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Pulmonology Procedures |

A Comparison of Forceps Versus Cryoprobe Biopsy in Lung Transplant Surveillance

Jason Akulian*, MD; Christopher Gilbert, DO; Jonathan Orens, MD; Christian Merlo, MD; David Feller-Kopman, MD; Lonny Yarmus, DO
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Johns Hopkins University, Baltimore, MD


Chest. 2012;142(4_MeetingAbstracts):903A. doi:10.1378/chest.1388487
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Abstract

SESSION TYPE: Diagnostic Bronchoscopy

PRESENTED ON: Tuesday, October 23, 2012 at 04:30 PM - 05:45 PM

PURPOSE: Obtaining sufficient tissue during post-lung transplant surveillance is important as the diagnosis of acute cellular rejection, lymphocytic bronchiolitis and infection directly impact therapy. Transbronchial biopsies (TBBx) using standard biopsy forceps suffer from crush artifact and small size. Recent studies have shown superior sample size and architectural preservation when comparing cyroprobe biopsies (CB) to standard forceps (FB). There have been no studies assessing the use of CB in the LT population. We present the results from the first 10 patients enrolled in an IRB approved study comparing CB to FB TBBx in patients undergoing surveillance biopsies after lung transplantation.

METHODS: Patients undergoing routine surveillance bronchoscopy were sequentially enrolled between October 2011 and February 2012. All patients underwent 10 FB followed by 5 CB positioned under fluoroscopic guidance using a flexible bronchoscope inserted through the rigid bronchoscope. Procedures were conducted in a surgical suite using rigid bronchoscopy and jet ventilation with a deflated bronchial blocker in place for safety. All samples were fixed in formaldehyde and transported to pathology. During and after the procedure patients were monitored for complications including pneumothorax, hemodynamic instability or respiratory compromise. Bleeding was categorized on an adapted grading system.

RESULTS: Ten patients, (57 years, 5 females). Mean specimen areas were 12.9 ± 4.8 mm2 for FB and 57.9 ± 11.3 mm2 for CB (p=0.002). 0/10 patients showed pathology on FB and 1/10 patients showed acute cellular rejection on CB. No episodes of hemodynamic or respiratory instability occurred and all patients were discharged the day of the procedure. One delayed pneumothorax was noted (pleura not seen on either biopsy) and one CB patient had a bleeding grade >1.

CONCLUSIONS: CB showed superior sample size, architectural preservation and potentially improved diagnostic yield when compared to FB for post-lung transplant surveillance.

CLINICAL IMPLICATIONS: The use of cryoprobes is a safe and potentially exciting alternative technique to increase diagnostic yield in TBBx during post-lung transplant surveillance bronchoscopy.

DISCLOSURE: The following authors have nothing to disclose: Jason Akulian, Christopher Gilbert, Jonathan Orens, Christian Merlo, David Feller-Kopman, Lonny Yarmus

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Johns Hopkins University, Baltimore, MD

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