Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: A systematic review and meta‐analysis

Abstract

Forceps biopsy (FB) is the most commonly used diagnostic tool for lung pathologies. FB is associated with a high diagnostic failure rate. Cryobiopsy (CB) is a novel technique providing a larger specimen size, few artefacts, more alveolar parts and superior diagnostic yield. CB, however, has drawbacks such as higher bleeding and pneumothorax rate. We conducted a metaanalysis to investigate the specimen area, diagnostic rate and bleeding severity in CB versus FB in interstitial lung diseases (ILDs) and lung tumours. A systematic literature search of PUBMED, BIOSIS PRE-VIEW and OVID databases was conducted using specific search terms. Eligible studies including RCTs and nonRCTs comparing cryobiopsy/cryotransbronchial biopsy (CB/CTBB) and forceps biopsy/forceps transbronchial biopsy (FB/FTBB) for specimen area, diagnostic rate and bleeding rate in ILDs and lung tumours were analysed. Two reviewers independently extracted data and evaluated the quality of the studies. Eight studies involving 916 patients were analysed. Specimen area (mm 2 ) was significantly larger in CB/CTBB than FB/FTBB (standard mean difference = 1.21, 95% confidence interval (0.94, 1.48), P < 0.00001). The diagnostic rate was significantly higher in CB/CTBB than FB/FTBB (Risk ratio 1.36, 95% confidence interval (1.16, 1.59), P = 0.0002). Three studies compared the bleeding severity with only one showing significantly more bleeding in CB. Cryobiopsy/cryotransbronchial shows superiority to FB/FTBB for specimen area and diagnostic rate. CB/CTBB has better efficacy over FB/FTBB.

Acute histopathological effects of cryotherapy on lung tissue

“…Although surgical biopsy is still the gold standard for diagnosis of interstitial lung diseases, transbronchial cryobiopsy is getting more common with satisfactory results [20][21][22][23]. Pneumothorax and bleeding are the most common complications [21].…”

Transbronchial Cryobiopsies

“…9,10 However, the overall DY is poor, reported to be as low as 38 to 50% in large retrospective case reviews of patients with DPLD. 10,11 Although the yield may be higher in specific diseases such as sarcoidosis, hypersensitivity pneumonitis (HP), and infectious lung disease, 6,11,12 the low overall DY has resulted in fTBB falling out of favor in a majority of diagnostic algorithms. SLB remains the gold standard for obtaining histopathologic diagnoses but carries a significant associated morbidity and mortality.…”

“…3 Reports have largely focused on the diagnosis of diffuse parenchymal lung disease (DPLD); however, reports on its utility in cancer, postlung transplant, and immunocompromised hosts are emerging. [4][5][6] The diagnostic yield (DY) of TBLCB has been promising with most studies reporting a specific DPLD DY of >80%. 7 Despite growing interest and implementation of TBLCB into practice, its role in the diagnosis of DPLD remains unclear.…”

New Technologies for C Ryosurgery in Endoscopic Treatment of Lung and Bronchial Tumors

“…Криобиопсия позволяет осуществлять забор биологиче-ской ткани в 3-4 раза большего объема, сохраняя ее структуру для последующего гистологического и иммуно-гистохимического исследования. Криобиопсия позволяет избежать повреждения ткани, свойственного традицион-ной биопсии, -раздавливание ткани в процессе забора материала и последующая химическая фиксация [27][28][29].…”