Late Breaking Abstract - Transbronchial lung cryobiopsy for interstitial lung disease diagnosis: results of the COLDICE Study

Troy, Lauren; Grainge, Christopher; Corte, Tamera J.; Williamson, Jonathan; Vallely, Michael P.; Cooper, Wendy A.; Mahar, Annabelle; Lai, Simon; Mulyadi, Ellie; Torzillo, Paul J.; Phillips, Martin J.; Jo, Helen; Webster, Susanne; Lin, Qi; Rhodes, Jessica; Salamonsen, Matthew; Wrobel, Jérémy; Harris, Benjamin; Don, Garrick; Wu, Peter; Ng, Benjamin; Oldmeadow, Christopher; Raghu, Ganesh; Lau, Edmund; Investigators, Coldice

doi:10.1183/13993003.congress-2019.rct1886

Cited by 21 publications

(18 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…8,83 More recently, the COLDICE trial (Cryobiopsy vs. Open Lung Biopsy in the Diagnosis of Interstitial Lung Disease) has shown 76.9% agreement to establish a diagnosis by MDD between SLB and TBLC, which demonstrates that TBLC is a reliable alternative for the gold-standard method. 2 Our meta-analysis of all available literature to date on TBLC draws conclusions which for the most part, are in concordance with the most recent American College of Chest Physicians (ACCP) guidelines on transbronchial cryobiopsy for diagnosis of ILD except that our study demonstrates that biopsy of > 1 segment does not increase diagnostic yield, a finding that is limited by the fact that only 2 studies performed biopsies from single segments while all other studies performed biopsies from multiple segments. In addition, there may be a limited role of SLB after a nondiagnostic TBLC.…”

Section: Discussionsupporting

confidence: 86%

“…In a recent study among patients who had unclassified disease after TBLC, SLB only reclassified 23% of patients. 2 Similarly, in another study performing SLB after nondiagnostic TBLC, histopathologic diagnosis was changed in 3 of 12 patients, while the histopathologic pattern remained unchanged and confirmed the diagnosis in 5 patients, and 4 patients of the 12 continued to have unclassified disease. 29 This raises a concern that may predispose patients to more complications without aiding in diagnosis for majority of patients who have unclassified disease after TBLC.…”

Section: Discussionmentioning

confidence: 91%

“…In ∼30% of patients, lung biopsy is needed to reach a final diagnosis. [1][2][3] Surgical lung biopsy (SLB) is considered the gold-standard method for obtaining lung tissue for diagnosis in patients with ILD. However, it is associated with risks of infection, prolonged air leak, prolonged hospital stay, and mortality.…”

mentioning

confidence: 99%

“…In a recent study, TBLC was concordant with SLB in achieving a final definite or high-confidence MDD diagnosis. 2 However, another study has shown poor concordance between both approaches. 8 Previous meta-analyses reported a diagnostic yield of TBLC of around 80%.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Role of Transbronchial Lung Cryobiopsy in the Diagnosis of Interstitial Lung Disease

Zayed

Alzghoul

Hyde

et al. 2022

Journal of Bronchology &Amp; Interventional Pulmonology

View full text Add to dashboard Cite

Background: Diagnosis of interstitial lung disease (ILD) is based on multidisciplinary team discussion (MDD) with the incorporation of clinical, radiographical, and histopathologic information if available. We aim to evaluate the diagnostic yield and safety outcomes of transbronchial lung cryobiopsy (TBLC) in the diagnosis of ILD.Methods: We conducted a meta-analysis by comprehensive literature search to include all studies that evaluated the diagnostic yields and/or adverse events with TBLC in patients with ILD. We calculated the pooled event rates and their 95% confidence intervals (CIs) for the diagnostic yield by MDD, histopathologic diagnostic yield, and various clinical adverse events.Results: We included 68 articles (44 full texts and 24 abstracts) totaling 6386 patients with a mean age of 60.7 ± 14.1 years and 56% men. The overall diagnostic yield of TBLC to achieve a definite or high-confidence diagnosis based on MDD was 82.3% (95% CI: 78.9%-85.2%) and histopathologic diagnosis of 72.5% (95% CI: 67.7%-76.9%). The overall rate of pneumothorax was 9.6% (95% CI: 7.9%-11%), while the rate of pneumothorax requiring drainage by a thoracostomy tube was 5.3% (95% CI: 4.1%-6.9%). The rate of moderate bleeding was 11.7% (95% CI: 9.1%-14.9%), while the rate of severe bleeding was 1.9% (95% CI: 1.4%-2.6%). The risk of mortality attributed to the procedure was 0.9% (95% CI: 0.7%-1.3%).Conclusion: Among patients with undiagnosed or unclassified ILD requiring tissue biopsy for diagnosis, transbronchial cryobiopsy represents a reliable alternative to surgical lung biopsy with decreased incidence of various clinical adverse events.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 91%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Role of Transbronchial Lung Cryobiopsy in the Diagnosis of Interstitial Lung Disease

Zayed

Alzghoul

Hyde

et al. 2022

Journal of Bronchology &Amp; Interventional Pulmonology

View full text Add to dashboard Cite

show abstract

“…Histologic diagnosis remains, admittedly, an essential component of the multidisciplinary approach to ILD diagnosis, based on evidence suggesting improved diagnostic confidence and interobserver agreement. 8 The advent of effective antifibrotic therapies for IPF and the realization that historically used antiinflammatory agents such as steroids may, in fact, be harmful, constitute indirect evidence that early and accurate diagnosis may lead to improved patient outcomes. But it remains, as of this writing, indirect evidence only.…”

mentioning

confidence: 99%

Transbronchial Lung Cryobiopsy for the Diagnosis of Interstitial Lung Disease

Low

Kaminski

Maldonado

2023

Journal of Bronchology &Amp; Interventional Pulmonology

View full text Add to dashboard Cite

I nterstitial lung diseases (ILD) are a heterogeneous group of pulmonary diseases diagnosed through a multidisciplinary iterative process known as multidisciplinary discussion (MDD). Since the original classification of fibrotic lung diseases by Liebow and Carrington in 1969, the classification of ILD remains primarily based on histology, and a biopsy is occasionally needed when clinical and radiological data are insufficient to firmly establish the diagnosis. Surgical lung biopsy (SLB) has traditionally been recommended despite the high and arguably prohibitive morbidity and mortality rates associated with the procedure. Transbronchial cryobiopsy (TBC) has been proposed as a safer alternative based on mostly noncomparative, retrospective data and was conditionally endorsed in the recently published clinical practice guideline update for idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis. 1 In this issue of the Journal of Bronchology, Zayed et al 2 report a metaanalysis that includes 68 articles with 6386 patients to estimate diagnostic yield and safety outcomes of TBC in patients with ILD. This study is the most comprehensive to date, both qualitatively and quantitatively, and methodologically robust. It is noteworthy in several aspects: first, it supports prior estimates of diagnostic yield when considered in the context of a multidisciplinary discussion which exceeds 80%. Second, it suggests that a higher diagnostic yield may be achieved in patients with higher forced vital capacity, while paradoxically finding no correlation with numbers of biopsies or biopsied segments, a change compared to prior reports. Somewhat counter intuitively, the diagnostic yield does not appear to be affected by the bronchoscopy approach (via rigid or flexible bronchoscopy), cryoprobe size (1.9 or 2.4 mm), number of lobes or segments biopsied, and size of the tissue specimen. Finally, and more interestingly, the pooled analysis of complications reveals that moderate bleeding occurs in 11.7% of cases, with severe bleeding in 1.9%, and pneumothorax complicates 9.6% of cases, with 5.3% required tube thoracostomy. However, the mortality rate was alarmingly estimated at 0.9%, a rate that is substantially higher than previously reported 3,4 but consistent with prior data that included 30-day follow-up. 5

show abstract