Diagnostic yield and risk/benefit analysis of trans-bronchial lung cryobiopsy in diffuse parenchymal lung diseases: a large cohort of 699 patients

Abstract

BackgroundStandardization of trans-bronchial lung cryobiopsy in diffuse parenchymal lung diseases is imminent; however, the majority of published series on cryobiopsy include a limited number of patients and are characterized by several differences in procedural technical details.MethodsThis is an observational, retrospective cohort study. Aim of the study was to suggest some sampling strategies related to transbronchial cryobiopsy in the diagnostic work-up of patients with diffuse parenchymal lung diseases.ResultsSix hundred ninety-nine patients with suspected diffuse parenchymal lung disease were recruited. A specific pathological diagnosis was achieved in 614/699 cases (87.8%) and a multidisciplinary diagnosis was obtained in 630/699 cases (90.1%). Diagnostic yield was significantly influenced by the number of samples taken (1 vs ≥ 2 biopsies, p < 0.005). In 60.4% of patients, biopsies were taken from one site and in 39.6% from different sites (in the same lobe or in two different lobes), with a significant increase in diagnostic yield, specifically in patients with fibrotic lung diseases (65.5% vs 93.4%, p < 0.0001). The 2.4 mm or 1.9 mm probes were used, with no differences in terms of diagnostic yield. Regarding safety, pneumothorax occurred in 19.2% and was influenced by baseline lung function; in all patients Fogarty balloon has been used and severe haemorrhage occurred in 0.7% of cases. Three patients (0.4% of cases) died within 30 days after the procedure.ConclusionsWe propose some sampling strategies of cryobiopsy which seem to be associated with a higher diagnostic yield and a favorable risk/benefit ratio: sampling at least two samples in different sites, using either the 2.4 mm or the 1.9 mm probe, intubating the patients and using bronchial blockers/catheters.

Durchführung der transbronchialen Kryobiopsie

“…Es ist sinnvoll, aus verschiedenen Lungenbereichen Proben zu entnehmen. Aus einer Untersuchung von Ravaglia et al [10] geht hervor, dass die Entnahme von Biopsien aus verschiedenen Segmenten desselben Lappens anstelle von Biopsien aus nur ei-nem Segment die diagnostische Ausbeute von 69 % auf 96 % erhöht. Areale, die rein fibrotische Veränderungen in der HRCT zeigen, sollten zur Biopsie vermieden werden.…”

Guidelines of the Polish Respiratory Society for Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis

“…On the other hand, there is a safety analysis performed in 699 patients with ILDs. The analysis revealed that complications were not more frequent in patients with FVC < 50% of predicted and T L,CO < 35% of predicted compared with individuals with higher values of these parameters [154]. Pneumothorax was more frequent in patients with a higher radiographic fibrosis index and pathomorphological UIP diagnosis, irrespective of FVC < 50% of predicted or T L,CO < 35% of predicted [154].…”

A Pilot Study of the Ultrathin Cryoprobe in the Diagnosis of Peripheral Pulmonary Ground-Glass Opacity Lesions

“…Conventional cryoprobe was thick and straight and limited to large bronchus. Hemorrhage is also a considerable problem and it induced more bleeding than forceps [15,[25][26][27]. Usually, the conventional cryoprobe need to be withdrawn with bronchoscope after biopsy, leaving the airway out of surveillance, so an additional insertion of a bronchoscope is required immediately after the former bronchoscope retreated [28].…”