Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/35466
Title: A systematic review of procedural and sampling techniques for cryobiopsy in interstitial lung disease.
Austin Authors: Lachowicz, Julia A;Smallwood, Natasha E;Prasad, Jyotika D;Patel, Purab;Voutier, Catherine;Khor, Yet H ;Steinfort, Daniel P
Affiliation: Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia.;Faculty of Medicine, University of Melbourne, Melbourne, Australia.
Department of Respiratory Medicine, The Alfred, Melbourne, Australia.;Faculty of Medicine, Monash University, Melbourne, Australia.
Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia.;Faculty of Medicine, Monash University, Melbourne, Australia.;Department of Respiratory Medicine and Lung Transplant Unit, The Alfred, Melbourne, Australia.;University of Melbourne, Melbourne, Australia.
Nova Southeastern University, Fort Lauderdale, FL, USA.
Health Sciences Library, Royal Melbourne Hospital, Melbourne, Australia.
Respiratory and Sleep Medicine
Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia.;Faculty of Medicine, University of Melbourne, Melbourne, Australia.
Institute for Breathing and Sleep
Issue Date: Jul-2024
Date: 2024
Publication information: European Respiratory Review : an Official Journal of the European Respiratory Society 2024-07; 33(173)
Abstract: Transbronchial lung cryobiopsy (TBLC) is an alternative to surgical lung biopsy for histopathological evaluation of unclassifiable interstitial lung disease (ILD) or ILD diagnosed with low confidence. This meta-analysis synthesised current literature regarding cryobiopsy diagnostic performance and safety, focusing on procedural and sampling techniques. Medline and Embase were searched on 11 April 2022. Studies included adults with unclassifiable ILD, reporting diagnostic yield, complications and methodological techniques of TBLC. Meta-analyses were performed for diagnostic yield, pneumothorax and bleeding. Subgroup analyses and meta-regression assessed methodological variables. PROSPERO registration: CRD42022312386. 70 studies were included with 6183 participants. Diagnostic yield of TBLC was 81% (95% CI 79-83%, I2=97%), with better yield being observed with general anaesthesia (p=0.007), ILD multidisciplinary meeting prior to cryobiopsy (p=0.02), 2.4 mm cryoprobe (p=0.04), higher mean forced vital capacity (p=0.046) and higher mean diffusing capacity for carbon monoxide (p=0.023). Pneumothorax rate was 5% (95% CI 4-5%, I2=91%), with higher rates associated with a 2.4 mm cryoprobe (p<0.00001), routine post-procedure imaging (p<0.00001), multiple lobe sampling (p<0.0001), reduced mean diffusing capacity for carbon monoxide (p=0.028) and general anaesthesia (p=0.05). Moderate-to-severe bleeding rate was 12% (11-14%, I2=95%) and higher rates were associated with a 2.4 mm cryoprobe (p=0.001) and bleeding score selection (p=0.04). Patient characteristics and modifiable factors, including procedural methods and anaesthetic techniques, impacted diagnostic yield and safety outcomes of TBLC in people with unclassifiable ILD and contributed to heterogeneity of clinical outcomes. These variables should be considered for individualised clinical decision making and guideline development and warrant routine reporting in future research.
URI: https://ahro.austin.org.au/austinjspui/handle/1/35466
DOI: 10.1183/16000617.0035-2024
ORCID: 0000-0002-4854-108X
0000-0002-5434-9342
0000-0002-8998-2949
Journal: European Respiratory Review : an Official Journal of the European Respiratory Society
PubMed URL: 39142710
ISSN: 1600-0617
Type: Journal Article
Subjects: Lung Diseases, Interstitial/pathology
Lung Diseases, Interstitial/diagnosis
Biopsy/adverse effects
Biopsy/methods
Cryosurgery/adverse effects
Cryosurgery/methods
Lung/pathology
Bronchoscopy/adverse effects
Bronchoscopy/methods
Bronchoscopy/instrumentation
Pneumothorax/etiology
Appears in Collections:Journal articles

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