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:10.4103/lungindia.lungindia_75_18

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 GopalKedar 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

Research output: Contribution to journal › Article › peer-review

26 Scopus citations

Abstract

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.

Original language	English
Pages (from-to)	48-59
Number of pages	12
Journal	Lung India
Volume	36
Issue number	1
DOIs	https://doi.org/10.4103/lungindia.lungindia_75_18
State	Published - 1 Jan 2019
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2019 Wolters Kluwer Medknow Publications. All rights reserved.

Funding

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

Funders	Funder number
City Clinic
Medical Research and Development
City, University of London
Baylor College of Medicine
Juvenile Diabetes Research Foundation United States of America
Strategic Management Society
All-India Institute of Medical Sciences
Jawaharlal Institute of Postgraduate Medical Education and Research

Keywords

Bronchoscopy
hypersensitivity pneumonitis
idiopathic pulmonary fibrosis
interstitial lung disease
interventional pulmonology
lung biopsy
sarcoidosis
video-assisted thoracoscopic surgery

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10.4103/lungindia.lungindia_75_18

Cite this

Dhooria, S., Agarwal, R., Sehgal, I. S., Aggarwal, A. N., Goyal, R., Guleria, R., Singhal, P., Shah, S. P., Gupta, K. B., Koolwal, S., Akkaraju, J., Annapoorni, S., Bal, A., Bansal, A., Behera, D., Chhajed, P. N., Dhamija, A., Dhar, R., Garg, M., ... Thangakunam, B. (2019). Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement. Lung India, 36(1), 48-59. https://doi.org/10.4103/lungindia.lungindia_75_18

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title = "Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement",

abstract = "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.",

keywords = "Bronchoscopy, hypersensitivity pneumonitis, idiopathic pulmonary fibrosis, interstitial lung disease, interventional pulmonology, lung biopsy, sarcoidosis, video-assisted thoracoscopic surgery",

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

year = "2019",

month = jan,

day = "1",

doi = "10.4103/lungindia.lungindia_75_18",

language = "אנגלית",

volume = "36",

pages = "48--59",

journal = "Lung India",

issn = "0970-2113",

publisher = "Wolters Kluwer Medknow Publications",

number = "1",

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Dhooria, S, Agarwal, R, Sehgal, IS, Aggarwal, AN, Goyal, R, Guleria, R, Singhal, P, Shah, SP, Gupta, KB, Koolwal, S, Akkaraju, J, Annapoorni, S, Bal, A, Bansal, A, Behera, D, Chhajed, PN, Dhamija, A, Dhar, R, Garg, M, Gopal, B, Hibare, KR, James, P, Jindal, A, Jindal, SK, Khan, A, Kishore, N, Koul, PA, Kumar, A, Kumar, R, Lall, A, Madan, K, Mandal, A, Mehta, RM, Mohan, A, Nangia, V, Nath, A, Nayar, S, Patel, D, Pattabhiraman, V, Raghupati, N, Sarkar, PK, Singh, V, Sivaramakrishnan, M, Srinivasan, A, Swarnakar, R, Talwar, D & Thangakunam, B 2019, 'Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement', Lung India, vol. 36, no. 1, pp. 48-59. https://doi.org/10.4103/lungindia.lungindia_75_18

TY - JOUR

T1 - Bronchoscopic lung cryobiopsy

T2 - An Indian association for bronchology position statement

AU - Dhooria, Sahajal

AU - Agarwal, Ritesh

AU - Sehgal, Inderpaul Singh

AU - Aggarwal, Ashutosh Nath

AU - Goyal, Rajiv

AU - Guleria, Randeep

AU - Singhal, Pratibha

AU - Shah, Shirish P.

AU - Gupta, Krishna B.

AU - Koolwal, Suresh

AU - Akkaraju, Jayachandra

AU - Annapoorni, Shankar

AU - Bal, Amanjit

AU - Bansal, Avdhesh

AU - Behera, Digambar

AU - Chhajed, Prashant N.

AU - Dhamija, Amit

AU - Dhar, Raja

AU - Garg, Mandeep

AU - Gopal, Bharat

AU - Hibare, Kedar R.

AU - James, Prince

AU - Jindal, Aditya

AU - Jindal, Surinder K.

AU - Khan, Ajmal

AU - Kishore, Nevin

AU - Koul, Parvaiz A.

AU - Kumar, Arvind

AU - Kumar, Raj

AU - Lall, Ajay

AU - Madan, Karan

AU - Mandal, Amit

AU - Mehta, Ravindra M.

AU - Mohan, Anant

AU - Nangia, Vivek

AU - Nath, Alok

AU - Nayar, Sandeep

AU - Patel, Dharmesh

AU - Pattabhiraman, Vallandaramam

AU - Raghupati, Narasimhan

AU - Sarkar, Pralay K.

AU - Singh, Virendra

AU - Sivaramakrishnan, Mahadevan

AU - Srinivasan, Arjun

AU - Swarnakar, Rajesh

AU - Talwar, Deepak

AU - Thangakunam, Balamugesh

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Bronchoscopy

KW - hypersensitivity pneumonitis

KW - idiopathic pulmonary fibrosis

KW - interstitial lung disease

KW - interventional pulmonology

KW - lung biopsy

KW - sarcoidosis

KW - video-assisted thoracoscopic surgery

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ER -

Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement

Abstract

Bibliographical note

Funding

Keywords

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