Complication and cost analysis of transbronchial lung cryobiopsy and awake video-assisted thoracic surgery in diagnosis of interstitial lung disease Cryobiopsy in diagnosis of interstitial lung disease

Main Article Content

Nuran Katgı
Pınar Çimen
Ali Kadri Çırak
Tarık Şimşek
Kenan Can Ceylan
Özgür Samancılar
Elif Duman
Onur Fevzi Erer
Fatma Fevziye Tuksavul

Keywords

Interstitial lung disease, , transbronchial lung cryobiopsy, awake video-assisted thoracic surgery, complication, cost

Abstract

Aim and introduction: Diagnosis of Interstitial Lung Disease (ILD) is difficult and costly. The standard diagnostical approaches to ILD are bronchoalveolar lavage, transbronchial lung biopsy, transbronchial lung cryobiopsy (TBLC) and surgical lung biopsy (SLB). SLB is the gold standard for diagnosis of ILD. We conducted a retrospective study to point out that TBLC plays an important role in diagnosis of ILD and has fewer complications and lower cost than awake video-assisted thoracic surgery (AVATS).


Material and methods: 132 patients who underwent TBLC and AVATS with a pre-diagnosis of ILD in our hospital between 2015 and 2020 were evaluated retrospectively. Diagnosis rates, complications and costs were recorded.


 


            Cryobiopsy in diagnosis of interstitial lung disease


 


Results: There were no non-diagnostic materials in 44 patients in AVATS arm.  Prolonged air leak was observed in 11(25.0%) of the patients, and six of them (13.6%) were discharged with Heimlich Valve (HV). Median length of stay in the hospital was 8 days, while average patient cost was $515.9 (415.2-2662.9) in the AVATS arm.


Non-diagnostic material was obtained from 6 (6.8%) of 88 patients in TBLC arm. Six of them (6.8%) had pneumothorax, only one of them required a chest tube. No patient was discharged with HV (p=0.001).  Median cost for each patient with a median hospital stay of  2.0 (1.0-21.0) (p<0.001) days was $171.9 (80.8-1493.3) (p<0.001).


Discussion: Nowadays TBLC plays an important role in diagnosis of ILD and prevents SLB because of its higher diagnostic value compared to other non-surgical methods, and lower complications and cost compared to AVATS.

Downloads

Download data is not yet available.
Abstract 256 | PDF Downloads 185

References

1. Raghu G, Remy-Jardin M, Myers JL, et al. Diagnosis of idiopathic pulmonary fibrosis an official ATS/ERS/JRS/ALAT clinical practice guideline. American Journal of Respiratory and Critical Care Medicine Volume 2018; 198(5): e44-68, doi: : 10.1164/rccm.201807-1255ST.

2. Romagnoli M, Colby TV, Berthet JP, et al. Poor concordance between sequential transbronchial lung cryobiopsy and surgical lung biopsy in the diagnosis of diffuse interstitial lung diseases. American Journal of Respiratory and Critical Care Medicine 2019; 199(10) 1249–1256, doi: 10.1164/rccm.201810-1947OC.

3. Lentz RJ, Argento AC, Colby TV, Rickman OB, Maldonado F. Transbronchial cryobiopsy for diffuse parenchymal lung disease: A state-of-the-art review of procedural techniques, current evidence, and future
challenges. Journal of Thoracic Disease 2017; 9(7):2186-2203, doi: 10.21037/jtd.2017.06.96.

4. Lodhi T, Hughes G, Stanel S, Chaudhuri N, Hayton C. Transbronchial lung cryobiopsy in idiopathic pulmonary fibrosis: A state of the art review. Advanced in Therapeutics 2019; 36:2193–2204, doi: 10.1007/s12325-019-01036-y.


5. Babiak A, Hetzel J, Krishna G, et al. Transbronchial cryobiopsy: a new tool for lung biopsies. Respiration 2009;78:203-8. doi: 10.1159/000203987.

6. Barisione E, Saio M, Romagnoli M, Pratico A, Bargagli E, Corbetta L. Competence in transbronchial cryobiopsy. Panminerva Medica 2019; 61(3):290-7, doi: 10.23736/S0031-0808.18.03567-X.


7. Çirak AK, Katgi N, Erer OF, Çimen P, Tuksavul F, Hakoğlu B. Diagnostic approach in parenchymal lung diseases: transbronchial lung biopsy or cryobiopsy?
Turkish Journal of Medical Sciences 2020; 50: 1535-1539, doi:10.3906/sag-1910-47.

8. Bango-Alvarez A, Ariza-Porta M, Torres-Rivas H, Fernandez LF, Prieto A, Sanchez I, et al. Transbronchial cryobiopsy in interstitial lung disease: experience in 106 cases - how to do it. European Respiratory Society Open Research 2017; 3(1): 00148-2016, doi: 10.1183/23120541.00148-2016.




9. Ganganah O, Guo SL, Chiniah M, Li YS. Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: A systematic review and meta-analysis. Asian Pacific Society of Respirology 2016, 21, 834–841, doi: 10.1111/resp.12770.

10. Troy LK, Grainge C, Corte T, et al. Cryobiopsy versus open lung biopsy in the diagnosis of interstitial lung disease (coldice): protocol of a multicentre study. BMJ Open Respiratory Research 2019, 6:e000443. doi:10.1136/ bmjresp-2019-000443.

11. Lan L, Cen Y, Zhang C, Çiu Y, Ouyang B. A propensity score-matched analysis for onintubated thoracic surgery. Medical Science Monitor 2018; 24: 8081-8087 doi: 10.12659/MSM.910605.
12. Moon EJ, Go YJ, Chung JY, Yi JW. Non-intubated thoracoscopic surgery for decortication of empyema under thoracic epidural anesthesia -a case report. Korean Journal of Anesthesiology 2017; 70(3): 341-344. doi: https://doi.org/10.4097/kjae.2017.70.3.341.

13. Passera E, Rocco G. Awake video-assisted thoracic surgery resection of lung nodules. Video-Assisted Thoracic Surgery 2018;3:3. doi: 10.21037/vats.2018.01.01.

14. Kocatürk C, Kutluk AC, Usluer O, et al. Comparison of awake and intubated video-assisted thoracoscopic surgery in the diagnosis of pleural diseases: A prospective multicenter randomized trial. Turkish Journal of Thoracic and Cardiovascular Surgery 2019;27(4):550-556. doi: 10.5606/tgkdc.dergisi.2019.18214.


15. Sugino K, Otsuka H, Matsumoto Y, et al. The role of video-assisted thoracoscopic surgery in the diagnosis of interstitial lung disease. Sarkoidosis Vasculitis and Diffuse Lung Diseases 2019; 36 (2); 148-156. doi: 10.36141/svdld.v36i2.7797.

16. Iftikhar IH, Alghothani L, Sardi A, Berkowitz D, Musani AI. Transbronchial Lung Cryobiopsy and video-assisted thoracoscopic lung biopsy in the diagnosis of diffuse parenchymal lung disease a meta-analysis of diagnostic test accuracy. Annals of the. American Thoracic Society 2017; 14(7):1197-1211. doi: : 10.1513/AnnalsATS.201701-086SR.

17. Pajares V, Puzo C, Castillo D, et al. Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: a randomized trial. Respirology 2014; 19: 900–906. doi: 10.1111/resp.12322.



18. Hetzel J, Eberhardt R, Herth FJF, et al. Cryobiopsy increases the diagnostic yield of endobronchial biopsy: a multicentre trial. European Respiratory Journal 2012; 39(3):685-90. doi: 10.1183/09031936.00033011.

19. Ravaglia C, Bonifazi M, Wells AU, et al. Safety and diagnostic yield of transbronchial lung cryobiopsy in diffuse parenchymal lung diseases: A comparative study versus video-assisted thoracoscopic lung biopsy and a systematic review of the literatüre. Respiration 2016;91:215–227. doi : 10.1159/000444089.



20. Hetzel J, Maldonado F, Ravaglia C, et al. Transbronchial cryobiopsies for the diagnosis of diffuse parenchymal lung diseases: Expert statement from the cryobiopsy working group on safety and utility and a call for standardization of the procedure. Respiration 2018;95:188-200. doi: 10.1159/000484055

21. Brunelli A, Xiume F, Refai MA, Salati M, Marasco R, Sabbatini A. Air leaks after lobectomy increase the risk of empyema but not of cardiopulmonary complications: a casematched analysis. Chest 2006;130:1150–1156. doi: 10.1378/chest.130.4.1150.

22. Varela G, Jiménez MF, Novoa N, Aranda JL. Estimating hospital costs attributable to prolonged air leak in pulmonary lobectomy. European Journal of Cardio-Thoracic Surgery 2005;27:329–333. doi: 10.1016/j.ejcts.2004.11.005.

23. Ochroch A, Barnett R. Synthetic Sealants for Preventing Air Leaks after Pulmonary Resection. Official Newsletter
of the Society of Cardiovascular Anesthesiologist, October 2002.

24. González FH, Lucena CM, Ramírez J, et al. Cryobiopsy in the diagnosis of diffuse interstitial lung disease: yield and cost-effectiveness analysis. Archivos Bronconeumol 2015;51:261-267 doi: 10.1016/j.arbres.2014.09.009.

25. Hagmeyer L, Theegarten D, Treml M, Priegnitz C, Randerath W. Validation of transbronchial cryobiopsy in interstitial lung disease - interim analysis of a prospective trial and critical review of the literatüre.Sarkoidosis Vasculitis and Diffuse Lung Diseases 2016; 33; 2-9.

Most read articles by the same author(s)

  • Olcay Aycicek, Erdogan Cetinkaya, Fatma Demirci Ucsular, Nazan Bayram, Abdurrahman Senyigit, Nimet Aksel, Nurhan Atilla, Nurhan Sarioglu, Elif Yelda Niksarlioglu, Ahmet Ilgazli, Talat Kilic, Hulya Gunbatar, Sule Cilekar, Aydanur Ekici, Sibel Arinc, Haci Ahmet Bircan, Dildar Duman, Ozlem Sengoren Dikis, Onur Yazıcı, Abdullah Kansu, Nuri Tutar, Emine Ozsari, Serdar Berk, Yelda Varol, Ahmet Emin Erbaycu, Bunyamin Sertogullarindan, Ali Kadri Cirak, Mustafa Cortuk, Gulistan Karadeniz, Alper Simsek, Cengizhan Sezgi, Fuat Erel, Tuba Ciftci, Aysel Sunnetcioglu, Mehmet Savas Ekici, Ersin Gunay, Meltem Agca, Onder Ozturk, Hamza Ogun, Elif Acar, Omer Tamer Dogan, Dursun Alizoroglu, Esma Gezer, Tevfik Ozlu, Research Burden of Interstitial Lung Diseases in Turkey – RBILD , Sarcoidosis, Vasculitis and Diffuse Lung Disease: Vol. 39 No. 1 (2022)