Diagnostic Yield of Transbronchial Lung Cryobiopsy Compared to Transbronchial Forceps Biopsy in Patients with Sarcoidosis in a Prospective, Randomized, Multicentre Cross-Over Trial

Abstract

Background: Transbronchial lung forceps biopsy (TBLF) is of limited value for the diagnosis of interstitial lung disease (ILD). However, in cases with predominantly peribronchial pathology, such as sarcoidosis, TBLF is considered to be diagnostic in most cases. The present study examines whether transbronchial lung cryobiopsy (TBLC) is superior to TBLF in terms of diagnostic yield in cases of sarcoidosis. Methods: In this post hoc analysis of a prospective, randomized, controlled, multicentre study, 359 patients with ILD requiring diagnostic bronchoscopic tissue sampling were included. TBLF and TBLC were both used for each patient in a randomized order. Histological assessment was undertaken on each biopsy and determined whether sarcoid was a consideration. Results: A histological diagnosis of sarcoidosis was established in 17 of 272 cases for which histopathology was available. In 6 out of 17 patients, compatible findings were seen with both TBLC and TBLF. In 10 patients, where the diagnosis of sarcoidosis was confirmed by TBLC, TBLF did not provide a diagnosis. In one patient, TBLF but not TBLC confirmed the diagnosis of sarcoidosis. Conclusions: In this post hoc analysis, the histological diagnosis of sarcoidosis was made significantly more often by TBLC than by TBLF. As in other idiopathic interstitial pneumonias (IIPs), the use of TBLC should be considered when sarcoidosis is suspected.

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

“…This could explain the similar diagnostic yield of TBCB and TBFB in our study among patients with OP or EP. However, we did find TBCB to be superior for sarcoidosis (87% vs. 46%), as was shown in a recent prospective study by Hantschel et al [28]. TBCB and TBFB also showed similar results for patients with iNSIP.…”

S1-Leitlinie Interdisziplinäre Diagnostik interstitieller Lungenerkrankungen im Erwachsenenalter

“…Bei Sarkoidose liegt die diagnostische Wertigkeit der TBB ohne EBUS bei 71 %, mit EBUS steigt sie auf 87 % [55,129]. Ergebnisse einer prospektiven, randomisierten, multizentrischen Studie mit Cross-Over-Design (TBB vs. TBLC) wiesen eine deutlich niedrigere Trefferquote für die durch TBB als TBLC gewonnenen Proben auf (35 % vs. 59 %) [130]. Wegen der niedrigen Fallzahl (n = 17) müssen die Ergebnisse dieser Subgruppenanalyse allerdings mit Vorsicht interpretiert werden.…”

Diagnosis of pulmonary sarcoidosis in tuberculosis endemic area—a narrative review

“…Considering the role of TBLB in the diagnosis of TB, Chan et al reported the highest sensitivity of TBLB (77% of sensitivity) when using radial probe endobronchial ultrasound guidance, whereas other studies also reported the sensitivity range of 16–77% for the diagnosis of TB by using TBLB alone ( 49 , 50 ). Transbronchial lung cryobiopsy (TBLC) which retrieves lung tissue by freezing probe via bronchoscopy is considered to provide better diagnostic yield than TBLB in interstitial lung diseases including sarcoidosis as described in recent studies ( 51 , 52 ). However, the risk of hemorrhage and pneumothorax, the main complications of TBLC, is extremely high, and its indication should be carefully considered.…”