Transbronchial Cryobiopsy Is Superior to Forceps Biopsy for Diagnosing both Fibrotic and Non-Fibrotic Interstitial Lung Diseases

Abstract

<b><i>Background:</i></b> Interstitial lung disease (ILD) evaluation often requires lung biopsy for definite diagnosis. In recent years, transbronchial cryobiopsy (TBCB) emerged as a procedure with higher diagnostic yield than transbronchial forceps biopsy (TBFB), especially for fibrotic ILDs. Nonetheless, studies comparing these modalities in non-fibrotic ILDs and for specific ILD diagnoses are scarce. <b><i>Objectives:</i></b> The aim of this study was to evaluate the diagnostic yield and safety of TBCB and TBFB in patients with fibrotic and non-fibrotic ILDs. <b><i>Method:</i></b> An observational retrospective multicenter study including patients with ILD diagnosis by multidisciplinary discussion that underwent TBCB or TBFB between 2017 and 2021. Chest CT scans were reviewed by a chest radiologist. Biopsy specimens were categorized as diagnostic (with specific histological pattern), nondiagnostic, or without lung parenchyma. Nondiagnostic samples were reassessed by a second lung pathologist. TBCB and TBFB diagnostic yields were analyzed by multivariate regression. Procedural complications were evaluated as well. <b><i>Results:</i></b> 276 patients were included, 116 (42%) underwent TBCB and 160 (58%) TBFB. Fibrotic ILDs were present in 148 patients (54%). TBCB diagnostic yield was 78% and TBFB 48% (adjusted odds ratio [AOR] 4.2, 95% CI: 2.4–7.6, <i>p</i> < 0.01). The diagnostic yield of TBCB was higher than TBFB among patients with fibrotic ILD (AOR 3.8, <i>p</i> < 0.01), non-fibrotic ILD (AOR 5.8, <i>p</i> < 0.01), and across most ILD diagnoses. TBCB was associated with higher risk for significant bleeding (10% vs. 3%, <i>p</i> < 0.01), but similar risk for pneumothorax. <b><i>Conclusions:</i></b> Diagnostic yield of TBCB was superior to that of TBFB for both fibrotic and non-fibrotic ILDs, and across most diagnoses.

Tract creation with a 25-gauge needle for convex endobronchial ultrasound-guided core biopsy in intrapulmonary lesions adjacent to bronchi: three case reports

“…However, by performing EBUS-TBNA with a 25-gauge needle for tract creation, as in the present case report, the thinner CP-EBUS scope may enable clinicians to perform subsequent EBUS-CB with a 1.1-mm cryoprobe of more peripheral peribronchial lesions and overcome the inability to use a 22-gauge needle. Compared with forceps biopsy, cryobiopsy has been shown to have better diagnostic results without major complications ( 25 ). Accordingly, EBUS-CB using a 1.1 mm cryoprobe with a thinner CP-EBUS scope that has a narrow 5.9 mm tip may facilitate the diagnosis of more peripheral intrapulmonary lesions.…”