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Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: a randomized trial
Virginia Pajares1, Carmen Puzo, Diego Castillo
1Department of Respiratory Medicine, Biomedical Research Institute Sant Pau (IIb Sant Pau), Barcelona, Spain; Department of Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain.
Insights
Cryoprobe transbronchial lung biopsy (TBLB) significantly improves diagnostic yield for interstitial lung disease (ILD) compared to conventional forceps. This safer method provides larger tissue samples, aiding in accurate histopathologic diagnosis.
Area of Science:
- Pulmonology
- Interventional Pulmonology
- Diagnostic Pathology
Background:
- Transbronchial lung biopsy (TBLB) is crucial for diagnosing interstitial lung disease (ILD).
- Conventional forceps TBLB has variable diagnostic yield influenced by sample size and artifacts.
- Cryoprobe sampling offers a potential alternative for TBLB.
Purpose of the Study:
- To compare the diagnostic yield and safety of cryoprobe TBLB versus conventional forceps TBLB in ILD evaluation.
- To assess histopathologic diagnosis rates, sample quality, and procedural complications.
Main Methods:
- Randomized clinical trial involving 77 patients with ILD undergoing TBLB.
- Patients were assigned to either conventional forceps or cryoprobe sampling.
- Histopathologic diagnoses were assessed by two pathologists; procedural data and complications were compared.
Main Results:
- Cryoprobe TBLB yielded significantly higher histopathologic diagnosis rates (74.4% vs. 34.1%, P < 0.001) and diagnostic yield (51.3% vs. 29.1%, P = 0.038).
- Larger tissue samples were obtained with cryoprobe (14.7 mm² vs. 3.3 mm², P < 0.001).
- Increased grade 2 bleeding was observed in the cryoprobe group (56.4% vs. 34.2%), but other complications were similar.
Conclusions:
- Cryoprobe TBLB is a safe and effective method for diagnosing ILD, offering improved diagnostic yield.
- The procedure yields larger tissue samples, facilitating better histopathologic assessment.
- Larger multisite trials are needed to confirm these benefits.
Background And Objective:
Transbronchial lung biopsy (TBLB) is required for evaluation in selected patients with interstitial lung disease (ILD). The diagnostic yield of histopathologic assessment is variable and is influenced by factors such as the size of samples and the presence of crush artefacts left by conventional biopsy forceps. We compared the diagnostic yield and safety of TBLB with cryoprobe sampling versus conventional forceps sampling.
Methods:
This randomized clinical trial analysed data for 77 patients undergoing TBLB for evaluation of ILD; patients were assigned to either a conventional-forceps group or a cryoprobe group. Two pathologists assessed the tissue samples and agreed on histopathologic diagnoses. We also compared the duration of procedures, complications and sample-quality variables.
Results:
The most frequent diagnosis observed in the cryoprobe group was non-specific interstitial pneumonia. Histopathologic diagnoses were identified in more cases in the cryoprobe group (74.4%) than in the conventional-forceps group (34.1%) (P < 0.001), and the diagnostic yield was higher in the cryoprobe group (51.3% vs 29.1% in the conventional forceps group; P = 0.038). A larger mean area of tissue was harvested by cryoprobe (14.7 ± 11 mm(2) ) than by conventional forceps (3.3 ± 4.1 mm(2)) (P < 0.001). More grade 2 bleeding (not statistically significant) occurred in the cryoprobe group (56.4%) than in the conventional-forceps group (34.2%). No differences in other complications were observed.
Conclusions:
TBLB by cryoprobe is safe and potentially useful in the diagnosis of ILD. Larger multisite randomized trials are required to confirm the potential benefits of this procedure. Clinical trial registration at ClinicalTrials.gov: NCT01064609.
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