The role of transbronchial cryobiopsy and surgical lung biopsy in the diagnostic algorithm of interstitial lung disease

Abstract

This is the first study to correlate histological results and complications following TCB and SLB in ILD subjects, some of whom underwent both procedures. TCB is a suitable diagnostic tool in ILD, potentially completely dispensing with the need for an SLB in some cases. In all cases, an interdisciplinary case evaluation is necessary as a final step.

Diagnostic Yield and Safety of Cryoprobe Transbronchial Lung Biopsy in Diffuse Parenchymal Lung Diseases: Systematic Review and Meta-Analysis

“…1). 27,[37][38][39][40][41][42][43][44][45][46][47][48][49] Nine studies were retrospective, 27 39,41 one in immunocompromised subjects with pulmonary infiltrates, 38 and one including subjects from all 3 categories 46 (Table 1). The studies were generally of good quality (Table 2), with the median (interquartile range) QualSyst score being 18 (17)(18)(19).…”

“…42,49 Nine studies explicitly defined a diagnostic reference standard (Table 5), which included: (1) interdisciplinary discussion between clinician, radiologist, and pathologist (5 studies); (2) clinical, radiographic, and pathological findings with 6-month follow-up (one study); and (3) clinical, radiographic, and pathological findings (3 studies). 27,38,40,[43][44][45][47][48][49] A variety of diffuse parenchymal lung diseases, including IPF and nonspecific interstitial pneumonia, could be diagnosed with the help of cryo-transbronchial lung biopsy (Table 5).…”

“…27,[37][38][39][40][42][43][44][45][47][48][49] Five studies further classified the diagnoses achieved with the help of cryo-transbronchial lung biopsy as definite (or confident) or probable. 42,43,[47][48][49] The diagnoses achieved in the remaining 7 studies were considered definite.…”

Evaluation of patients with fibrotic interstitial lung disease: A Canadian Thoracic Society position statement

“…The diagnostic yield and complication rates of TBLC for ILD have been reported in 10 publications from 8 distinct cohorts, [64][65][66][67][68][69][70][71][72][73][74] although there was significant heterogeneity among studies (eg, patient population, method of sedation, flexible vs. rigid bronchoscope, method of determining the diagnosis). The reported diagnostic yield ranges from 51%-98% when TBLC is guided by HRCT and real-time fluoroscopy, varying by whether the diagnostic yield is reported based on pathological findings assessed in isolation or whether biopsies were reviewed in a MDD.…”

“…70 There is significant heterogeneity in the reported complications following TBLC with pneumothorax rates ranging from 0%-33% 64,67,70,73 and moderate to severe bleeding ranging from 0%-78%. 66,67,69,71 It is unclear whether this heterogeneity reflects differences in study populations, reporting standards, procedural techniques and/or operator expertise. A prospective study is needed to directly compare the yield and safety of TBLC to SLBx in the evaluation of fibrotic ILD prior to widespread adoption of TBLC into clinical practice.…”