Transbronchial cryobiopsy in interstitial lung disease: experience in 106 cases – how to do it

Abstract

Transbronchial biopsy using forceps (TBB) is the first diagnostic technique performed on patients with interstitial lung disease (ILD). However, the small size of the samples and the presence of artefacts in the tissue obtained make the yield variable.Our objectives were 1) to attempt to reproduce transbronchial cryobiopsy under the same conditions with which we performed conventional TBB, that is, in the bronchoscopy unit without intubating the patient and without fluoroscopy or general anaesthesia; 2) to describe the method used for its execution; and 3) to analyse the diagnostic yield and its complications.We carried out a prospective study that included 106 patients with clinical and radiological features suggestive of ILD who underwent cryo-transbronchial lung biopsy (cryo-TBB) under moderate sedation without endotracheal intubation, general anaesthesia or use of fluoroscopy. We performed the procedure using two flexible bronchoscopes connected to two video processors, which we alternated until obtaining the number of desired samples.A definitive diagnosis was obtained in 91 patients (86%). As for complications, there were five pneumothoraces (4.7%) and in no case was there severe haemorrhage or exacerbation of the underlying interstitial disease. Cryo-TBB following our method is a minimally invasive, rapid, safe and economic technique that can be performed in a bronchoscopy suite under moderate sedation without the need for intubating the patient or using fluoroscopy and without requiring general anaesthesia.

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

“…• There is a need for standardization of TBCB procedures given the majority reported variability in diagnostic yield (50-100%) and complications (rate of pneumothorax from 0% up to about 30%) [34][35][36].…”

Transbronchial Lung Cryobiopsy in Interstitial Lung Diseases: Best Practice

“…The study showed that fewer pneumothoraces and moderate-to-severe bleeding were observed using fluoroscopy and bronchial blocker, respectively [23]. Alternatively, two scopes alternated during the procedure may avoid the need for intubation [24]. In a study by Bango-Álvarez et al [24], bleeding was controlled with this technique.…”

“…Alternatively, two scopes alternated during the procedure may avoid the need for intubation [24]. In a study by Bango-Álvarez et al [24], bleeding was controlled with this technique. Out of 106 patients, they obtained a diagnosis in 91 cases (86%), pneumothoraces were observed in 4.7% and no acute exacerbation of IPF or severe bleeding were observed.…”

The safety and efficacy of different methods for obtaining transbronchial lung cryobiopsy in diffuse lung diseases

“…Most centers perform TBLC under fluoroscopic guidance . A recent study, however, has described the procedure without the use of fluoroscopy and such a technique has been advocated in view of its simplicity . There is also a varying practice with the use of an occlusion balloon to block the biopsied segment .…”