Transbronchial lung cryo-rebiopsy for progressive interstitial lung disease

Transbronchial lung cryobiopsy (TBLC) is recommended as an alternative to surgical lung biopsy. However, the diagnostic accuracy of TBLC is lower than that of surgical biopsy, which occasionally necessitates re-evaluation of the initial treatment strategy following disease progression. The present retrospective study aimed to evaluate the diagnosis and/or treatment modifications following cryo-rebiopsy, as well as the safety of the procedure in patients with progressive interstitial lung disease (ILD).

We reviewed the medical records of 36 consecutive ILD patients who underwent rebiopsy by TBLC after developing clinical progression between June 2017 and June 2023 at our hospital. We assessed the diagnostic changes, treatment modifications and complications associated with the rebiopsy.

Cryo-rebiopsy resulted in an updated diagnosis for 19 cases (52.8 %). Nine out of the 16 cases that were initially classified as unclassifiable interstitial pneumonia had a different specific diagnosis following a rebiopsy. Treatment was modified in 27 cases (75.0 %), with 18 cases (50.0 %) receiving additional anti-inflammatory therapy and 13 cases (36.1 %) starting antifibrotic drugs. Among the total cases, 23 (63.9 %) were classified as progressive pulmonary fibrosis (PPF). Among the PPF cases, 11 received additional anti-inflammatory treatment and nine underwent antifibrotic therapy following rebiopsy. The complication risks associated with rebiopsy were consistent with that of first biopsy.

Cryo-rebiopsy in patients with progressive ILD is as safe as the initial TBLC and provides opportunities for pathology-based treatment adjustment for precision medicine.