Bronchoscopic Cryobiopsy and Forceps Biopsy for the Diagnostic Evaluation of Diffuse Parenchymal Lung Disease in Clinical Practice

Abstract

Objective: To assess the contribution and safety of bronchoscopic cryobiopsy vs traditional forceps biopsy used in clinical practice for diagnosing diffuse parenchymal lung disease (DPLD). Patients and Methods: We identified 271 patients who underwent bronchoscopic biopsy for DPLD at Mayo Clinic, MN (June 1, 2013, through September 30, 2017). Medical records were reviewed including prebiopsy clinical and radiographic impressions. Diagnostic yield was assessed in terms of a specific histologic pattern resulting in a diagnosis when combined with the clinical-radiologic context. Clinical utility was defined as a biopsy result deemed useful in patient management. Results: The cohort included 120 cryobiopsy and 151 forceps biopsy cases with mean age 61AE14 years and 143 (53%) men. Diagnostic yield (55% vs 41%; odds ratio [OR], 1.73; 95% CI, 1.07 to 2.83; P¼.026) and clinical utility (60% vs 40%; OR, 2.21; 95% CI, 1.36 to 3.63; P¼.001) were higher for the cryobiopsy group, and the association remained after control for prebiopsy clinical impressions (OR, 2.21; 95% CI, 1.22 to 4.08; P¼.010 and OR, 3.23; 95% CI, 1.76 to 6.10; P<.001, respectively). However, pneumothorax (5.4% vs 0.7%; P¼.022) and serious bleeding (7.1% vs 0%; P¼.001) rates were higher for the cryobiopsy group. Thirty-day mortality was 1.6% in the cryobiopsy group vs 0% for the forceps biopsy group (P¼.20). Conclusion: Bronchoscopic cryobiopsy revealed higher diagnostic yield and clinical utility than did forceps biopsy. However, procedure-related complications were higher in the cryobiopsy group. The choice of bronchoscopic biopsy procedure for patients with DPLD depends on the clinicalradiologic context.

Efficacy and Safety of Cryobiopsy vs. Forceps Biopsy for Interstitial Lung Diseases, Lung Tumors, and Peripheral Pulmonary Lesions: An Updated Systematic Review and Meta-Analysis

“…The detailed literature search process is presented in Figure 1 . A total of 39 studies, such as 9 RCTs ( 11 , 12 , 17 – 23 ), 16 retrospective studies ( 4 , 9 , 24 – 37 ), 13 prospective studies ( 10 , 38 – 49 ), and 1 cohort study ( 50 ) representing 3,586 biopsies (1,759 cryobiopsies and 1,827 flexible forceps biopsies) were analyzed. The mean age of the study patients ranged from 45 to 69.5 years.…”

Diagnostic yield and safety of transbronchial lung cryobiopsy and surgical lung biopsy in interstitial lung diseases: a systematic review and meta-analysis

“…Eight studies reported histopathologic diagnosis (figure 2b), with a pooled diagnostic yield of 95.3% (95% CI 84.7-98.7; I 2 =87.5%, p<0.001); 10 studies reported the diagnostic yield after multidisciplinary team discussion, with a pooled estimate of 93.5% (95% CI 88.3-96.5; I 2 =81.1%, p<0.001). 2017) [25] TBLC 2) KOSLOW (2020) [34] TBLC (120) 52.4 2 (1.6) 6 (5.0) 1 (0.9) NA 8 (7.0) # 1 (0.8) PAJARES (2020) [36] TBLC Only three studies compared TBLC diagnostic accuracy with the gold standard of SLB, in which two studies [61,62] Procedure-related complications 41 studies reported procedure-related complications. In relation to TBLC, 26 studies described the occurrence of bleeding.…”

Transbronchial Cryobiopsy Is Superior to Forceps Biopsy for Diagnosing both Fibrotic and Non-Fibrotic Interstitial Lung Diseases

“…TBCB has demonstrated better safety outcomes and lower procedural-related mortality than SLB [8]. TBCB also allows for a larger specimen size without crush artifacts when compared to TBFB, resulting in a superior diagnostic yield [11]. These advantages led different guidelines to recommend TBCB as a first-line procedure for lung biopsy in patients with ILDs, especially fibrotic ILDs [5, 12, 13].…”