Transbronchial Cryobiopsies for the Diagnosis of Diffuse Parenchymal Lung Diseases: Expert Statement from the Cryobiopsy Working Group on Safety and Utility and a Call for Standardization of the Procedure

Abstract

Transbronchial cryobiopsies (TBCB) have recently been introduced as a promising and safer alternative to surgical lung biopsy in the diagnostic approach to diffuse parenchymal lung diseases (DPLD). Despite a substantial and expanding body of literature, the technique has not yet been standardized and its place in the diagnostic algorithm of DPLD remains to be defined. In part, this reflects concerns over the diagnostic yield and safety of the procedure, together with the rapid spread of the technique without competency and safety standards; furthermore, there is a substantial procedural variability among centers and interventional pulmonologists. We report this expert statement proposed during the third international conference on “Transbronchial Cryobiopsy in Diffuse Parenchymal Lung Disease” (Ravenna, October 27–28, 2016), which formulates evidence- and expert-based suggestions on the indications, contraindications, patient selection, and procedural aspects of the procedure. The following 5 domains were reviewed: (1) what is the role of TBCB in the diagnostic evaluation of DPLD: patient selection; (2) pathological considerations; (3) contraindications and safety considerations; (4) how should TBCB be performed and in what procedural environment; and (5) who should perform TBCB. Finally, the existence of white paper recommendations may also reassure local hospital credentialing committees tasked with endorsing an adoption of the technique.

Confocal Laser Endomicroscopy as a Guidance Tool for Transbronchial Lung Cryobiopsies in Interstitial Lung Disorder

“…Transbronchial cryobiopsy (TBCB) has recently been introduced as a promising and safer alternative to surgical lung biopsy in the diagnostic approach to diffuse parenchymal lung diseases [1, 2]. However, this technique is hampered by two major limitations; a substantial nondiagnostic rate (20–30%) [3, 4] and the proportion of complications (pneumothorax and moderate bleeding) of 10–20% [1, 4-7].…”

“…A recent “Expert Statement” from the Cryobiopsy Working Group formulates evidence- and expert-based suggestions on the procedural aspects of the TBCB procedure [2]. The working group emphasizes that biopsies with distances of less than 1 cm from the pleura are associated with a significantly increased risk of pneumothorax [8].…”

“…Therefore, optimal positioning of the cryoprobe with a distance of 1 cm from the pleura is recommended to minimize complications [2]. Furthermore, the working group’s recommendation concerning the diagnostic yield of TBCB is that the most densely fibrotic lung parenchyma is of limited diagnostic value and should be avoided [2]. …”

Transbronchial Lung Cryobiopsy in Interstitial Lung Diseases: Best Practice

“…Several reports [19, 20] indicated that TBLC is safe also in patients with lower pulmonary function and in ILDs with acute or subacute behavior. However, progressive clinical and functional deterioration and the onset of ground glass areas on HRCT could be predictors of high exacerbation risk.…”

Interstitielle Lungenerkrankungen: epidemiologische Herausforderungen, Register und Biobanken

“…In dieser Ausgabe von Karger Kompass Pneumologie wird das kürzlich veröffentlichte Statement zur Durchführung und Interpretation der transbronchialen Kryobiopsie bei interstitiellen Lungenerkrankungen kommentiert. Die Autoren des Originalartikels befassten sich mit dem wichtigen Thema der Standardisierung dieser bronchoskopischen Technik [13]. Bronchoskopische Methodenstandardisierung ist ein wichtiger Aspekt nicht nur bei IPF, sondern auch bei anderen ILDs, wie z.B.…”