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Wang S, Yang J, Luo S, Geng J, Ren Y, Zhao L, Liu M, Wang D, Li Y, Tian Z, Liu W, Zhou G, Dai H. The accuracy of electromagnetic navigation bronchoscopy compared to fluoroscopy in navigation of transbronchial lung cryobiopsy in patients with interstitial lung disease. BMC Pulm Med 2024; 24:108. [PMID: 38438922 PMCID: PMC10910665 DOI: 10.1186/s12890-024-02925-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/22/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Safely implementing transbronchial lung cryobiopsy (TBLC) in patients with interstitial lung disease (ILD) requires accurate navigation. Traditional fluoroscopy falls short in reducing the risk of post-procedure pneumothorax. The potential of electromagnetic navigation bronchoscopy (ENB) as a more precise navigation method warrants further exploration. METHODS A prospective cohort study was conducted on ILD patients undergoing TBLC. Patients were assigned either fluoroscopy or ENB for cryoprobe positioning. Navigation accuracy was evaluated using cone beam computed tomography (CBCT) images as the standard. Safety and diagnostic yield were also observed. RESULTS Seventeen patients underwent TBLC, with 10 guided by fluoroscopy and seven by ENB. Fluoroscopy-guided cryoprobe navigation required more adjustments [9/15 (60%) v.s. 1/9 (11%), p = 0.018] for subsequent TBLC compared to ENB, as confirmed by CBCT images. Clinical characteristics, post-procedure complications, and biopsy specimen size showed no significant differences between the groups. Fourteen patients obtained a pathological diagnosis, and 15 received a multidisciplinary discussion (MDD) diagnosis. In the fluoroscopy group, three patients failed to obtain a pathological diagnosis, and two failed to obtain an MDD diagnosis. CONCLUSIONS ENB demonstrates significantly superior accuracy in TBLC navigation compared to traditional fluoroscopy when CBCT images are used as a reference. Further studies are necessary to determine the value of ENB in TBLC navigation for ILD patients.
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Affiliation(s)
- Shiyao Wang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Jinmi Yang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Inner Mongolia Autonomous Region People's Hospital, Hohhot, 010017, Inner Mongolia Autonomous Region, China
| | - Sa Luo
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Jing Geng
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Yanhong Ren
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Ling Zhao
- Department of Pathology, China-Japan Friendship Hospital, 100029, Beijing, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, 100029, Beijing, China
| | - Dan Wang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Ying Li
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Zheng Tian
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Wei Liu
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Guowu Zhou
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China.
| | - Huaping Dai
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China.
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Husnain SMN, Sarkar A, Huseini T. Utility and Safety of Bronchoscopic Cryotechniques-A Comprehensive Review. Diagnostics (Basel) 2023; 13:2886. [PMID: 37761254 PMCID: PMC10530195 DOI: 10.3390/diagnostics13182886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Cryosurgical techniques are employed for diagnostic and therapeutic bronchoscopy and serve as important tools for the management of pulmonary diseases. The diagnosis of interstitial lung disease requires multidisciplinary team discussions after a thorough assessment of history, physical exam, computed tomography, and lung-function testing. However, histological diagnosis is required in selected patients. Surgical lung biopsy has been the gold standard but this can be associated with increased morbidity and mortality. Transbronchial lung cryobiopsy is an emerging technique and multiple studies have shown that it has a high diagnostic yield with a good safety profile. There is wide procedural variability and the optimal technique for cryobiopsy is still under investigation. There is emerging data that demonstrate that cryobiopsy is safe and highly accurate in the diagnosis of thoracic malignancies. Furthermore, cryorecanalization procedures are a useful adjunct for the palliation of tumors in patients with central airway obstruction. One should keep in mind that these procedures are not free from complications and should be carried out in a specialized center by a trained and experienced bronchoscopy team. We present a review of the literature on the diagnostic and therapeutic utility of bronchoscopy-guided cryosurgical procedures and their safety profile.
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Affiliation(s)
- Shaikh M. Noor Husnain
- Department of Internal Medicine, Division of Interventional Pulmonary Medicine, Westchester Medical Center, New York, NY 10595, USA
| | - Abhishek Sarkar
- Department of Internal Medicine, Division of Interventional Pulmonary Medicine, Westchester Medical Center, New York, NY 10595, USA
| | - Taha Huseini
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA 6150, Australia
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Proposal of a novel pipeline involving precise bronchoscopy of distal peripheral pulmonary lesions for genetic testing. Sci Rep 2022; 12:19774. [PMID: 36396864 PMCID: PMC9672070 DOI: 10.1038/s41598-022-24372-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Next-generation sequencing (NGS) has become increasingly more important for lung cancer management. We now expect biopsies to be sensitive, safe, and yielding sufficient samples for NGS. In this study, we propose ultraselective biopsy (USB) with sample volume adjustment (SVA) as a novel method that integrates an ultrathin bronchoscope, radial probe endobronchial ultrasound, and the direct oblique method for ultraselective navigation, and adjustment of sample volume for NGS. Our purpose was to estimate the diagnostic potential and the applicability of USB-SVA for amplicon-based NGS analysis. The diagnostic yield of bronchoscopy in forty-nine patients with malignant peripheral pulmonary lesions (PPLs) was retrospectively analyzed, and amplicon-based NGS analysis was performed on samples from some patients using USB. The diagnostic yields of distal PPLs in the USB group were significantly higher than those in the non-USB group (90.5% vs. 50%, respectively, p = 0.015). The extracted amounts of nucleic acids were at least five times the minimum requirement and the sequence quality met the criteria for the Oncomine™ Target Test. Only the tumor cell content of some samples was insufficient. The feasibility of the pipeline for USB, SVA, and amplicon-based NGS in distal PPLs was demonstrated.
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Genova C, Tagliabue E, Mora M, Aloè T, Dono M, Salvi S, Zullo L, Barisione E. Potential application of cryobiopsy for histo-molecular characterization of mediastinal lymph nodes in patients with thoracic malignancies: a case presentation series and implications for future developments. BMC Pulm Med 2022; 22:5. [PMID: 34996404 PMCID: PMC8741535 DOI: 10.1186/s12890-021-01814-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background The management of non-small cell lung cancer (NSCLC) has become increasingly complex due to the evolution of personalized medicine approaches. Such approaches are characterized by the necessity of adequate tumor samples; hence, improved biopsy techniques are needed. Transbronchial lung cryobiopsy is a novel endoscopic procedure designed to collect peripheral pulmonary tissue, and it is currently employed in interstitial lung diseases. The use of this technique in oncology might result in improved mediastinum staging and molecular characterizations; however, available data involving the use of a cryoprobe on mediastinal lymph nodes are still limited. Case presentation Here we present a series of five consecutive patients who underwent endoscopic assessment of mediastinal lymph nodes for oncologic reasons. All patients were subjected both to endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA) and cryobiopsy of mediastinal lymph nodes during the same procedure, and no complications were observed. In three of the reported cases, both cryobiopsy and cell block from EBUS TBNA were positive, while in one case cryobiopsy was not diagnostic and EBUS TBNA was negative; moreover, one case showed discordance between the procedures, as cryobiopsy was negative and cell block obtained from multiple stations was diagnostic for small cell lung cancer. In one case involving a patient treated for lymphoma, cryobiopsy provided more complete histologic characterization, and in another case involving a patient affected by NSCLC cryobiopsy provided more material for molecular analyses. Conclusion This case presentation series suggests that cryobiopsy, which has been generally used on peripheral lung lesions so far, is a feasible and safe approach for diagnosis and staging of mediastinal lymph nodal involvement, especially when station 7 is involved. Compared to EBUS TBNA, cryobiopsy might provide more adequate histological samples, with a possible impact on molecular characterizations and, therefore, therapeutic decisions. However, the learning curve of the procedure has not to be understated and optimal protocols for implementing this technique are needed. In our opinion, further studies designed to integrate the routine use of cryobiopsy in current practice for solid and eventually hematologic tumors with mediastinal lymph node involvement are warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01814-x.
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Affiliation(s)
- Carlo Genova
- UOC Clinica Di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy. .,Dipartimento Di Medicina Interna E Specialità Mediche (DiMI), Facoltà Di Medicina E Chirurgia, Università Degli Studi Di Genova, Genova, Italy.
| | - Elena Tagliabue
- UOC Pneumologia Interventistica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marco Mora
- UOC Anatomia Patologica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Teresita Aloè
- UOC Pneumologia Interventistica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Mariella Dono
- UO Diagnostica Molecolare, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sandra Salvi
- UO Diagnostica Molecolare, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lodovica Zullo
- UOC Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Emanuela Barisione
- UOC Pneumologia Interventistica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Babu PS S, Marwah V, Katoch CDS, Garg Y, Kumar TA, Sharma M, Choudhary R, Peter DK, Chopra M, Bhati G. Diagnostic Yield and Safety of Bronchoscopic Lung Cryobiopsy in Evaluation of Lung Mass. Cureus 2021; 13:e19940. [PMID: 34984115 PMCID: PMC8714048 DOI: 10.7759/cureus.19940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2021] [Indexed: 12/25/2022] Open
Abstract
Background A mass lesion in the lung is a common finding seen on chest radiology. The prognosis of patients with mass lesions in the lung is capricious as malignancy is a consideration. It is essential to diagnose the underlying aetiology at the earliest with minimally invasive procedures for prompt treatment of the case. Bronchoscopic lung cryobiopsy (BLC) is a newer interventional technique in pulmonary medicine for the diagnosis of mass lesions in the lung. Materials and methods This is a retrospective study of patients reporting to a tertiary care centre who were radiologically (by computed tomography scan of the chest) diagnosed with a mass lesion of the lung and who underwent BLC during the period from January 2018 to January 2021. We analysed the diagnostic yield of the technique defined as a positive tissue diagnosis after the histopathological examination (HPE) along with the safety of the procedure. Results During the above period, we evaluated 70 patients who were diagnosed radiologically with mass lesions of the lung and underwent BLC. We obtained tissue diagnoses for 66 cases and the result of four cases was inconclusive. The diagnostic yield of the BLC procedure was 94.29%. There was no mortality and complications were minimal bleeding and small pneumothorax. Conclusion BLC is a newer technique for obtaining lung tissue via a flexible bronchoscope obviating the need for open lung biopsy. The main advantage of the technique is providing larger tissue samples with minimal or no side effects without undergoing multiple procedures as compared to other bronchoscopic or surgical methods for obtaining a diagnosis from lung tissue. BLC is a safer and promising technique in diagnosing mass lesions of the lung with better yield.
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Giannoni P, Grosso M, Fugazza G, Nizzari M, Capra MC, Bianchi R, Fiocca R, Salvi S, Montecucco F, Bertolotto M, Fais F, Salio M, Barisione E, de Totero D. Establishment and Characterization of a Novel Fibroblastic Cell Line (SCI13D) Derived from the Broncho-Alveolar Lavage of a Patient with Fibrotic Hypersensitivity Pneumonitis. Biomedicines 2021; 9:1193. [PMID: 34572381 PMCID: PMC8465388 DOI: 10.3390/biomedicines9091193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 12/18/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is a diffuse interstitial lung disease (ILD) caused by the inhalation of a variety of antigens in susceptible individuals. Patients with fibrotic HP (fHP) may show histopathological and radiological manifestations similar to patients with idiopathic pulmonary fibrosis (usual interstitial pneumonia-like pattern of fibrosis) that are associated with a worse prognosis. We describe here the establishment and characterization of a fibroblastic cell line derived from the broncho-alveolar lavage (BAL) of a patient with fHP, a 53 year old man who presented at our Pneumology Unit with cough and dyspnea. The fHP diagnosis was based on international criteria and multidisciplinary discussion. Primary fibroblasts were expanded in vitro until passage 36. These fibroblasts displayed morpho/phenotypical features of myofibroblasts, showing high positivity for α-smooth muscle actin, type I collagen, and fibronectin as determined by quantitative RT-PCR and cyto-fluorographic analysis. Cytogenetic analyses further evidenced trisomy of chromosome 10, which interestingly harbors the FGF2R gene. To our knowledge, this is the first fibroblastic cell line derived from an fHP patient and might, therefore, represent a suitable tool to model the disease in vitro. We preliminarily assessed here the activity of pirfenidone, further demonstrating a consistent inhibition of cells growth by this antifibrotic drug.
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Affiliation(s)
- Paolo Giannoni
- Department Experimental Medicine, University of Genoa, 16132 Genoa, Italy; (P.G.); (F.F.)
| | - Marco Grosso
- Interventional Pulmonary Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (M.G.); (E.B.)
| | - Giuseppina Fugazza
- Department Internal Medicine and Medical Specialties, University of Genoa, 16132 Genoa, Italy; (G.F.); (F.M.); (M.B.)
| | - Mario Nizzari
- Department Internal Medicine and Centre of Excellence for Biomedical Research, University of Genoa, 16132 Genoa, Italy;
| | - Maria Cristina Capra
- Molecular Pathology Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy;
| | - Rita Bianchi
- Anatomic Pathology Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (R.B.); (R.F.); (S.S.)
| | - Roberto Fiocca
- Anatomic Pathology Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (R.B.); (R.F.); (S.S.)
- Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, 16132 Genoa, Italy
| | - Sandra Salvi
- Anatomic Pathology Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (R.B.); (R.F.); (S.S.)
| | - Fabrizio Montecucco
- Department Internal Medicine and Medical Specialties, University of Genoa, 16132 Genoa, Italy; (G.F.); (F.M.); (M.B.)
- Italian Cardiovascular Network, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy
| | - Maria Bertolotto
- Department Internal Medicine and Medical Specialties, University of Genoa, 16132 Genoa, Italy; (G.F.); (F.M.); (M.B.)
| | - Franco Fais
- Department Experimental Medicine, University of Genoa, 16132 Genoa, Italy; (P.G.); (F.F.)
- Molecular Pathology Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy;
| | - Mario Salio
- S.C. Malattie Apparato Respiratorio, Azienda Ospedaliera Nazionale Antonio, Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Emanuela Barisione
- Interventional Pulmonary Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (M.G.); (E.B.)
| | - Daniela de Totero
- Molecular Pathology Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy;
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Barisione E, Grillo F, Ball L, Bianchi R, Grosso M, Morbini P, Pelosi P, Patroniti NA, De Lucia A, Orengo G, Gratarola A, Verda M, Cittadini G, Mastracci L, Fiocca R. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch 2021; 478:471-485. [PMID: 32989525 PMCID: PMC7521863 DOI: 10.1007/s00428-020-02934-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/19/2020] [Accepted: 09/18/2020] [Indexed: 12/24/2022]
Abstract
Data on the pathology of COVID-19 are scarce; available studies show diffuse alveolar damage; however, there is scarce information on the chronologic evolution of COVID-19 lung lesions. The primary aim of the study is to describe the chronology of lung pathologic changes in COVID-19 by using a post-mortem transbronchial lung cryobiopsy approach. Our secondary aim is to correlate the histologic findings with computed tomography patterns. SARS-CoV-2-positive patients, who died while intubated and mechanically ventilated, were enrolled. The procedure was performed 30 min after death, and all lung lobes sampled. Histopathologic analysis was performed on thirty-nine adequate samples from eight patients: two patients (illness duration < 14 days) showed early/exudative phase diffuse alveolar damage, while the remaining 6 patients (median illness duration-32 days) showed progressive histologic patterns (3 with mid/proliferative phase; 3 with late/fibrotic phase diffuse alveolar damage, one of which with honeycombing). Immunohistochemistry for SARS-CoV-2 nucleocapsid protein was positive predominantly in early-phase lesions. Histologic patterns and tomography categories were correlated: early/exudative phase was associated with ground-glass opacity, mid/proliferative lesions with crazy paving, while late/fibrous phase correlated with the consolidation pattern, more frequently seen in the lower/middle lobes. This study uses an innovative cryobiopsy approach for the post-mortem sampling of lung tissues from COVID-19 patients demonstrating the progression of fibrosis in time and correlation with computed tomography features. These findings may prove to be useful in the correct staging of disease, and this could have implications for treatment and patient follow-up.
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Affiliation(s)
- Emanuela Barisione
- Interventional Pulmonology Unit, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Federica Grillo
- Anatomic Pathology Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Lorenzo Ball
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
- Anesthesia and Intensive Care Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Rita Bianchi
- Anatomic Pathology Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Marco Grosso
- Interventional Pulmonology Unit, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Patrizia Morbini
- Unit of Pathology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Pelosi
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
- Anesthesia and Intensive Care Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Nicolò Antonino Patroniti
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
- Anesthesia and Intensive Care Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
| | - Arduino De Lucia
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Giovanni Orengo
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Angelo Gratarola
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Marta Verda
- Radiology, Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - Giuseppe Cittadini
- General Radiology, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
| | - Luca Mastracci
- Anatomic Pathology Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy.
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy.
| | - Roberto Fiocca
- Anatomic Pathology Unit, Department of Surgical Science and Integrated Diagnostics (DISC), University of Genova, Genova, Italy
- Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genova, Italy
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Seashore J, Nishi SPE. Ice Capades: Skating Around Current Practice of Cryobiopsy for ILD. J Bronchology Interv Pulmonol 2021; 28:53-59. [PMID: 32604319 DOI: 10.1097/lbr.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 05/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transbronchial lung cryobiopsy (TBLC) has been proposed as a potentially safer alternative in the diagnosis of interstitial lung disease. The current practice of TBLC is unknown as most published data come from case reports, case series, and a few trials. The authors report the practice patterns of TBLC on the basis of survey responses. METHODS The authors created an anonymous online survey to assess how proceduralists evaluate patients, perform, and manage complications of TBLC. Surveys were distributed through social media and e-mail distribution lists from the American Association of Bronchology and Interventional Pulmonology and the Society of Advanced Bronchoscopists. Aggregated responses are reported as counts, percentages, and averages. RESULTS Surveys show significant variation in parameters providers use to assess appropriate patients for procedures, how specific aspects of TBLC are performed, and how complications and results are managed. CONCLUSION This is the first and largest survey of providers describing the current large variation in the use of cryobiopsy for the evaluation of interstitial lung disease. The standardized practice is essential to understand the true diagnostic accuracy or rate of complications related to TBLC.
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Affiliation(s)
- Justin Seashore
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, TX
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Pang L, Jiang T, Liu X, Li Z, Zou S, Yu P. The value of virtual bronchoscopic navigation and radial endobronchial ultrasound-guided transbronchial lung cryobiopsies for pulmonary lymphangitic carcinomatosis. J Thorac Dis 2020; 12:7666-7674. [PMID: 33447459 PMCID: PMC7797829 DOI: 10.21037/jtd-2020-abpd-002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Pulmonary lymphangitic carcinomatosis (PLC) is characterized by malignant infiltration into lung lymphatic channels from a primary site and is often observed in advanced malignant tumors. This study aimed to evaluate the diagnostic yield of transbronchial lung cryobiopsy in PLC guided by radial endobronchial ultrasound and virtual bronchoscopic navigation (VBN). Methods This prospective study enrolled 40 patients with clinical and radiologic features indicating PLC. The radial endobronchial ultrasound probe was initially advanced to the region of interest of the desired lobe near the pleura with guidance by VBN. Transbronchial lung biopsy and transbronchial lung cryobiopsy were both performed in the same ROI of all patients with the obtained samples being sent to the pathology laboratory for diagnostic analysis. Procedural complications were recorded. Results The average number of transbronchial lung biopsy and transbronchial lung cryobiopsy specimens were 4 (3 to 6) and 2 (1 to 3), respectively (t=10.43, P<0.01), with the corresponding mean diameters per biopsy being 3.7 and 8.7 mm (t=12.37, P<0.01). The diagnostic yields of transbronchial lung biopsy and transbronchial lung cryobiopsy were 70% (28/40) and 92.5% (37/40), respectively. The final positive predictive values of transbronchial lung cryobiopsy and transbronchial lung biopsy for PLC were 94.4% (34/36) and 77.8% (28/36), respectively (χ2=23.94, P<0.01). Further, 52.2% (12/23) and 81.5% (22/27) of the patients in the transbronchial lung biopsy and transbronchial lung cryobiopsy groups, respectively, were diagnosed with non-small lung cancer after further molecular analysis (χ2=19.56, P<0.01). Only 2 (5%) cases presented postoperative pneumothorax. Moreover, 0 (0%), 3 (7.5%), and 17 (42.5%) patients presented severe, moderate, and mild bleeding, respectively. There were no other adverse events or deaths. Conclusions Transbronchial lung cryobiopsy with the guidance of radial endobronchial ultrasound and VBN without fluoroscopy has a good diagnostic yield for PLC; moreover, it allows one to obtain adequate and intact tissue samples for further molecular analysis.
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Affiliation(s)
- Lingling Pang
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Yantai, China
| | - Tingshu Jiang
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Yantai, China
| | - Xueping Liu
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Yantai, China
| | - Zhan Li
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Yantai, China
| | - Shenchun Zou
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Yantai, China
| | - Pengfei Yu
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Yantai, China
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10
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Patrucco F, Bellan M, Solidoro P. Serum biomarkers in idiopathic pulmonary fibrosis. Panminerva Med 2020; 63:199-200. [PMID: 32759912 DOI: 10.23736/s0031-0808.20.04049-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Filippo Patrucco
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy - .,Unit of Respiratory Diseases, Department of Specialty Medicine, Maggiore della Carità University Hospital, Novara, Italy -
| | - Mattia Bellan
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Center for Autoimmune and Allergic Diseases (CAAD), Novara, Italy
| | - Paolo Solidoro
- Department of Medical Sciences, University of Turin, Turin, Italy.,Unit of Pneumology, Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, Turin, Italy
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11
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Colt HG, Williamson JP. Training in interventional pulmonology: What we have learned and a way forward. Respirology 2020; 25:997-1007. [PMID: 32453479 DOI: 10.1111/resp.13846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/15/2020] [Accepted: 04/09/2020] [Indexed: 12/01/2022]
Abstract
IP encompasses a complex list of procedures requiring knowledge, technical skills and competence. Modern, learner-centric educational philosophies and an explosion of multidimensional educational tools including manikins, simulators, online resources, social media and formal programs can foster learning in IP, promoting professionalism and a culture of lifelong learning. This paper provides background and guidance to a structured, multidimensional and learner-centric strategy for medical procedural education. Focusing on our experience in IP, we describe how competency-based measures, simulation technology and various teaching modalities contribute to a more uniform learning environment in which patients do not suffer the burdens of procedure-related training.
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Affiliation(s)
- Henri G Colt
- School of Medicine, University of California, Irvine, CA, USA
| | - Jonathan P Williamson
- South Western Sydney Clinical School, Liverpool Hospital, The University of New South Wales, Sydney, NSW, Australia.,MQ Health Respiratory and Sleep, Macquarie University Hospital, Sydney, NSW, Australia
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12
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Sánchez-Cabral O, Santillán-Díaz C, Flores-Bello ÁP, Herrera-Ortega MI, Sandoval-Gutiérrez JL, Santillán-Doherty P, Martínez-Mendoza D. GeneXpert ® MTB/RIF assay with transbronchial lung cryobiopsy for Mycobacterium tuberculosis diagnosis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:351. [PMID: 32355795 PMCID: PMC7186622 DOI: 10.21037/atm.2020.02.100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Early tuberculosis (TB) diagnostic is one of the critical steps to TB control. GeneXpert MTB/RIF has been widely proven for a prompt TB diagnosis. The use of GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy samples may increase diagnostic accuracy. We aim to assess the diagnostic of TB with GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy. Methods Patients with suspected diagnosis of TB and negative smear microscopies, with TB culture and GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy were included in this cross-sectional study. Participants were enrolled from 2016 to 2018 at National Institute of Respiratory Diseases, Mexico. Results We included 54 patients (77.8% males) aged 30 to 65 years. The sensitivity of the GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy was 81.3% (95% CI, 62.1-100%), with a specificity of 100% (95% CI, 100-100%) and a negative predictive value of 92.7% (95% CI, 84.7-100%). Twenty-two patients of the total population have HIV, the sensitivity of the test in these patients was 87.5% (95% CI, 64.6-100%). Also, 28 patients with a peripheral localized lesion which had a solid pattern were identified (51.9%). The sensitivity in patients with peripheral localized lesions was 88.9% (68.4-100%). Conclusions The GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy test is as efficient as broncho alveolar lavage for TB diagnosis. Transbronchial lung cryobiopsy increases a major diagnostic opportunity when the nature of illness is malignant. Transbronchial lung cryobiopsy is efficient in HIV patients, especially in patients with peripheral localized lesion.
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Affiliation(s)
- Olivia Sánchez-Cabral
- Interventional Pulmonology Unit, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Cira Santillán-Díaz
- Interventional Pulmonology Unit, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Ángel Paul Flores-Bello
- Clinic of Tuberculosis and Pleural Diseases, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Mildred Ivannia Herrera-Ortega
- Interventional Pulmonology Unit, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - José Luis Sandoval-Gutiérrez
- Auxiliary and Diagnostic Services, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Patricio Santillán-Doherty
- Medical Direction, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Dina Martínez-Mendoza
- Epidemiology Surveillance Unit, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
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13
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Patrucco F, Daverio M, Gavelli F, Castello L, Boldorini R, Rena O, Casadio C, Balbo P. Cryobiopsy in the diagnosis of lung tumors: a single center experience. MINERVA BIOTECNOL 2019. [DOI: 10.23736/s1120-4826.19.02561-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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14
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Harari S, Cereda F, Pane F, Cavazza A, Papanikolaou N, Pelosi G, Scarioni M, Uslenghi E, Zompatori M, Caminati A. Lung Cryobiopsy for the Diagnosis of Interstitial Lung Diseases: A Series Contribution to a Debated Procedure. ACTA ACUST UNITED AC 2019; 55:medicina55090606. [PMID: 31546869 PMCID: PMC6780159 DOI: 10.3390/medicina55090606] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 12/31/2022]
Abstract
Introduction: Transbronchial cryobiopsy is an alternative to surgical biopsy for the diagnosis of fibrosing interstitial lung diseases, although the role of this relatively new method is rather controversial. Aim of this study is to evaluate the diagnostic performance and the safety of transbronchial cryobiopsy in patients with fibrosing interstitial lung disease. Materials and methods: The population in this study included patients with interstitial lung diseases who underwent cryobiopsy from May 2015 to May 2018 at the Division of Pneumology of San Giuseppe Hospital in Milan and who were retrospectively studied. All cryobiopsy procedures were performed under fluoroscopic guidance using a flexible video bronchoscope and an endobronchial blocking system in the operating room with patients under general anaesthesia. The diagnostic performance and safety of the procedure were assessed. The main complications evaluated were endobronchial bleeding and pneumothorax. All cases were studied with a multidisciplinary approach, before and after cryobiopsy. Results: Seventy-three patients were admitted to this study. A specific diagnosis was reached in 64 cases, with a diagnostic sensitivity of 88%; 5 cases (7%) were considered inadequate, 4 cases (5%) were found to be non-diagnostic. Only one major bleeding event occurred (1.4%), while 14 patients (19%) experienced mild/moderate bleeding events while undergoing bronchoscopy; 8 cases of pneumothorax (10.9%) were reported, of which 2 (2.7%) required surgical drainage. Conclusions: When performed under safe conditions and in an experienced center, cryobiopsy is a procedure with limited complications having a high diagnostic yield in fibrotic interstitial lung disease.
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Affiliation(s)
- Sergio Harari
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria-Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, via San Vittore 12, 20123 Milan, Italy.
- U.O. di Medicina Generale, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy.
| | - Francesca Cereda
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria-Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, via San Vittore 12, 20123 Milan, Italy.
| | - Federico Pane
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria-Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, via San Vittore 12, 20123 Milan, Italy.
| | - Alberto Cavazza
- U.O. di Anatomia Patologica Azienda USL/IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy.
| | - Nikolaos Papanikolaou
- Servizio Interaziendale di Anatomia Patologica, Polo Scientifico e Tecnologico, IRCCS MultiMedica, Via Gaudenzio Fantoli 16/15, 20138 Milan, Italy.
| | - Giuseppe Pelosi
- Servizio Interaziendale di Anatomia Patologica, Polo Scientifico e Tecnologico, IRCCS MultiMedica, Via Gaudenzio Fantoli 16/15, 20138 Milan, Italy.
- Dipartimento di Oncologia ed Onco-ematologia, Università degli Studi di Milano, 20122 Milan, Italy.
| | - Monica Scarioni
- U.O. di Anestesia e Rianimazione, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy.
| | - Elisabetta Uslenghi
- Dipartimento di Diagnostica per Immagini e U.O. di Radiologia MultiMedica IRCCS, 20123 Milan, Italy.
| | - Maurizio Zompatori
- Dipartimento di Diagnostica per Immagini e U.O. di Radiologia MultiMedica IRCCS, 20123 Milan, Italy.
- Dipartimento Universitario DIMES, Università di Bologna, 40126 Bologna, Italy.
| | - Antonella Caminati
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria-Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, via San Vittore 12, 20123 Milan, Italy.
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