Transbronchial Lung Cryobiopsy and Awake Video-Assisted Thoracic Surgery in Interstitial Lung Disease: Complementary...

Area of Science:

• Pulmonology
• Thoracic Surgery
• Diagnostic Procedures

Background:

• Diagnosing interstitial lung diseases (ILDs) is challenging with inconclusive clinical and imaging data.
• Surgical lung biopsy, the traditional gold standard, has limitations due to invasiveness and risks, especially in vulnerable patients.

Purpose of the Study:

• To review the roles of transbronchial lung cryobiopsy (TBLC) and awake video-assisted thoracoscopic surgery (Awake VATS) in ILD diagnosis.
• To analyze their diagnostic performance, safety, indications, and integration into ILD diagnostic pathways.

Main Methods:

• A narrative literature review was conducted.
• Evidence from multidisciplinary ILD centers and guidelines was critically analyzed.

Main Results:

• TBLC shows an ~80% diagnostic yield with an acceptable safety profile, emerging as a first-line procedure.
• Awake VATS provides high diagnostic accuracy while preserving spontaneous ventilation.
• A TBLC-first strategy followed by selective surgical escalation is comparable to upfront biopsy but with fewer complications.

Conclusions:

• TBLC and Awake VATS are complementary, not competitive, tools for ILD diagnosis.
• Integrated use optimizes accuracy, minimizes invasiveness, and improves patient safety.
• A personalized, risk-adapted approach to histological assessment is supported.