Transbronchial cryobiopsy in fibrosing interstitial lung disease: modifications of the procedure lead to risk reduction

Abstract

Sixty-one subjects with fibrosing interstitial lung disease were prospectively analysed to determine the efficacy of transbronchial cryobiopsy (CryoTBB) and the effect of procedural modifications which were introduced after an interim analysis of the first 19 subjects. The modifications significantly reduced complication rates from 84% to 14% (p<0.001). 30-day-mortality was 2%. The algorithm with initial CryoTBB and surgical lung biopsy (SLB) as optional step-up procedure was feasible. CryoTBB led to a confident diagnosis in 46/61 subjects (75%). Only 21% out of all subjects were forwarded for SLB. As the modified CryoTBB reduced but not eliminated the risk of severe complications, tissue sampling should be limited to patients where confident diagnosis enables life prolonging therapy. Trial registration number: NCT01714518.

Bronchoscopic Cryobiopsy and Forceps Biopsy for the Diagnostic Evaluation of Diffuse Parenchymal Lung Disease in Clinical Practice

“… 10 The true mortality risk may be higher as indicated in our study and the 2% 30-day mortality rate in the recent prospective study by Hagmeyer et al. 40 More recently, Pannu et al 41 also reported a 30-day mortality rate of 2.0% in 187 patients undergoing TBCB.…”

“…Although procedurerelated complications such as pneumothorax and bleeding are well documented in multiple TBCB studies, 10,15 reports of 30-day deaths appear limited to those deemed related to the procedure. 2,3,5,16,39 This limitation may explain the very low 0.3% mortality in the meta-analysis by Sethi et al 10 The true mortality risk may be higher as indicated in our study and the 2% 30-day mortality rate in the recent prospective study by Hagmeyer et al 40 More recently, Pannu et al 41 also reported a 30-day mortality rate of 2.0% in 187 patients undergoing TBCB.…”

S2K-Leitlinie zur Diagnostik der idiopathischen Lungenfibrose

“…Eine prospektive Studie untersuchte dabei die Blutungskomplikationen im Vergleich zwischen konventioneller Zangen-und Kryo-TBB und zeigte, dass die Rate klinisch relevanter Blutungereignisse nach Kryobiopsie häufiger ist (16,2 % vs. 4,2 %, p < 0,05), während letale Blutungen allerdings nicht auftraten [131]. Sicherheitsaspekten widmete sich u. a. auch die Studie von Hagmeyer, die ein optional konsekutives Vorgehen einer chirurgischen Lungenbiopsie nach TBLC analysierte [132]. Nach einer initial hohen Morbiditäts-und Mortalitätsrate wurde die Prozedur angepasst und nun deutlich niedrigere Komplikationsraten gefunden.…”

S2K Guideline for Diagnosis of Idiopathic Pulmonary Fibrosis

“…A prospective study compared bleeding-related complications of conventional forceps and cryo-TBB and showed that the rate of clinically relevant bleeding events was higher after cryobiopsy (16.2 vs. 4.2%, p < 0.05) although no lethal hemorrhage was seen [131]. Safety aspects were addressed, among others, in a study by Hagmeyer et al [132] who analyzed optional sequential SLB after TBLC. After initially high morbidity and mortality rates, the procedure was adjusted and significantly lower complication rates were observed.…”