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Optimize Initial Freezing Time of Transbronchial Cryobiopsy for the Diagnosis of Interstitial Lung Disease: A
Xiaobo Chen1, Yongshun Ye2, Qian Han3
1State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China, xiaobo-win@163.com.
Insights
Transbronchial cryobiopsy (TBCB) for interstitial lung disease (ILD) diagnosis yields larger specimens with longer freezing times. A 4-second freezing time is recommended for optimal diagnostic yield and safety.
Area of Science:
- Pulmonology
- Interventional Pulmonology
- Diagnostic Procedures
Background:
- Transbronchial cryobiopsy (TBCB) is an emerging diagnostic tool for interstitial lung disease (ILD).
- Specimen size in TBCB correlates with freezing time, but optimal parameters for ILD diagnosis are not established.
Purpose of the Study:
- To determine the optimal initial freezing time for TBCB in ILD diagnosis.
- To evaluate the impact of freezing time on specimen size, diagnostic yield, and complications.
Main Methods:
- Prospective randomized study of 100 ILD patients requiring TBCB.
- Patients were assigned to TBCB groups with freezing times of 3s, 4s, 5s, or 6s.
- Operations used a 1.9-mm cryoprobe with 60-65 bar freezing gas pressure.
Main Results:
- Specimen size positively correlated with freezing time (r=0.639, p<0.05).
- Multidisciplinary discussion diagnostic yields were 64% (3s), 88% (4s), 88% (5s), and 96% (6s) (p<0.05).
- No Grade 3 bleeding occurred; pneumothorax occurred in one patient in the 4s, 5s, and 6s groups.
Conclusions:
- Increasing TBCB freezing time enhances specimen size and diagnostic efficiency in ILD.
- A 4-second freezing time is recommended for TBCB in ILD, balancing diagnostic yield and safety.
- This initial freezing time is associated with high diagnostic efficiency and low complication rates.
Background:
Transbronchial cryobiopsy (TBCB) is increasingly being identified as a potential alternative for the diagnosis of interstitial lung disease (ILD). The specimen size of TBCB is positively related to the freezing time. However, the proper initial freezing time for the clinical application of TBCB in ILD remains unknown.
Methods:
A prospective randomized parallel group study was employed to investigate ILD patients with unclear diagnosis, who were admitted to the First Affiliated Hospital of Guangzhou Medical University from May 2019 to October 2020 and required TBCB. All patients were randomly divided into 4 groups according to the different freezing times of TBCB: 3 s, 4 s, 5 s, and 6 s groups. All operations were performed under intravenous anesthesia with endotracheal intubation, 60-65 bar pressure of freezing gas source, and 1.9-mm cryoprobe. Compare differences among groups in specimen size, complications, pathological diagnosis efficiency, and multidisciplinary discussion (MDD) diagnostic efficiency.
Results:
A total of 100 patients were recruited and randomly assigned into 4 groups (n = 25 each group). The specimen sizes of TBCB in ILD were positively correlated with the freezing time (r = 0.639, p < 0.05). None of the patients experienced Grade 3 severe bleeding. Pneumothorax occurred in 1 patient in the 4 s, 5 s, and 6 s groups, respectively. The diagnostic yield of MDD in the 3 s, 4 s, 5 s, and 6 s groups were 64%, 88%, 88%, and 96%, respectively (p < 0.05), but showing no significant differences among 4 s, 5 s, and 6 s groups.
Conclusions:
The specimen size and diagnostic efficiency of TBCB in ILD increased with a longer freezing time. When the freezing gas pressure is 60-65 bar, we recommended 4 s as the initial freezing time of TBCB, and this time is associated with high diagnostic efficiency and low incidence of complications.
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