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