The application of transbronchial cryobiopsy in interstitial lung disease: a prospective, multicenter, real-world study

Abstract

Background: Transbronchial cryobiopsy (TBCB) has been widely used to diagnose interstitial lung disease (ILD). Existing reports on TBCB in ILD are mostly single-center prospective or retrospective studies but rarely multicenter prospective real-world studies. We explored the diagnostic efficiency and safety of TBCB in ILD in a real world setting. Methods: A prospective, multicenter, real-world study was conducted to analyze the data of patients with unclarified ILD who underwent TBCB in 20 hospitals in China from October 2018 to October 2019. The results of the pathological and multidisciplinary discussion (MDD) diagnosis and complications related to TBCB were then analyzed.Results: A total of 373 patients were enrolled in this study, including 194 males and 179 females, with an average age of 52.6±12.4 years. None of the patients had severe hemorrhaging, and the incidence of Original Article pneumothorax was 4.8%. The proportions of definitive, possible, and unclassified pathological diagnoses were 62.5%, 5.6%, and 31.9%, respectively. The overall diagnostic yield of MDD was 63.5%. There were 237 patients with a definitive diagnosis of MDD and 136 patients with an unclarified MDD diagnosis.The cooling gas pressure, freezing durations, number of specimens, maximum lengths of specimens, and specimen sizes varied significantly between the definitive and unclarified MDD diagnoses.Conclusions: In China, the application of TBCB in ILD is generally safe, and its diagnostic efficiency is acceptable. Using a 1.9-mm cryoprobe to collect five samples would achieve a better positive diagnostic rate for TBCB in ILD, without a significant increase in complication risk.

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

“…Pneumothorax is one of the main TBLC complications and may be related to cryoprobe size. Previous studies showed that pneumothorax incidence was higher with 2.4-mm cryoprobes than with 1.9-mm cryoprobes (10) (11). However, a study by Zhou et al (26) comparing the use of 2.4-mm and 1.9-mm cryoprobes guided by cone-beam computed tomography rather than uoroscopy demonstrated no signi cant differences in pneumothorax incidence.…”

“…The recent CHEST Guidelines and Expert Panel Report recommends using a smaller cryoprobe (1.9-mm) rather than a larger cryoprobe (2.4 mm) in patients with suspected ILD undergoing TBLC and cites no differences in diagnostic yields (9). According to previous studies, smaller cryoprobes may reduce pneumothorax risk caused by TBLC (10,11), although evidence is lacking. Recently, a 1.1-mm cryoprobe has been developed for TBLC.…”

Assessment of a Randomized Controlled Trial on the Safety of Pre-placing Bronchial Balloons in Transbronchial Lung Cryobiopsy for Diagnosing Interstitial Lung Disease

“…Furthermore, it has been reported that the risk of pneumothorax is probably related to the size of the probe and the method of guidance. Previous studies showed that the risk of pneumothorax increased with the use of 2.4-mm probes compared with 1.9-mm probes (34,35), while Zhou's study (36) showed that there was no difference in the risk of pneumothorax owing to the probe size, but guided by cone-beam computed tomography (CBCT), which is attributed to the low prevalence of pneumothorax. A recent study also showed that there was no signi cant difference in occurrence of pneumothorax between the 1.7-mm cryoprobe and 1.9-mm cryoprobe (37).…”