42.2 years) were analyzed. Most (97.8%) were pulmonologists or physicians, and a majority (94.8%) practicing in either a private multi-specialty setting or medical college. 40.3% had received procedure training at a formal training program. Mild/moderate sedation was the most common strategy (70.1%). Midazolam (76.7%), Fentanyl (76.0%), followed by propofol (46.5%), were the most frequent drugs, and 82.8% preferred combination sedation. 26.1% used cricothyroid lignocaine injection, and the use of 1% or 2% lignocaine for spray-as-you-go administration was similar. The oral route was preferred, while the laryngeal mask airway was the most common airway conduit under general anesthesia. Suspected granulomatous mediastinal lymphadenopathy (TB/sarcoidosis) (67.2%), followed by lung cancer (32.8%), were the most common indications of EBUS-TBNA. 81.3% performed EBUS-TBNA for lung cancer staging. 21 G needle was preferred (64.9%), and vacuum suction was common (80.6%). 55.2% routinely performed ROSE. Alcohol fixed glass slide smears were the most common method (93.1%) for cytological preparation. 49.3% also performed EUS-B-FNA. 76.9% routinely obtained endo bronchial biopsy and transbronchial lung biopsy in patients with suspected sarcoidosis. Elastography was infrequently used. Nearly three-fourths (77.6%) reused EBUS needles.Conclusion:There is practice variability in the multiple aspects related technical performance of EBUS-TBNA. Evidence-based guidelines addressing the multiple technical aspects are required to standardize the practice of EBUS-TBNA.

Pulmonary Hypertension and Transbronchial Lung Biopsy: Does It Increase the Risk of Hemorrhage?

BackgroundBronchoscopy with transbronchial lung biopsy (TBLB) is commonly used as a diagnostic tool for pulmonary disease. Hemorrhage is a major complication of TBLB. While pulmonary hypertension (PH) is considered a risk factor, evidence supporting this is limited. In this study, we compare complications of TBLB in patients with PH to those without PH.Material and methodsWe performed a retrospective review of patients who underwent TBLB in our institution from January 2010 to May 2016. PH and non-PH groups were compared with respect to patient demographics, biopsy guidance, number of lobes biopsied (single or multiple), positive pressure ventilation, pre- and post-procedure diagnoses, and complications. Complications were defined as major hemorrhage, prolonged intubation, and reintubation within 72 hours from TBLB.ResultsThe PH group had 45 patients with a mean age of 71 ± 14 years, and the non-PH group had 349 patients with a mean age of 63 ± 14 years. There were no significant differences with regards to gender, pre-procedure anticoagulation and antiplatelet agents, biopsy guidance, or number of lobes biopsied (p > 0.371). There was no significant difference in the occurrence of major hemorrhage between the two groups (p = 0.491). Prolonged intubation occurred more frequently in the PH group (p = 0.007).ConclusionsThere appears to be no increased risk of post-procedure hemorrhage with TBLB in patients with mild PH. There is, however, an increased risk of post-procedure prolonged intubation in these patients.

Cryoprobe transbronchial lung biopsy with flexible bronchoscope using Arndt endobronchial blocker.

Cryoprobe transbronchial lung biopsy (TBLB)/transbronchial lung cryobiopsy (TBLC) is increasingly being described as an alternative to surgical lung biopsy and provides larger lung biopsy samples as compared with conventional TBLB in patients with diffuse parenchymal lung diseases. The technique for cryoprobe TBLB procedure has not yet been standardized, and various authors describe different modalities. However, the use of an artificial airway (rigid bronchoscope or endotracheal tube) is preferred for airway protection. In addition, the use of an occlusion balloon provides safety to prevent excessive bleeding. The exclusive use of rigid bronchoscopy may limit the widespread adoption of this diagnostic modality. We describe a method to perform cryoprobe TBLB with exclusive use of a flexible bronchoscope and utilization of Arndt endobronchial blocker as an occlusion balloon. The procedure was performed in two patients under moderate conscious sedation. Adequate lung biopsies were obtained in both the cases without any complications. This modality may allow safe performance of cryoprobe TBLB with a flexible bronchoscope. Herein, we describe the technical and procedural considerations of this modality.

Predictors of Successful Yield of Transbronchial Lung Biopsy in Patients With Sarcoidosis.

Transbronchial lung biopsy (TBLB) is an important bronchoscopic procedure used in the diagnosis of sarcoidosis. Only a few studies have evaluated determinants associated with successful diagnostic yield of TBLB. Herein, we evaluate the factors predicting successful yield of TBLB in subjects with sarcoidosis. Consecutive subjects with a clinical suspicion of sarcoidosis who underwent TBLB were enrolled. We evaluated the association between symptoms, spirometric lung function, radiologic stage of sarcoidosis, number of specimens, presence of floating biopsies, number of alveoli, and successful diagnostic yield (presence of granuloma) on TBLB. Of the 223 subjects, sarcoidosis was diagnosed in 209 [mean (SD) age, 43.9 (12.6) y; 50.7% men] individuals. A total of 1021 TBLB specimens were obtained. Granulomas were demonstrated in 123 (58.9%) subjects on TBLB. On a multivariate analysis, there was no association between successful diagnostic yield and the presence of dyspnea, spirometric lung function, radiologic stage of sarcoidosis, presence of floating biopsies, presence of at least 50 alveoli, or crush artifacts during histopathologic examination. Complications were encountered in 25 (11.9%) subjects. There were no deaths. TBLB is a reasonably safe procedure with a good diagnostic yield. The present study did not identify any predictors associated with successful diagnostic yield of TBLB in sarcoidosis.

Elective intubation and positive pressure ventilation for transbronchial lung biopsy

BackgroundThe safety of transbronchial lung biopsy (TBLB) on positive pressure mechanical ventilation has been controversial due to a presumed risk of pneumothorax. Data are especially limited on TBLB with elective intubation and mechanical ventilation. In this study, we compared complications of TBLB in patients who were electively mechanically ventilated for the procedure to those who were not. Material and methodsA retrospective review of nonventilator-dependent patients who underwent TBLB in our institution from January 2010 to May 2016 was performed. The mechanical ventilation (MV) and nonmechanical ventilation (NMV) groups were compared with respect to patient demographics, numbers of lobes biopsied (single or multiple), preprocedure and postprocedure diagnoses, and complications. Complications were defined as pneumothorax of any size, major hemorrhage, prolonged intubation, and reintubation within 72 hours from TBLB. ResultsA total of 394 patients were identified. The MV group had 351 patients with mean age of 64.6 years, and the NMV group had 43 patients with mean age of 60.0 years. There were no significant differences with regards to age, gender, or number of lobes biopsied. There was no significant difference in the occurrence of pneumothorax (5.4% versus 4.7%, P = 1.00), hemorrhage (1.7% versus 4.7%, P = 0.21), and prolonged intubation or reintubation (3.1% versus 2.3%, P = 1.00) between the two groups. ConclusionsWhen performing TBLB, there was no significant difference observed in the rate of complications between MV and NMV groups. Elective positive pressure mechanical ventilation for TBLB for nonventilator-dependent patients is safe and does not increase the risk of complications.

Diagnostic performance of convex probe EBUS-TBNA in patients with mediastinal and coexistent endobronchial or peripheral lesions.

To compare the performance of convex probe endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) with conventional endobronchial biopsy (EBB) or transbronchial lung biopsy (TBLB) in patients with mediastinal, and coexisting endobronchial or peripheral lesions.Retrospective review of records of patients undergoing diagnostic EBUS-TBNA and conventional bronchoscopy in 2014.A total of 74 patients had mediastinal, and coexisting endobronchial or peripheral lesions. The detection rate of EBUS-TBNA for mediastinal lesion >1 cm in short axis, EBB for visible exophytic type of endobronchial lesion, and TBLB for peripheral lesion with bronchus sign were 71%, 75%, and 86%, respectively. In contrast, the detection rate of EBUS-TBNA for mediastinal lesion ≤1 cm in short axis, EBB for mucosal hyperemia type of endobronchial lesion, and TBLB for peripheral lesion without bronchus sign were 25%, 63%, and 38%, and improved to 63%, 88%, and 62% respectively by adding EBB or TBLB to EBUS-TBNA, and EBUS-TBNA to EBB or TBLB. Postprocedure bleeding was significantly more common in patients undergoing EBB and TBLB 8 (40%) versus convex probe EBUS-TBNA 2 patients (2.7%, P = 0.0004).EBUS-TBNA is a safer single diagnostic technique compared with EBB or TBLB in patients with mediastinal lesion of >1 cm in size, and coexisting exophytic type of endobronchial lesion, or peripheral lesion with bronchus sign. However, it requires combining with EBB or TBLB and vice versa to optimize yield when mediastinal lesion is ≤1 cm in size, and coexisting endobronchial and peripheral lesions lack exophytic nature, and bronchus sign, respectively.

Which Patients With ARDS Benefit From Lung Biopsy?

A central tenet of caring for patients with ARDS is to treat the underlying cause, be it sepsis, pneumonia, or removal of an offending toxin. Identifying the risk factor for ARDS has even been proposed as essential to diagnosing ARDS. Not infrequently, however, the precipitant for acute hypoxemic respiratory failure is unclear, and this raises the question of whether a histologic lung diagnosis would benefit the patient. In this review, we consider the historic role of pathology in establishing a diagnosis of ARDS and the published experience of surgical and transbronchial lung biopsy in patients with ARDS. We reflect on which pathologic diagnoses influence treatment and suggest a patient-centric approach to weigh the risks and benefits of a lung biopsy for critically ill patients who may have ARDS.

Clinical significance of intra-alveolar fibrin deposition in transbronchial lung biopsy in patients with organizing pneumonia.

This study examined the clinical significance of intra-alveolar fibrin deposition (IAFD) in transbronchial lung biopsy specimens obtained from patients with organizing pneumonia. Pathological reports of transbronchial lung biopsies performed between 2004 and 2012 were reviewed to identify cases of intra-alveolar organization with or without fibrin deposition. Clinical charts, computed tomography images, and transbronchial lung biopsy specimens from these cases were examined retrospectively. Diagnosis of organizing pneumonia was reevaluated based upon the consensus of a respiratory physician, a radiologist, and a pathologist. Transbronchial lung biopsy results of the reviewed patients with organizing pneumonia found seven patients who had IAFD, and 34 who did not. Seven patients' conditions were associated with collagen vascular disease (CVD), and 34 were cryptogenic. IAFD was significantly associated with high C-reactive protein (CRP) values (>5 mg/dl) (p = 0.0012) and underlying CVD (p = 0.0099). Multivariate analysis revealed that IAFD was independently associated with high CRP values (p = 0.0184). Three of 31 patients and six of 27 patients experienced a relapse of organizing pneumonia within 6 months and 1 year, respectively. IAFD (p = 0.0044) and high CRP values (p = 0.0207) were significantly related to relapse within 6 months, while only CRP was significantly related to relapse within 1 year (p = 0.0007). In patients with organizing pneumonia, IAFD was significantly associated with high CRP values. High CRP values and/or IAFD predicted relapse of organizing pneumonia within 6 months to 1 year.

Transbronchial lung biopsy in patients with diffuse parenchymal lung disease without 'idiopathic pulmonary fibrosis pattern' on HRCT scan - Experience from a tertiary care center of North India.

Background:Diffuse parenchymal lung diseases (DPLD) are a group of disorders characterized by chest radiological findings of bilateral diffuse shadowing. Lung biopsy is generally required to make an etiological diagnosis of DPLD's. Transbronchial lung biopsy (TBLB) is a minimally invasive method to achieve a lung sample which has been found to be a useful diagnostic tool in patients with DPLD. As per American Thoracic Society guidelines for management of idiopathic interstitial pneumonias, TBLB is not required in patients who have findings consistent with idiopathic pulmonary fibrosis (IPF) on HRCT scan thorax. Some Indian researchers have evaluated, on a small number of subjects, the role of TBLB in patients with DPLD, but they had not excluded patients with ‘IPF pattern’. This study was planned to assess TBLB in patients with DPLD after excluding patients with ‘IPF pattern’.Materials and Methods:A prospective non-randomized study on 49 patients with DPLD without a characteristic ‘IPF pattern’ were subjected to TBLB.Results:The overall diagnostic yield of TBLB was 85.7%. Non-specific interstitial pneumonitis, tuberculosis and sarcoidosis were the most common histology patterns found (22.4, 18.4 and 16.3%, respectively). Procedure-related mortality was nil. Iatrogenic pneumothorax occurred in five patients (10.2%). Minor complications included hemorrhage and transient hypoxia.Conclusion:TBLB is a safe and effective tool in the diagnosis of DPLD.

Bronchoscopic Myths and Legends

In Brief Transbronchial lung biopsy is an important tool for the bronchoscopist in the evaluation of lung disease. It has, however, been associated with increased rates of major complications including bleeding and pneumothorax. It has been suggested that platelet dysfunction, potentially from antiplatelet medications, contributes to this increased risk. Additionally, although no recommendations exist, physician surveys have found that the majority of pulmonologists withhold antiplatelet pharmacotherapy before bronchoscopy when biopsies are planned. We reviewed the existing literature to determine whether antiplatelet medications contribute to an increased bleeding risk and provide recommendations on their use. Antiplatelet pharmacotherapy should be withheld at least 5 days before bronchoscopy to minimize the risk of bleeding when transbronchial lung biopsies are planned. Bronchoscopy contraindications are based on training, experience, and evidence based medicine when available. We set out to review the available literature on the bleeding risks associated with transbronchial lung biopsy in patients on anti-platelet pharmacotherapy.

Evaluation of transbronchial lung biopsy in patients with sarcoidosis (author's transl)

Evaluation of transbronchial lung biopsy in patients with sarcoidosis (author's transl)