Three-Dimensional Fluoroscopic Guidance During Transbronchial Cryobiopsy

PRIMARY OBJECTIVE:

I. To determine if transbronchial cryobiopsy guided by three-dimensional fluoroscopy reduces the incidence of pneumothorax up to 72 hours after transbronchial cryobiopsy.

SECONDARY OBJECTIVE:

I. To describe outcomes of cryobiopsy, need for interventions related to transbronchial cryobiopsy, radiation dose, and any complications or adverse events after transbronchial cryobiopsy guided by three-dimensional fluoroscopy.

OUTLINE:

Patients undergo transbronchial cryobiopsy guided by three-dimensional fluoroscopy. Patients' medical records are also reviewed.

Inclusion criteria

• Age 18 years or older
• Presence of an intraparenchymal lung lesion for which cryobiopsy is deemed the most appropriate method of biopsy
• Ability to provide informed consent

Exclusion criteria

• Acute respiratory failure (defined as oxygen requirement > 4 L/min by nasal cannula above baseline, or need for any intervention to support ventilation and/or gas exchange for any duration, including invasive and non-invasive positive pressure ventilation, high-flow therapy, non-rebreather mask, or Venturi mask)
• Intensive care unit (ICU) admission
• Forced vital capacity (FVC) < 50% or diffusing capacity of the lung for carbon monoxide (CO) (DLCO) < 35% (if pulmonary function tests are available)
• Known or suspected pulmonary hypertension (defined as elevated right ventricular systolic pressure on echocardiogram, if available)
• Acute renal failure or chronic kidney disease
• Platelets < 100,000/uL
• International normalized ratio (INR) > 1.5
• Use of anticoagulant therapy that cannot be held for 2 days
• Use of antiplatelet therapy (other than baby aspirin) that cannot be held for 5 days
• Any bleeding diathesis
• Pregnancy