Transbronchial Cryobiopsy for the Diagnosis of Interstitial Lung Diseases

Maldonado, Fabien; Danoff, Sonye K.; Wells, Adrian; Colby, Thomas V.; Ryu, Jay H.; Liberman, Moïshe; Wahidi, Momen M.; Frazer, Lindsy; Hetzel, Juergen; Rickman, Otis B.; Herth, Felix J.F.; Poletti, Venerino; Yarmus, Lonny

doi:10.1016/j.chest.2019.10.048

Cited by 144 publications

(148 citation statements)

References 49 publications

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“…Increasing data support the use of TBLCs for the diagnosis of DPLDs with diagnostic yield ranging between 72 and 87% [11]. From the 81 patients included in the study, we obtained similar results as published data in term of diagnostic yield (84% when including NSIP diagnoses and 64% when excluding NSIP).…”

Section: Discussionsupporting

confidence: 84%

“…However, SLB is an invasive procedure, requesting systematic pleural drainage and burdened with an estimate postoperative mortality rate of 2% that ranges to 3,6% [3][4][5][6][7]. Therefore, trans-bronchial lung cryobiopsy (TBLC) is increasingly recognized as an alternative technique for the diagnosis of DPLDs [6,[8][9][10][11]. TBLC appears to be safer than SLB, and its contribution to the diagnosis obtained via multidisciplinary discussion is comparable to that of SLB, although the histological diagnostic yield is higher with SLB (approximately 80% for TBLC vs 95% for SLB) [11].…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of Surgical Lung Biopsies after Cryobiopsies when Pathological Results Are Inconclusive or show a Pattern Suggestive of a Nonspecific Interstitial Pneumonia

Bondue

Leduc

Froidure

et al. 2020

Preprint

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BACKGROUND The equivalence of transbronchial lung cryobiopsies (TBLCs) and surgical lung biopsy (SLB) in the diagnosis of diffuse parenchymal lung diseases (DPLDs) is still debated. The aim of this study was to evaluate the benefit of SLBs performed in selected patients after TBLCs.METHOD We conducted a multicentric Belgian prospective trial in which SLBs were performed after TBLCs when the pathological diagnosis was uncertain or if a nonspecific interstitial pneumonia (NSIP) pattern was observed hypothesizing that SLB could provide additional information and that a co-existent UIP pattern could be missed.RESULTS 81 patients with TBLCs performed for a DPLD were included in the study between April 2015 and December 2019. A specific histological diagnosis was obtained in 52 patients (64%) whereas no pathological diagnosis following TBLCs was obtained in 13 patients (16%) and a pattern suggestive of a NSIP observed in 16 patients (20%). 14 of these 29 patients had SLBs after TBLCs. SLBs showed a UIP pattern in 11 (79%), a pattern suggestive of a hypersensitivity pneumonitis in two and a NSIP pattern in one patient. Among the 16 patients with pathological NSIP following TBLCs, six benefited from SLBs showing a UIP in five and confirming a NSIP in only one patient. A retrospective pathological analysis of patients having both procedures showed lower diagnostic confidence and agreement among pathologists for TBLCs compared to SLBs. Major determinants underlying the added value of SLBs were, as expected, the bigger size and the subpleural localization of the biopsies.CONCLUSIONS TBLCs are useful in the setting of DPLDs with a good diagnostic yield. However, our study suggests that SLB provides critical additional information in case TBLCs are inconclusive or show a pattern suggestive of a NSIP, questioning the accuracy of TBLC to identify adequately this histological pattern.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Usefulness of Surgical Lung Biopsies after Cryobiopsies when Pathological Results Are Inconclusive or show a Pattern Suggestive of a Nonspecific Interstitial Pneumonia

Bondue

Leduc

Froidure

et al. 2020

Preprint

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“…Dies konnte in einer prospektiven Multicenterstudie von Troy 2019 bestätigt werden [15]. Die Darstellung der folgenden Empfehlungen orientiert sich an der 2019 veröffentlichen Leitlinie des American College of Chest Physicians zur transbronchialen Kryobiopsie [16].…”

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Durchführung der transbronchialen Kryobiopsie

Böckeler¹

2020

Pneumologie

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Cryosurgery has been successfully in bronchoscopy for several years. In addition to the local therapy of tumors and stenoses, cryo extraction enables the endobronchial and transbronchial extraction of large, high-quality biopsies. This is with regard to the diagnosis of diffuse lung diseases and the molecular analysis of malignant lung tumors of outstanding importance. This article explains the method and implementation of transbronchial cryobiopsy.

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“…However, SLB is an invasive procedure with signi cant comorbidities, a hospitalization for a few days, systematic chest drainage, and a postoperative mortality rate of 2% up to 3.6% [3][4][5][6][7]. Therefore, transbronchial lung cryobiopsy (TBLC) is increasingly recognized as an alternative technique for the diagnosis of DPLDs [6,[8][9][10][11]. TBLC appears to be safer than SLB, and its contribution to the diagnosis obtained via multidisciplinary discussion is comparable to that of SLB, although the histological diagnostic yield is higher with SLB (approximately 80% for TBLC vs 95% for SLB) [11].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, transbronchial lung cryobiopsy (TBLC) is increasingly recognized as an alternative technique for the diagnosis of DPLDs [6,[8][9][10][11]. TBLC appears to be safer than SLB, and its contribution to the diagnosis obtained via multidisciplinary discussion is comparable to that of SLB, although the histological diagnostic yield is higher with SLB (approximately 80% for TBLC vs 95% for SLB) [11].…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Surgical Lung Biopsies after Cryobiopsies when Pathological Results Are Inconclusive or show a Pattern Suggestive of a Nonspecific Interstitial Pneumonia

Bondue

Leduc

Froidure

et al. 2020

Preprint

View full text Add to dashboard Cite

BACKGROUND Although increasing data supports the use of transbronchial lung cryobiopsies (TBLCs) for the diagnosis of diffuse parenchymal lung diseases (DPLDs), its role as an alternative to surgical lung biopsy (SLB) is still under debate. The aim of this study was to assess the benefit of additional SLBs performed in selected patients after TBLCs. METHOD We conducted a multicentric Belgian prospective trial in which SLBs were performed after TBLCs when the pathological diagnosis was uncertain or if a nonspecific interstitial pneumonia (NSIP) pattern was observed hypothesizing that SLB could provide additional information and that a co-existent UIP pattern could be missed. RESULTS 81 patients with TBLCs performed for a DPLD were included in the study between April 2015 and December 2019. A specific histological diagnosis was obtained in 52 patients (64%) whereas no pathological diagnosis following TBLCs was obtained in 13 patients (16%) and a pattern suggestive of a NSIP was observed in 16 patients (20%). 14 out of these 29 patients had SLBs after TBLCs. SLBs showed a UIP pattern in 11 (79%), a pattern suggestive of a hypersensitivity pneumonitis in two (14%) and a NSIP pattern in one patient (7%). Among the 16 patients with pathological NSIP following TBLCs, six underwent a SLBs showing a UIP in five and confirming a NSIP in one patient only. A retrospective pathological analysis of patients having both procedures showed a lower diagnostic confidence and agreement among pathologists for TBLCs compared to SLBs. Major factors underlying the added value of SLBs were the bigger size of the sample as well as the subpleural localization of the biopsies. CONCLUSIONS TBLCs are useful in the setting of DPLDs with a good diagnostic yield. However, our study suggests that SLB provides critical additional information in case TBLCs are inconclusive or show a pattern suggestive of a NSIP, questioning the accuracy of TBLC to adequately identify this histological pattern.

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Transbronchial Cryobiopsy for the Diagnosis of Interstitial Lung Diseases

Cited by 144 publications

References 49 publications

Usefulness of Surgical Lung Biopsies after Cryobiopsies when Pathological Results Are Inconclusive or show a Pattern Suggestive of a Nonspecific Interstitial Pneumonia

Usefulness of Surgical Lung Biopsies after Cryobiopsies when Pathological Results Are Inconclusive or show a Pattern Suggestive of a Nonspecific Interstitial Pneumonia

Durchführung der transbronchialen Kryobiopsie

Usefulness of Surgical Lung Biopsies after Cryobiopsies when Pathological Results Are Inconclusive or show a Pattern Suggestive of a Nonspecific Interstitial Pneumonia

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