title: High Complication Rate after Introduction of Transbronchial Cryobiopsy into Clinical Practice at an Academic Medical Center.
abstract: BACKGROUND
  Transbronchial cryobiopsy is an emerging technique for obtaining biopsies of lung parenchyma. Despite limited evidence of its safety and efficacy in direct comparison with other available biopsy procedures, pulmonologists are integrating this technique into clinical practice with the hope of avoiding the risks of surgical lung biopsy.
  
  
  OBJECTIVE
  To report the rate of severe complications and diagnostic outcomes immediately after introduction of transbronchial cryobiopsy into the clinical practice of a single-center, high-volume, interventional pulmonary group at a large academic medical center in the United States.
  
  
  METHODS
  We conducted a retrospective review of a case series.
  
  
  RESULTS
  Twenty-five consecutive patients underwent transbronchial cryobiopsy for a variety of indications over a period of 14 weeks. In the absence of a strict protocol, a variety of techniques were employed by four attending interventional pulmonologists and one advanced interventional pulmonology fellow to plan and complete the procedures. Three patients (12%) experienced serious hemorrhage immediately after biopsy, including one patient who survived a life-threatening bleed. Two procedures were complicated by an iatrogenic pneumothorax. One patient experienced hypercapnic respiratory failure shortly after the procedure. A definitive diagnosis was made with 14 cryobiopsies (56%). Another five biopsies (20%) contributed to a presumptive diagnosis achieved by multidisciplinary consensus.
  
  
  CONCLUSIONS
  Transbronchial cryobiopsy may have diagnostic and safety limitations that are not yet well appreciated, given the state of the published medical literature. Major questions remain regarding the safest procedural protocol to be used when performing transbronchial cryobiopsy. Thorough planning and a high degree of caution are encouraged on first introduction of this technique into a clinical practice.
authors.affiliation: 1 Division of Pulmonary, Allergy and Critical Care and.
authors.forename: David M
authors.initials: DM
authors.lastname: DiBardino
authors.affiliation: 1 Division of Pulmonary, Allergy and Critical Care and.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Haas
authors.affiliation: 1 Division of Pulmonary, Allergy and Critical Care and.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Lanfranco
authors.affiliation: 2 Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Litzky
authors.affiliation: 3 Division of Pulmonary, Critical Care and Sleep Medicine, New York University, New York, New York.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sterman
authors.affiliation: 3 Division of Pulmonary, Critical Care and Sleep Medicine, New York University, New York, New York.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Bessich
mesh_terms: D000046:Academic Medical Centers; D001706:Biopsy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D001999:Bronchoscopy / Q000009:adverse effects; D003452:Cryosurgery / Q000009:adverse effects* / Q000379:methods; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007049:Iatrogenic Disease; D008168:Lung / Q000473:pathology*; D010414:Pennsylvania; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000209:etiology*; D013902:Radiography, Thoracic; D012189:Retrospective Studies
keywords: biopsy; bronchoscopy; cryosurgery; cryotherapy