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Transbronchial cryobiopsy in immunocompromised patients with pulmonary infiltrates: a pilot study
Oren Fruchter1, Ludmila Fridel, Dror Rosengarten
1The Pulmonary Division, Rabin Medical Center, Beilinson Hospital, 49100, Petah Tikva, Israel, orenfr@clalit.org.il.
Insights
Cryo-transbronchial lung biopsy (cryo-TBB) is an effective and safe new method for diagnosing lung infiltrates in immunocompromised patients. This technique yields high-quality tissue samples, leading to improved patient management.
Area of Science:
- Pulmonology
- Interventional Pulmonology
- Oncology
Background:
- Transbronchial lung biopsy (TBB) improves diagnostic yield for pulmonary infiltrates in immunocompromised patients compared to bronchoalveolar lavage.
- Cryo-TBB is an emerging technique for obtaining lung biopsies.
Purpose of the Study:
- To evaluate the efficacy and safety of cryo-TBB in immunocompromised patients with pulmonary infiltrates.
Main Methods:
- Retrospective evaluation of 15 immunocompromised patients undergoing cryo-TBB for pulmonary infiltrates.
- Assessment of procedure characteristics, complications, and diagnostic yield.
Main Results:
- Cryo-TBB demonstrated a mean specimen surface area of 9 mm², with 70% alveolated tissue, enabling histological diagnosis.
- Diagnoses included drug reaction, diffuse alveolar damage, and granulomatous inflammation.
- No major complications were observed.
- Management was altered in 80% of patients based on cryo-TBB findings.
Conclusions:
- Cryo-TBB is a safe and effective method for obtaining diagnostic tissue in immunocompromised patients with pulmonary infiltrates.
- The technique offers advantages in sample quality and diagnostic yield.
- Further comparison with traditional forceps TBB in a randomized trial is warranted.
Background:
In immunocompromised patients with pulmonary infiltrates, transbronchial lung biopsies (TBB) obtained by forceps has been shown to increase the diagnostic yield over simple bronchoalveolar lavage. Cryo-TBB is a novel modality for obtaining lung biopsies. We aimed to evaluate for the first time the efficacy and safety of cryo-TBB in immunocompromised patients.
Methods:
Fifteen immunocompromised patients with pulmonary infiltrates underwent cryo-TBB. During the procedure two to three biopsy samples were taken. Procedure characteristics, complications, and the diagnostic yield were retrospectively evaluated.
Results:
Most patients (n = 11) were immunocompromised due to hematological malignancies. The remaining four patients were receiving chronic immunosuppressive treatment due to previous solid-organ transplantation (n = 2) or collagen-vascular disease (n = 2). No major complications occurred in the cryo-TBB group. The mean surface area of the specimen taken by cryo-TBB was 9 mm(2). The increase in surface area and quality of biopsy samples translated to a high percentage of alveolated tissue (70 %) that enabled a clear histological detection of the following diagnoses: noncaseating granulomatous inflammation (n = 2), acute interstitial pneumonitis consistent with drug reaction (n = 5), nonspecific interstitial pneumonia fibrotic variant (n = 1), diffuse alveolar damage (n = 3), organizing pneumonia (n = 3), and pulmonary cryptococcal pneumonia (n = 1). Diagnostic information obtained by cryo-TBB led to change in the management of 12 patients (80 %).
Conclusion:
Cryo-TBB in immunocompromised patients with pulmonary infiltrates provides clinically important diagnostic data with a low complication rate. These advantages should be further compared with traditional forceps TBB in a prospective randomized trial.