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

Abstract

Introduction:Transbronchial lung cryobiopsy (TBLC) is increasingly being used as an alternative to video-assisted thoracoscopic surgery (VATS) biopsy to establish the histopathologic pattern in interstitial lung disease (ILD).Methods:A systematic literature search of the PubMed and Embase databases, from October 2010 to October 2020, was conducted to identify studies that reported on diagnostic yield or safety of VATS or TBLC in the diagnosis of ILD.Results:43 studies were included. 23 evaluated the diagnostic yield of TBLC after multidisciplinary discussion, with a pooled diagnostic yield of 76.8% (95% confidence interval (CI) 70.6–82.1), rising to 80.7% in centres that performed ≥70 TBLC. 10 studies assessed the use of VATS and the pooled diagnostic yield was 93.5% (95% CI 88.3–96.5). In TBLC, pooled incidences of complications were 9.9% (95% CI 6.8–14.3) for significant bleeding (6.9% for centres with ≥70 TBLC), 5.6% (95% CI 3.8–8.2) for pneumothorax treated with a chest tube and 1.4% (95% CI 0.9–2.2) for acute exacerbation of ILD after TBLC. The mortality rates were 0.6% and 1.7% for TBLC and VATS, respectively.Conclusions:TBLC has a fairly good diagnostic yield, an acceptable safety profile and a lower mortality rate than VATS. The best results are obtained from more experienced centres.

The diagnostic efficiency and safety of transbronchial lung cryobiopsy using 1.1-mm cryoprobe in diagnosing interstitial lung disease

“…Currently, 2.4-mm and 1.9-mm cryoprobes are used for TBLC (20,23). Several pilot studies have described higher accessibility and reduced bleeding with a 1.1-mm cryoprobe (12,24).…”

Radial endobronchial ultrasound - guided bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta-analysis of prospective trials

“…Plus, GGOs rarely penetrate the bronchus. Consequently, the use of transbronchial lung cryobiopsy (TBLC) that can yield larger samples with better cellular architecture preservation and fewer crush artifacts, thereby aiding in making histologic diagnosis, seems a promising diagnostic technique for GGOs [ [70] , [71] , [72] ]. Bronchus sign refers to the presentation of an air-filled bronchus leading to the PPLs, which was firstly described by Tsuboi and colleagues in 1967 [ 73 ].…”

Use of a pulmosphere model to evaluate drug antifibrotic responses in interstitial lung diseases

“…Transbronchial biopsies are less invasive,have lower risks compared to surgical lung biopsies and could be an alternative to surgical lung biopsies in certain ILDs [ 22 ]. Transbronchial lung cryobiopsy (TBLC) is another minimally invasive bronchospic technique which is increasingly used in the diagnosis of ILD’s [ 23 ]. Recent studies indicate that results acquired via TBLC are comparabale to surgical lung biopies [ 24 ].…”