Integration of transbronchial cryobiopsy into multidisciplinary board decision: a single center analysis of one hundred consecutive patients with interstitial lung disease

• Published in: Respiratory research Vol. 22; no. 1; p. 228
• Main Authors: Hostettler, Katrin E, Tamm, Michael, Bubendorf, Lukas, Grendelmeier, Peter, Jahn, Kathleen, Stolz, Daiana, Bremerich, Jens, Prince, Spasenija Savic
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 14.08.2021; BioMed Central; BMC
• Subjects: Aged; Alveolitis; Biopsy; Biopsy - methods; Bronchoalveolar Lavage - methods; Bronchoscopy - methods; Bronchus; Care and treatment; Complications; Confidence; Cryobiopsy; Cryosurgery - methods; Decision analysis; Diagnosis; Diagnostic systems; Disease; Female; Fibrosis; Granulomas; Histology; Humans; Interstitial lung disease; Letter to the Editor; Lung diseases; Lung diseases, Interstitial; Lung Diseases, Interstitial - diagnostic imaging; Lung Diseases, Interstitial - pathology; Lung Diseases, Interstitial - surgery; Lungs; Male; Medical imaging; Medical instruments; Middle Aged; Multidisciplinary team discussion; Patient Care Team; Patient outcomes; Patients; Pneumonia; Pneumothorax; Sarcoidosis; Switzerland; Multidisciplinary team discussion; Interstitial lung disease; Cryobiopsy
• ISSN: 1465-993X; 1465-9921; 1465-993X; 1465-9921
• DOI: 10.1186/s12931-021-01821-w

Transbronchial cryobiopsy in the evaluation of patients with interstitial lung diseases (ILD) is expected to reduce the need for surgical lung biopsy (SLB). To evaluate the diagnostic value of cryobiopsy in combination with bronchoalveolar lavage (BAL), radiologic and clinical data in patients with ILD. Between 08/15 and 01/20 patients with ILD underwent cryobiopsy if they: did not have (i) an usual interstitial pneumonia (UIP)-pattern on CT, (ii) predominant ground-glass opacities suggesting alveolitis, (iii) findings suggestive of sarcoidosis on CT, or if they had (i) a CT showing UIP-pattern, but had findings suggesting alternative diagnosis than idiopathic pulmonary fibrosis (IPF), or (ii) had previous non-diagnostic conventional transbronchial forceps biopsy. Histological findings were integrated into the multidisciplinary team discussion (MDTD) and a diagnostic consensus was sought. One hundred patients underwent cryobiopsy. In 88/100 patients, cryobiopsy was representative with diagnostic findings in 45/88 and non-specific histological findings in 43/88 patients. In 25/43 with non-specific findings, a consensus diagnosis was reached after MDTD integrating BAL, radiologic and clinical data; eight of the remaining 18 patients with non-specific findings were referred to SLB. In 12/100 patients cryobiopsy was not representative and three of these patients were also referred to SLB. In 7/11 patients (64%) SLB was diagnostic. Complications of cryobiopsy included pneumothorax (14%) and locally controlled bleeding (24%). The diagnostic yield of cryobiopsy was 70%:45% of cryobiopsies were diagnostic based on histology alone and an additional 25% provided non-specific, but valuable findings allowing a consensus diagnosis after MDTD. Our data demonstrate that the diagnostic value of cryobiopsy is high if combined with BAL, radiologic and clinical data.