Current practice of cryobiopsy procedures for the evaluation of interstitial lung disease
Transbronchial lung cryobiopsies (TBLC) was first introduced in 2009 in the diagnostic approach to interstitial lung diseases (ILD) and has recently been introduced as a promising and safer alternative to surgical lung biopsy. However, there is little known about the current use of cryobiopsy other than case reports and series. We plan to survey pulmonary physicians regarding their use of lung cryobiopsy.
1. What sort of practice do you work?
2. What is your current level of experience/training?
3. How many years has it been since you finished Pulmonary fellowship?
4. In what state / country do you practice?
Survey of current practice of transbronchial lung cryobiopsy (TBLC)
This survey is for research purposes only and is voluntary. The intent is to ascertain the current practice of transbronchial lung cryobiopsy (TBLC) in the evaluation of interstitial lung disease (ILD).
Practice Demographics
Academic Community
Community affiliated with academic Other:
Resident Fellow Faculty
Other practicing physician
5. Choose the appropriate answer for each row:
6. How many patients have you performed TBLC in the last 12 months?
Please enter a number, if none, please enter 0.
7. How many years have you been performing TBLC?
8. How were you trained in lung cryobiopsy?
9. Do you teach fellows in training on how to perform TBLC?
General Pulmonary
Interventional Pulmonary (Board Certified)
Cardiothoracic Surgery
No one at my institution performs this
procedure
Other
Describe your practice Which physician usually performs TBLC at your
institution?
Which physician usually performs conventional
forceps lung biopsy at your
institution?
In Fellowship
Procedure course / workshop
Self learning (non proctored learning ie webnairs, videos, reading) Other:
10. What other indications have you performed TBLC?
Select all that apply
11. What parameters do you routinely check pre-procedure that would pre-clude TBLC?
Select all that apply. If yes, share cutoff value in comments for which you would not proceed.
12. When are medications discontinued prior to procedure?
Please select the appropriate response regarding pre-procedure medications?
Yes, I teach fellows TBLC
No, I teach fellows, but I do not teach them how to perform TBLC Not applicable ( I do not teach fellows)
Patient Selection
Infection
Transplant surveillance Other: Please list
INR Platelets FEV1 FVC DLCO PaO2 TTE for PH Comment:
≤ 24hours prior 48 hours prior 5 days prior 1 week prior Don't stop Aspirin
NSAIDs
13. When are medications restarted post-procedure?
Please select the most appropriate response
14. What do you most commonly use for sedation for TBLC?
Select all that apply Antiplatelets (clopidogrel, thienopyridines)
Vitamin K antagonists
NOACs Prophylactic
Heparin
Same day Next day 48 hour Do not stop prior
Aspirin NSAIDs Antiplatelets (clopidogrel, thienopyridines) Vitamin K Antagonists
NOACs Prophylactic Heparin
AIRWAY/ANESTHESIA MANAGEMENT
Topical Anesthesia only Conscious sedation only
Topical anesthesia + conscious sedation Deep sedation
General Anesthesia Other
Select all that apply
16. What location are the majority of your TBLC performed?
17. Answer regarding the number of samples you usually obtain using TBLC?
18. How do you choose the location for TBLC sampling?
None LMA Large ETT
Rigid Bronchoscopy
Operating Room Bronchoscopy suite Other:
PROCEDURE/TECHNIQUE
0 1-3 4-6 7-9 ≥10
Average Total # for entire procedure
# of lobes sampled:
# of samples per lobe:
# of segments sampled per lobe:
# samples per segment:
Based on CT imaging
routinely sample multiple areas regardless of CT imaging the easiest location based on anatomy, fluoroscopy view, etc.
Other:
19. Does your place of practice have a written TBLC protocol?
20. How many seconds do you activate the cryoprobe?
21. What cryoprobe size do you use to perform TBLC?
22. Do you use image guidance/flouroscopy for cryobiopsy of the lung?
23. Immediately following TBLC, what steps do you to take to manage potential hemorrhage?
24. What adjuncts do you keep readily available (in the same room) to manage hemorrhage or pneumothorax related to TBLC procedures?
Please select all that apply Yes
No
1.9mm 2.4mm both neither
yes, but less than 50%
yes, > 50% but < 100%
Yes, 100%
No
COMPLICATION/MONITORING
Inflation of endobronchial blocker/balloon to occlude the airway after taking each sample Two bronchoscopy method
None Other:
25. In the last year, what percent of cases have had Moderate bleeding (requiring endoscopic procedure like bronchial blocker, Epinephrine, or use of cold saline, etc).
26. In the last year, what percent of cases have had Severe bleeding (hemodynamic or respiratory instability, surgical/IR intervention, ICU monitoring, transfusion).
27. In the past year, what percent of patients undergoing cryobiopsy have developed a post procedure pneumothorax requiring placement of a chest tube?
28. Have you ever had a death attributed to cryobiopsy procedure?
29. Do you keep a registry and/or review outcomes of cryobiopsy procedures performed?
cold saline Bronchial Blocker chest tube epinephrine Ultrasound fluoroscopy blood products None of the above Other:
Yes No
30. Who reads your TBLC samples?
31. Following TBLC, do you order a Chest X-Ray?
32. In an uncomplicated biopsy, after what duration is the patient usually discharged home?
33. Does your institution have a multidisciplinary committee to discuss imaging, pathology, and clinicals to determine diagnoses for ILDs?
Yes No
POST PROCEDURE
We send out TBLC samples to a facility with specialization in reading lung pathology.
We have a dedicated pulmonary pathologist who reads our TBLC samples.
Our in facility pathologist reads our samples though they are not a dedicated lung pathologist.
Immediately post procedure.
2-4 hours post procedure
Chest X-Ray is not routinely ordered, as needed only.
Same day Next day Other:
Yes No
