Implementation of Transbronchial Lung Cryobiopsy in a Tertiary Referral Center for Interstitial Lung Diseases – A Cohort Study on Diagnostic Yield, Complications, and Learning Curves

Abstract

BackgroundTransbronchial lung cryobiopsy (TBLC) has been introduced as an alternative to surgical lung biopsy (SLB) in the diagnostics of interstitial lung diseases (ILD). Despite controversy on safety, TBLC is increasingly implemented in ILD centers with an apparent diagnostic yield comparable to SLB. The aim of this study was to assess TBLC implementation experiences from a tertiary Danish ILD center regarding diagnosis, complications, and learning curves for TBLC performance.MethodsTBLC was prospectively performed in a cohort of patients with unclassifiable ILD based on a preceding multidisciplinary clinical and radiological revision. TBLC was performed as an outpatient procedure with the patients in general anesthesia using a flexible bronchoscope with 1.9 or 2.4 mm cryoprobes. Learning curves for TBLC performance were calculated using cumulated sum (CUSUM) scores for diagnostic yield, pneumothorax, and bleeding.Results From February 2017 to March 2020 141 patients (86 (61%) men, median age 69 years [IQR, 60 years to 74 years]) had TBLC performed. A histological and confirmative diagnosis was made in 101 patients (75.2%) and 124 patients (87.9%, i.e. clinical diagnostic yield), respectively, in whom idiopathic interstitial pneumonias constituted the majority (67.3%) of the clinical diagnoses. We observed 2 deaths (1.4%) within 30 days of TBLC, but no procedure-related mortality or severe bleeding. Moderate bleeding occurred in 23 patients (16.3%), pneumothorax in 21 patients (14.9%) with only 14 patients (9.9%) requiring a pleural drain. Based on the CUSUM score analysis, the diagnostic yield obtained was satisfactory throughout the period.ConclusionThis study reports experiences of outpatient TBLC implementation in a tertiary referral ILD center from the largest investigated TBLC cohort in Scandinavia The diagnostic yield and prevalence of complications obtained by TBLC from this single center study on unclassifiable ILD support outpatient TBLC as a valuable and safe alternative to SLB to diagnose ILD in well-selected patients. The learning curves for TBLC were acceptable in the hands of experienced bronchoscopists.Of note, the majority of the abstract details have been presented as a poster at the European Respiratory Society’s Congress in Madrid, Spain in 2019 (European Respiratory Journal 2019 54: PA3107; DOI: 10.1183/13993003.congress-2019.PA3107).

Transbronchial Lung Cryobiopsy for Diagnosing Interstitial Lung Disease: A Retrospective Single-Center Experience

“…The diagnostic yield of TBLC and classification rate of unclassifiable-ILD in this study were similar to those in previous studies (26,29,34). Histopathologic classification of probable UIP was diagnosed in 18.5% of patients, and there was no UIP pattern.…”

Cryotherapy in the paediatric airway: Indications, success and safety

“…This must be viewed through the prism of higher morbidity and a very different set of indications in this population. Of note, no procedure‐related deaths were documented 20 . Cryotherapy seems to be a promising new technique for paediatric airway endoscopy suited for a wide range of indications.…”

“…Of note, no procedure-related deaths were documented. 20 Cryotherapy seems to be a promising new technique for paediatric airway endoscopy suited for a wide range of indications. However, due to the novelty, lack of experience and safety concerns, there is hesitation about its applicability in the paediatric airway, 21 which has led the European Respiratory Society to call for studies addressing the role of cryotherapy in children.…”

European Respiratory Society guidelines on transbronchial lung cryobiopsy in the diagnosis of interstitial lung diseases

“…Studies directly addressing the PICO question were not identified, but three studies were found that evaluated outcomes in early versus late procedures, which was considered as a surrogate for operator experience. Of these, one study reported cumulated sum (CUSUM) scores for some of the prioritised outcomes [45]. However, as these scores were not comprehensible and raw data regarding the outcomes were not published, the Task Force decided to exclude the study from the analyses.…”