Diagnostic accuracy of transbronchial lung cryobiopsy for interstitial lung disease diagnosis (COLDICE): a prospective, comparative study

Troy, Lauren; Grainge, Christopher; Corte, Tamera J.; Williamson, Jonathan; Vallely, Michael P.; Cooper, Wendy A.; Mahar, Annabelle; Myers, Jeffrey L.; Lai, Simon; Mulyadi, Ellie; Torzillo, Paul J.; Phillips, Martin J.; Jo, Helen; Webster, Susanne; Lin, Qi; Rhodes, Jessica; Salamonsen, Matthew; Wrobel, Jérémy; Harris, Benjamin; Don, Garrick; Wu, Peter; Ng, Benjamin; Oldmeadow, Christopher; Raghu, Ganesh; Lau, Edmund; Arnold, David H.; Cao, Christopher; Cashmore, Amy; Cleary, Shannon; Evans, Tiffany‐Jane; French, Bruce; Geis, Monika; Glenn, Laura; Hibbert, Michael; Ing, Alvin; James, A.; Meredith, Graham; Merry, Christopher; Pudipeddi, Anand; Saghaie, Tajalli; Thomas, Raji; Thomson, Claire; Twaddell, Scott

doi:10.1016/s2213-2600(19)30342-x

Cited by 286 publications

(256 citation statements)

References 20 publications

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“…This analysis does not re ect clinical routine but was interesting as it highlighted a higher inter-observer agreement among pathologists with higher con dence levels for SLBs diagnoses compared to TBLCs diagnoses. Moreover, the overall histopathological agreement (independently of the level of con dence) between paired TBLC and SLB was 40%, contrasting to the agreement observed in the COLDICE study of 71% [13]. Concerning the identi cation of a NSIP pattern, the diagnostic con dence was systematically low on TBLCs samples and con rmed on SLB in a minority of cases.…”

Section: Discussioncontrasting

confidence: 67%

“…This result contrasts with data from the recent and bigger COLDICE study including 65 patients and showing a histopathological agreement between TBLC and SLB of 71%. Moreover, for TBLC with a high to de nite con dence at MDD, 95% of TBLC diagnoses were concordant with SLB diagnoses [13]. In these studies, SLB are performed in all patients whatever the level of con dence obtained after TBLC (5% of nondiagnostics TBLCs in the COLDICE study).…”

Section: Discussionmentioning

confidence: 81%

“…In these studies, SLB are performed in all patients whatever the level of con dence obtained after TBLC (5% of nondiagnostics TBLCs in the COLDICE study). Moreover, these studies do not speci cally address the accuracy of histological NSIP diagnosis in TBLCs compared to SLB (NSIP was only present on TBLC pathological analysis in 2 patients in the COLDICE study and in 3 patients in the Romagnoli study) [13]. In the present study, even if we acknowledge that the number of patients remains low, the bene t to perform SLB after TBLCs (following MDD) was speci cally assessed in case of unspeci c results including NSIP patterns on TBLC.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, whereas many data support the use of TBLC for the diagnosis of DPLDs, only three studies compared the result of TBLC and SLB performed in a same patient. A rst study was conducted on a limited number of patients (seven) [12] while the other two were conducted on a larger cohort, both providing con icting results concerning the agreement between TBLC and SLB for histological diagnoses [13,14]. Nevertheless, the COLDICE study [14] was the biggest and the unique multicentric study showing a high level of agreement between TBLC and SLB for both histopathological interpretation and MDD diagnoses.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of Surgical Lung Biopsies after Cryobiopsies when Pathological Results Are Inconclusive or show a Pattern Suggestive of a Nonspecific Interstitial Pneumonia

Bondue

Leduc

Froidure

et al. 2020

Preprint

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BACKGROUND Although increasing data supports the use of transbronchial lung cryobiopsies (TBLCs) for the diagnosis of diffuse parenchymal lung diseases (DPLDs), its role as an alternative to surgical lung biopsy (SLB) is still under debate. The aim of this study was to assess the benefit of additional SLBs performed in selected patients after TBLCs. METHOD We conducted a multicentric Belgian prospective trial in which SLBs were performed after TBLCs when the pathological diagnosis was uncertain or if a nonspecific interstitial pneumonia (NSIP) pattern was observed hypothesizing that SLB could provide additional information and that a co-existent UIP pattern could be missed. RESULTS 81 patients with TBLCs performed for a DPLD were included in the study between April 2015 and December 2019. A specific histological diagnosis was obtained in 52 patients (64%) whereas no pathological diagnosis following TBLCs was obtained in 13 patients (16%) and a pattern suggestive of a NSIP was observed in 16 patients (20%). 14 out of these 29 patients had SLBs after TBLCs. SLBs showed a UIP pattern in 11 (79%), a pattern suggestive of a hypersensitivity pneumonitis in two (14%) and a NSIP pattern in one patient (7%). Among the 16 patients with pathological NSIP following TBLCs, six underwent a SLBs showing a UIP in five and confirming a NSIP in one patient only. A retrospective pathological analysis of patients having both procedures showed a lower diagnostic confidence and agreement among pathologists for TBLCs compared to SLBs. Major factors underlying the added value of SLBs were the bigger size of the sample as well as the subpleural localization of the biopsies. CONCLUSIONS TBLCs are useful in the setting of DPLDs with a good diagnostic yield. However, our study suggests that SLB provides critical additional information in case TBLCs are inconclusive or show a pattern suggestive of a NSIP, questioning the accuracy of TBLC to adequately identify this histological pattern.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Usefulness of Surgical Lung Biopsies after Cryobiopsies when Pathological Results Are Inconclusive or show a Pattern Suggestive of a Nonspecific Interstitial Pneumonia

Bondue

Leduc

Froidure

et al. 2020

Preprint

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“…Transbronchial lung cryobiopsy (TBLC) is an alternative technique that has been widely used for the diagnosis of diffuse parenchymal lung disease (DPLD) (11). The sample sizes are significantly larger than those obtained with TBLB, and the diagnostic yield approaches that of SLB with lower complication rates (12,13).…”

mentioning

confidence: 99%

Transbronchial Lung Cryobiopsy May be of Value for Nonresolving Acute Respiratory Distress Syndrome: Case series and Systematic literature Review

Zhou

Feng

Wang

et al. 2020

Preprint

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Abstract Background: Identifying pathologic features is helpful for the management of nonresolving acute respiratory distress syndrome (ARDS). Transbronchial lung cryobiopsy (TBLC) is a novel biopsy technique that may have comparable utility to surgical biopsy. The aim of this study was to assess the value of TBLC in patients with nonresolving ARDS. Methods: All patients with nonresolving ARDS who underwent TBLC from January 2019 to August 2019 in a tertiary medical ICU were included. In addition, a literature search of TBLC for ARDS was performed by searching PubMed, EMBASE, ATS/ERS/APSR meeting abstracts, clinicaltrial.gov, and Google Scholar. Data on complications, histologic diagnosis, management changes, and outcomes were analyzed. Results: Five patients (three women and two men) underwent TBLC. None of the patients developed pneumothorax although in two patients massive bleeding occurred, which was controlled by continuous occlusion using bronchial blockers. There were no procedure-related deaths. Diffuse alveolar damage (DAD) and alternative histologic patterns were found in two and three patients, respectively, resulting in management changes in all cases. Literature search yielded four studies, which together with the present study resulted in data from 25 cases in which TBLC was used in nonresolving ARDS. The summary diagnostic yield was 92% (23/25). Only 44% (11/25) of cases were proven to be DAD. TBLC contributed to management changes in 80% of patients (20/25). Procedure-related complications consisted of pneumothorax (16%, 4/25), significant bleeding (12%, 3/25), and persistent air leak (8%, 2/25). There were no procedure-related deaths. The follow-up survival rate was 61.9% (13/21). Conclusions: Given its acceptable safety profile and high diagnostic yield, TBLC may be of value in selected patients with nonresolving ARDS.

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Interstitial Lung Disease

Maher

2024

JAMA

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ImportanceInterstitial lung disease (ILD) consists of a group of pulmonary disorders characterized by inflammation and/or fibrosis of the lung parenchyma associated with progressive dyspnea that frequently results in end-stage respiratory failure. In the US, ILD affects approximately 650 000 people and causes approximately 25 000 to 30 000 deaths per year.ObservationsThe most common forms of ILD are idiopathic pulmonary fibrosis (IPF), which accounts for approximately one-third of all cases of ILD, hypersensitivity pneumonitis, accounting for 15% of ILD cases, and connective tissue disease (CTD), accounting for 25% of ILD cases. ILD typically presents with dyspnea on exertion. Approximately 30% of patients with ILD report cough. Thoracic computed tomography is approximately 91% sensitive and 71% specific for diagnosing subtypes of ILDs such as IPF. Physiologic assessment provides important prognostic information. A 5% decline in forced vital capacity (FVC) over 12 months is associated with an approximately 2-fold increase in mortality compared with no change in FVC. Antifibrotic therapy with nintedanib or pirfenidone slows annual FVC decline by approximately 44% to 57% in individuals with IPF, scleroderma associated ILD, and in those with progressive pulmonary fibrosis of any cause. For connective tissue disease–associated ILD, immunomodulatory therapy, such as tocilizumab, rituximab, and mycophenolate mofetil, may slow decline or even improve FVC at 12-month follow-up. Structured exercise therapy reduces symptoms and improves 6-minute walk test distance in individuals with dyspnea. Oxygen reduces symptoms and improves quality of life in individuals with ILD who desaturate below 88% on a 6-minute walk test. Lung transplant may improve symptoms and resolve respiratory failure in patients with end-stage ILD. After lung transplant, patients with ILD have a median survival of 5.2 to 6.7 years compared with a median survival of less than 2 years in patients with advanced ILD who do not undergo lung transplant. Up to 85% of individuals with end-stage fibrotic ILD develop pulmonary hypertension. In these patients, treatment with inhaled treprostinil improves walking distance and respiratory symptoms.Conclusions and RelevanceInterstitial lung disease typically presents with dyspnea on exertion and can progress to respiratory failure. First-line therapy includes nintedanib or pirfenidone for IPF and mycophenolate mofetil for ILD due to connective tissue disease. Lung transplant should be considered for patients with advanced ILD. In patients with ILD, exercise training improves 6-minute walk test distance and quality of life.

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Diagnostic accuracy of transbronchial lung cryobiopsy for interstitial lung disease diagnosis (COLDICE): a prospective, comparative study

Cited by 286 publications

References 20 publications

Usefulness of Surgical Lung Biopsies after Cryobiopsies when Pathological Results Are Inconclusive or show a Pattern Suggestive of a Nonspecific Interstitial Pneumonia

Usefulness of Surgical Lung Biopsies after Cryobiopsies when Pathological Results Are Inconclusive or show a Pattern Suggestive of a Nonspecific Interstitial Pneumonia

Transbronchial Lung Cryobiopsy May be of Value for Nonresolving Acute Respiratory Distress Syndrome: Case series and Systematic literature Review

Interstitial Lung Disease

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