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GENERAL PERSPECTIVE
Year : 2019  |  Volume : 36  |  Issue : 1  |  Page : 48-59

Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement


1 Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Respiratory Medicine, Jaipur Golden Hospital and Rajiv Gandhi Cancer Institute, New Delhi, India
3 Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
4 Department of Respiratory Medicine, Bombay Hospital and Fortis Hiranandani Hospital, Mumbai, India
5 Department of Respiratory Medicine, Nanavati Super Speciality Hospital, Mumbai, India
6 Department of Respiratory Medicine, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
7 Department of Chest Diseases, SMS Medical College, Jaipur, Rajasthan, India
8 Department of Respiratory Medicine, Century Hospital, Hyderabad, Telangana, India
9 Department of Respiratory Medicine, Royal Care Hospital, Coimbatore, India
10 Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
11 Department of Respiratory Medicine, Indraprastha Apollo Hospital, New Delhi, India
12 India and Lung Care and Sleep Centre, Institute of Pulmonology, Medical Research and Development, Mumbai, India
13 Department of Respiratory Medicine, Sir Ganga Ram Hospital, New Delhi, India
14 Department of Respiratory Medicine, Fortis Hospital Anandapur, Kolkata, West Bengal, India
15 Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
16 Department of Respiratory Medicine, Maharaja Agrasen Hospital, New Delhi, India
17 Department of Respiratory, Medicine, Narayana Health City, Bengaluru, Karnataka, India
18 Department of Pulmonary Medicine, Christian Medical College, Vellore, India
19 Department of Respiratory Medicine, Jindal Chest Clinic, Chandigarh, India
20 Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
21 Department of Respiratory Medicine, Max Hospital, New Delhi, India
22 Department of Internal and Pulmonary Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
23 Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, New Delhi, India
24 Fortis Hospital, Mohali, Punjab, India
25 Department of Respiratory Medicine, Apollo Hospital, Bengaluru, Karnataka, India
26 Department of Respiratory Medicine, Fortis Hospital, New Delhi, India
27 Department of Respiratory Medicine, BLK Super Speciality Hospital, New Delhi, India
28 Department of Respiratory Medicine, City Clinic and Bhailal Amin General Hospital, Vadodara, Gujarat, India
29 Department of Respiratory Medicine, Apollo Hospital, Chennai, Tamil Nadu, India
30 Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, United States of America
31 Department of Respiratory Medicine, Asthma Bhawan, Jaipur, Rajasthan, India
32 Department of Respiratory Medicine, Getwell Hospital and Research Institute, Nagpur, Maharashtra, India
33 Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh, India

Correspondence Address:
Dr. Ritesh Agarwal
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/lungindia.lungindia_75_18

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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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