Transbronchial Lung Cryobiopsy is Safe and Effective for Diagnosing Acutely Ill Hospitalized Patients with New Diffuse Parenchymal Lung Disease

Introduction Transbronchial lung cryobiopsy (TBLC) is an accepted alternative to surgical lung biopsy (SLB) for diagnosing diffuse parenchymal lung disease (DPLD) that is less invasive and results in comparable diagnostic yields. Performing lung biopsies on hospitalized patients, however, has increa...

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Veröffentlicht in:Lung 2022-04, Vol.200 (2), p.153-159
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description Introduction Transbronchial lung cryobiopsy (TBLC) is an accepted alternative to surgical lung biopsy (SLB) for diagnosing diffuse parenchymal lung disease (DPLD) that is less invasive and results in comparable diagnostic yields. Performing lung biopsies on hospitalized patients, however, has increased risk due to the patient’s underlying disease severity. Data evaluating the safety and efficacy of TBLC in hospitalized patients are limited. We present a comparison of TBLC for hospitalized and outpatients and provide the safety and diagnostic yields in these populations. Methods Demographic data, pulmonary function values, chest imaging pattern, procedural information, and diagnosis were recorded from enrolled patients. Complications from the procedure were the primary outcomes and diagnostic yield was the secondary outcome. Results 77 patients ( n  = 22 hospitalized vs n  = 55 outpatient) underwent TBLC during the study period. Comparing adverse events between hospitalized and outpatients revealed no statistically significant differences in pneumothorax (9%, n  = 2 vs 5%, n  = 3), tube thoracostomy placement (5%, n  = 1 vs 2%, n  = 1), grade 2 bleeding (9%, n  = 2 vs 0%, n  = 0), escalation in level of care (5%, n  = 1 vs 0%, n  = 0), 30-day mortality (9%, n  = 2 vs 2%, n  = 1), and 60-day mortality (9%, n  = 2 vs 4%, n  = 2) ( p  > 0.05 for all). No deaths were attributed to the procedure. 95% of cases received a multidisciplinary conference diagnosis (hospitalized 100%, n  = 22 vs outpatients 93%, n  = 51, p  = 0.32). Conclusion Our experience supports that TBLC may be a safe and effective modality for acutely ill-hospitalized patients with DPLD. Further efforts to enhance procedural safety and to determine the impact of an expedited tissue diagnosis on patient outcomes are needed.
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Performing lung biopsies on hospitalized patients, however, has increased risk due to the patient’s underlying disease severity. Data evaluating the safety and efficacy of TBLC in hospitalized patients are limited. We present a comparison of TBLC for hospitalized and outpatients and provide the safety and diagnostic yields in these populations. Methods Demographic data, pulmonary function values, chest imaging pattern, procedural information, and diagnosis were recorded from enrolled patients. Complications from the procedure were the primary outcomes and diagnostic yield was the secondary outcome. Results 77 patients ( n  = 22 hospitalized vs n  = 55 outpatient) underwent TBLC during the study period. Comparing adverse events between hospitalized and outpatients revealed no statistically significant differences in pneumothorax (9%, n  = 2 vs 5%, n  = 3), tube thoracostomy placement (5%, n  = 1 vs 2%, n  = 1), grade 2 bleeding (9%, n  = 2 vs 0%, n  = 0), escalation in level of care (5%, n  = 1 vs 0%, n  = 0), 30-day mortality (9%, n  = 2 vs 2%, n  = 1), and 60-day mortality (9%, n  = 2 vs 4%, n  = 2) ( p  &gt; 0.05 for all). No deaths were attributed to the procedure. 95% of cases received a multidisciplinary conference diagnosis (hospitalized 100%, n  = 22 vs outpatients 93%, n  = 51, p  = 0.32). Conclusion Our experience supports that TBLC may be a safe and effective modality for acutely ill-hospitalized patients with DPLD. Further efforts to enhance procedural safety and to determine the impact of an expedited tissue diagnosis on patient outcomes are needed.</description><identifier>ISSN: 0341-2040</identifier><identifier>EISSN: 1432-1750</identifier><identifier>DOI: 10.1007/s00408-022-00513-6</identifier><identifier>PMID: 35103841</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Biopsy ; Biopsy - adverse effects ; Biopsy - methods ; Bronchoscopy - adverse effects ; Bronchoscopy - methods ; Comparative analysis ; Complications ; Diagnosis ; Diagnostic systems ; Health aspects ; Hospital patients ; Hospitalization ; Humans ; Interventional Pulmonology ; Lung - diagnostic imaging ; Lung - pathology ; Lung diseases ; Lung Diseases, Interstitial - etiology ; Medical diagnosis ; Medicine ; Medicine &amp; Public Health ; Mortality ; Patients ; Pneumology/Respiratory System ; Pneumothorax ; Pneumothorax - etiology ; Pulmonary functions ; Respiratory function ; Safety ; Statistical analysis</subject><ispartof>Lung, 2022-04, Vol.200 (2), p.153-159</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022</rights><rights>2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>COPYRIGHT 2022 Springer</rights><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c610t-9cf096b0349e5b03912c162e64834e86734132378c0b9f6d7aa11b1620e84e9b3</citedby><cites>FETCH-LOGICAL-c610t-9cf096b0349e5b03912c162e64834e86734132378c0b9f6d7aa11b1620e84e9b3</cites><orcidid>0000-0002-1136-8287</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00408-022-00513-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00408-022-00513-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35103841$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Castellani, Carson</creatorcontrib><creatorcontrib>Castellani, Henry</creatorcontrib><creatorcontrib>Benn, Bryan S.</creatorcontrib><title>Transbronchial Lung Cryobiopsy is Safe and Effective for Diagnosing Acutely Ill Hospitalized Patients with New Diffuse Parenchymal Lung Disease</title><title>Lung</title><addtitle>Lung</addtitle><addtitle>Lung</addtitle><description>Introduction Transbronchial lung cryobiopsy (TBLC) is an accepted alternative to surgical lung biopsy (SLB) for diagnosing diffuse parenchymal lung disease (DPLD) that is less invasive and results in comparable diagnostic yields. Performing lung biopsies on hospitalized patients, however, has increased risk due to the patient’s underlying disease severity. Data evaluating the safety and efficacy of TBLC in hospitalized patients are limited. We present a comparison of TBLC for hospitalized and outpatients and provide the safety and diagnostic yields in these populations. Methods Demographic data, pulmonary function values, chest imaging pattern, procedural information, and diagnosis were recorded from enrolled patients. Complications from the procedure were the primary outcomes and diagnostic yield was the secondary outcome. Results 77 patients ( n  = 22 hospitalized vs n  = 55 outpatient) underwent TBLC during the study period. Comparing adverse events between hospitalized and outpatients revealed no statistically significant differences in pneumothorax (9%, n  = 2 vs 5%, n  = 3), tube thoracostomy placement (5%, n  = 1 vs 2%, n  = 1), grade 2 bleeding (9%, n  = 2 vs 0%, n  = 0), escalation in level of care (5%, n  = 1 vs 0%, n  = 0), 30-day mortality (9%, n  = 2 vs 2%, n  = 1), and 60-day mortality (9%, n  = 2 vs 4%, n  = 2) ( p  &gt; 0.05 for all). No deaths were attributed to the procedure. 95% of cases received a multidisciplinary conference diagnosis (hospitalized 100%, n  = 22 vs outpatients 93%, n  = 51, p  = 0.32). Conclusion Our experience supports that TBLC may be a safe and effective modality for acutely ill-hospitalized patients with DPLD. 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Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Lung</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Castellani, Carson</au><au>Castellani, Henry</au><au>Benn, Bryan S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transbronchial Lung Cryobiopsy is Safe and Effective for Diagnosing Acutely Ill Hospitalized Patients with New Diffuse Parenchymal Lung Disease</atitle><jtitle>Lung</jtitle><stitle>Lung</stitle><addtitle>Lung</addtitle><date>2022-04-01</date><risdate>2022</risdate><volume>200</volume><issue>2</issue><spage>153</spage><epage>159</epage><pages>153-159</pages><issn>0341-2040</issn><eissn>1432-1750</eissn><abstract>Introduction Transbronchial lung cryobiopsy (TBLC) is an accepted alternative to surgical lung biopsy (SLB) for diagnosing diffuse parenchymal lung disease (DPLD) that is less invasive and results in comparable diagnostic yields. Performing lung biopsies on hospitalized patients, however, has increased risk due to the patient’s underlying disease severity. Data evaluating the safety and efficacy of TBLC in hospitalized patients are limited. We present a comparison of TBLC for hospitalized and outpatients and provide the safety and diagnostic yields in these populations. Methods Demographic data, pulmonary function values, chest imaging pattern, procedural information, and diagnosis were recorded from enrolled patients. Complications from the procedure were the primary outcomes and diagnostic yield was the secondary outcome. Results 77 patients ( n  = 22 hospitalized vs n  = 55 outpatient) underwent TBLC during the study period. Comparing adverse events between hospitalized and outpatients revealed no statistically significant differences in pneumothorax (9%, n  = 2 vs 5%, n  = 3), tube thoracostomy placement (5%, n  = 1 vs 2%, n  = 1), grade 2 bleeding (9%, n  = 2 vs 0%, n  = 0), escalation in level of care (5%, n  = 1 vs 0%, n  = 0), 30-day mortality (9%, n  = 2 vs 2%, n  = 1), and 60-day mortality (9%, n  = 2 vs 4%, n  = 2) ( p  &gt; 0.05 for all). No deaths were attributed to the procedure. 95% of cases received a multidisciplinary conference diagnosis (hospitalized 100%, n  = 22 vs outpatients 93%, n  = 51, p  = 0.32). Conclusion Our experience supports that TBLC may be a safe and effective modality for acutely ill-hospitalized patients with DPLD. Further efforts to enhance procedural safety and to determine the impact of an expedited tissue diagnosis on patient outcomes are needed.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>35103841</pmid><doi>10.1007/s00408-022-00513-6</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-1136-8287</orcidid><oa>free_for_read</oa></addata></record>
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subjects Biopsy
Biopsy - adverse effects
Biopsy - methods
Bronchoscopy - adverse effects
Bronchoscopy - methods
Comparative analysis
Complications
Diagnosis
Diagnostic systems
Health aspects
Hospital patients
Hospitalization
Humans
Interventional Pulmonology
Lung - diagnostic imaging
Lung - pathology
Lung diseases
Lung Diseases, Interstitial - etiology
Medical diagnosis
Medicine
Medicine & Public Health
Mortality
Patients
Pneumology/Respiratory System
Pneumothorax
Pneumothorax - etiology
Pulmonary functions
Respiratory function
Safety
Statistical analysis
title Transbronchial Lung Cryobiopsy is Safe and Effective for Diagnosing Acutely Ill Hospitalized Patients with New Diffuse Parenchymal Lung Disease
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