Transbronchial Lung Cryobiopsy in Idiopathic Pulmonary Fibrosis: A State of the Art Review

Abstract

Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease associated with significant morbidity and mortality. The diagnosis of IPF involves a combination of clinical history, radiological imaging and examination of histopathological samples in appropriate cases. Historically, transbronchial biopsy (TBB) has been used to obtain histological samples; however this lacks diagnostic accuracy. At present, surgical lung biopsy (SLB) is the gold standard technique for obtaining specimen samples; however this carries a significant mortality risk. Transbronchial lung cryobiopsy (TBLC) is a new technique that has been pioneered in the management of lung malignancy and offers a potential alternative to SLB. The technique employs a freezing probe, which is used to obtain lung tissue samples that are larger and better quality than traditional TBB samples. This affords TBLC an estimated diagnostic yield of 80% in interstitial lung disease. However, with limited evidence directly comparing TBLC to SLB, the diagnostic accuracy of the procedure has been uncertain. Common complications of TBLC include pneumothorax and bleeding. Mortality in TBLC is low compared with SLB, with exacerbation of IPF frequently reported as the cause. TBLC represents an exciting potential option in the diagnostic pathway in IPF; however its true value has yet to be determined.

Diagnostic and Treatment Standards in Idiopathic Pulmonary Fibrosis in the Era of Antifibrotic Drugs in Poland: A Real-World Practice Survey

“…More than half of the respondents refer patients with a suspicion of IPF for TBLC rarely and almost 40% never refer them for TBLC. TBLC represents a novel and exciting tool in the diagnostic pathway in IPF and offers a potentially safer, less-invasive and cheaper alternative to SLB, although less accurate [9]. The low use of TBLC in the diagnosis of IPF in Poland may be caused by less availability and experience with TBLC in our country.…”

Criobiopsia como método diagnóstico de neumonía por Pneumocystis jirovecii

“…De igual manera, podrían desarrollar hemorragias moderadas a severas, que se han asociado a la toma de muestras de lóbulos inferiores de hasta 40%. [14,15] CONCLUSIÓN Todos estos esfuerzos globales para desarrollar técnicas cada vez más seguras y eficientes en el diagnóstico están orientadas a llegar a un diagnóstico basado en evidencia histológica y microbiológica, más que realizar tratamientos basados en sospechas y así cambiar el curso clínico de nuestros pacientes, al igual que utilizar de mejor forma los recursos en salud.…”

Guidelines of the Polish Respiratory Society for Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis

“…Observational studies based on IPF patient registries indicate that material for lung pathomorphological examination is ever-more often collected using the TBLC method [146]. At present, the procedure is not commonly available or practiced, although there are ongoing attempts at its standardisation [147][148][149]. Material collected with this method is usually smaller than in surgical biopsy, with no possibility of choosing the precise biopsy siteit usually comes from the more centrally located areas [122].…”