Time to Trust Transbronchial Cryobiopsy in Identification of Usual Interstitial Pneumonia Pattern?

Transbronchial lung cryobiopsy for the diagnosis of interstitial lung diseases

“…Application of the four histopathological criteria for UIP may be more challenging when the pulmonary tissue is obtained by transbronchial cryobiopsy (TBLC), this concern being possibly explained by the fact that TBLC usually samples centrilobular zones [24]; TBLC is more likely to provide a probable UIP pattern (characterized by combination of 'fibroblast foci', 'patchy fibrosis' and 'absence of features suggesting an alternative diagnosis') than a definite UIP pattern, given the limited sampling of sub-pleural lung parenchyma in most cases [8 ] compared lung samples obtained in the same patients by TBLC and SLB and demonstrated that finding of a probable UIP pattern at TBLC samples is strongly predictive of a definite UIP pattern in the corresponding SLB. Hence, samples obtained by TLCB, although often not containing the most peripheral of alveolar parenchyma, may be adequate enough to classify as definite UIP by pathologists with experience in reporting such cases [23,[78][79][80] and combination of UIP and probable UIP patterns in the context of MDD may result in comparable rates of diagnostic agreement for both surgical lung biopsy and TBLC in patients with IPF [8…”

“…However, Cooper et al [63 ▪ ] compared lung samples obtained in the same patients by TBLC and SLB and demonstrated that finding of a probable UIP pattern at TBLC samples is strongly predictive of a definite UIP pattern in the corresponding SLB. Hence, samples obtained by TLCB, although often not containing the most peripheral of alveolar parenchyma, may be adequate enough to classify as definite UIP by pathologists with experience in reporting such cases [23,78–80] and combination of UIP and probable UIP patterns in the context of MDD may result in comparable rates of diagnostic agreement for both surgical lung biopsy and TBLC in patients with IPF [8 ▪ ].…”

Incidental discovery of interstitial lung disease: diagnostic approach, surveillance and perspectives

“…Mini-invasive biopsy techniques such as transbronchial lung cryobiopsy (TBLC) can be helpful in discriminating early IPF from ILA. The safety and feasibility of TBLC have been reported in several studies that included early ILD cases mixed with more advanced cases: thus, studies designed to evaluate the accuracy of TBLC in early ILDs and ILA are needed [30,[80][81][82][83][84][85][86][87]. Innovative guidance systems for TBLC are currently under investigation and may open new scenarios for a safer and more accurate diagnosis of cases with limited disease extent on HRCT [88].…”

“…As this is an "at risk" population, post-COVID abnormalities may best be viewed as distinct from ILA, pending further data. Importantly, COVID-19 data may well be relevant to severe viral pneumonitis in general and raises the possibility that, in a subset of patients, ILA may represent post-viral damage [26][27][28][29][30].…”

Biopsy in interstitial lung disease: specific diagnosis and the identification of the progressive fibrotic phenotype

“…However, Cooper and colleagues [32 ▪▪ ], comparing samples obtained by TBLC and SLB (surgical lung biopsy) in the same patient, demonstrated that the combination of ‘fibroblast foci’, ‘patchy fibrosis’ and ‘absence of features to suggest an alternative diagnosis’ in TBLC samples was strongly predictive of definite UIP in the corresponding SLB [32 ▪▪ ]. Hence, samples obtained by TBLC, although often not containing the most peripheral of alveolar parenchyma, may be adequate enough to classify as definite UIP by pathologists with experience in reporting such cases [33–35].…”