Role of Transbronchial Lung Cryobiopsies in Diffuse Parenchymal Lung Diseases: Interest of a Sequential Approach

Abstract

Background. Transbronchial lung cryobiopsies (TBLCs) are a promising diagnostic tool in the setting of diffuse parenchymal lung diseases (DPLDs). However, no comparison with surgical lung biopsy (SLB) in the same patient is available. Methods. The diagnostic yield and safety data of TBLCs, as well as the result of SLB performed after TBLCs, were analysed in a multicentric Belgian study. A SLB was performed after TBLCs in absence of a definite pathological diagnosis or if a NSIP pattern was observed without related condition identified following multidisciplinary discussion. Results. Between April 2015 and November 2016, 30 patients were included. Frequent complications included pneumothorax (20%) and bleeding (severe 7%, moderate 33%, and mild 53%). There was no mortality. The overall diagnostic yield was 80%. A SLB was performed in six patients (three without definite histological pattern and three with an NSIP). The surgical biopsy changed the pathological diagnosis into a UIP pattern in five patients and confirmed a NSIP pattern in one patient. Conclusion. TBLCs are useful in the diagnostic work-up of DPLDs avoiding a SLB in 80% of the patients. However, surgical biopsies, performed as a second step after TBLCs because of an indefinite diagnosis or a NSIP pattern, provide additional information supporting the interest of a sequential approach in these patients.

Usefulness of Surgical Lung Biopsies after Cryobiopsies when Pathological Results Are Inconclusive or show a Pattern Suggestive of a Nonspecific Interstitial Pneumonia

“…Therefore, the added value of SLB performed after TBLC was evaluated in this study when the latter showed nondiagnostic or unspeci c pathological results without con dent diagnosis following another multidisciplinary discussion. Preliminary results obtained on a limited number of patients were published in 2017 [9]. In this follow up study, we provide more evidence supporting the bene t of performing SLBs in these selected situations.…”

“…Procedures were performed as previously described [9]. Brie y, all procedures were performed under general anesthesia.…”

“…However, SLB is an invasive procedure with signi cant comorbidities, a hospitalization for a few days, systematic chest drainage, and a postoperative mortality rate of 2% up to 3.6% [3][4][5][6][7]. Therefore, transbronchial lung cryobiopsy (TBLC) is increasingly recognized as an alternative technique for the diagnosis of DPLDs [6,[8][9][10][11]. TBLC appears to be safer than SLB, and its contribution to the diagnosis obtained via multidisciplinary discussion is comparable to that of SLB, although the histological diagnostic yield is higher with SLB (approximately 80% for TBLC vs 95% for SLB) [11].…”

S2K-Leitlinie zur Diagnostik der idiopathischen Lungenfibrose

“…Die Leitliniengruppe empfiehlt jedoch, die u.a. Aspekte der Kryobiopsie unbedingt zu beachten [141]. Kritisch anzumerken ist, dass die Prozedur bisher nicht international standardisiert ist und bisher nur wenige, teils widersprüchliche Daten aus kontrollierten Studien zur TBLC im Vergleich zur chirurgischen Lungenbiopsie vorliegen.…”

Transbronchial Cryobiopsy in the Diagnosis of Fibrotic Interstitial Lung Disease

“…Studies comparing the diagnostic yield of transbronchial cryobiopsy and SLB in the same patient are few, and in the majority SLB was performed only when cryobiopsy results were inconclusive. Based on these limited studies, 33,41,42 SLB confirmed the diagnostic impression of the cryobiopsy in 15 of 22 patients (68%); however, the small number of cases and the selection bias are major limiting factors. Four studies have compared the diagnostic yield of cryobiopsy and SLB including 2 prospective studies 2,43 and 2 retrospective studies.…”