Lung India (Jan 2019)

Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement

  • Sahajal Dhooria,
  • Ritesh Agarwal,
  • Inderpaul Singh Sehgal,
  • Ashutosh Nath Aggarwal,
  • Rajiv Goyal,
  • Randeep Guleria,
  • Pratibha Singhal,
  • Shirish P Shah,
  • Krishna B Gupta,
  • Suresh Koolwal,
  • Jayachandra Akkaraju,
  • Shankar Annapoorni,
  • Amanjit Bal,
  • Avdhesh Bansal,
  • Digambar Behera,
  • Prashant N Chhajed,
  • Amit Dhamija,
  • Raja Dhar,
  • Mandeep Garg,
  • Bharat Gopal,
  • Kedar R Hibare,
  • Prince James,
  • Aditya Jindal,
  • Surinder K Jindal,
  • Ajmal Khan,
  • Nevin Kishore,
  • Parvaiz A Koul,
  • Arvind Kumar,
  • Raj Kumar,
  • Ajay Lall,
  • Karan Madan,
  • Amit Mandal,
  • Ravindra M Mehta,
  • Anant Mohan,
  • Vivek Nangia,
  • Alok Nath,
  • Sandeep Nayar,
  • Dharmesh Patel,
  • Vallandaramam Pattabhiraman,
  • Narasimhan Raghupati,
  • Pralay K Sarkar,
  • Virendra Singh,
  • Mahadevan Sivaramakrishnan,
  • Arjun Srinivasan,
  • Rajesh Swarnakar,
  • Deepak Talwar,
  • Balamugesh Thangakunam

DOI
https://doi.org/10.4103/lungindia.lungindia_75_18
Journal volume & issue
Vol. 36, no. 1
pp. 48 – 59

Abstract

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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.

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