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A systematic review of procedural and sampling techniques for cryobiopsy in interstitial lung disease
Julia A Lachowicz1,2, Natasha E Smallwood3,4, Jyotika D Prasad5,4,6,7
1Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia julia.lachowicz@mh.org.au.
Insights
Transbronchial lung cryobiopsy (TBLC) offers an 81% diagnostic yield for interstitial lung disease (ILD). Procedural factors like general anesthesia and probe size significantly impact TBLC
Area of Science:
- Pulmonology
- Interventional Pulmonology
- Diagnostic Procedures
Background:
- Transbronchial lung cryobiopsy (TBLC) serves as an alternative to surgical lung biopsy for diagnosing interstitial lung disease (ILD) with low confidence.
- Current literature on TBLC's diagnostic performance and safety, particularly concerning procedural and sampling techniques, requires synthesis.
- Unclassifiable ILD necessitates reliable histopathological evaluation methods.
Purpose of the Study:
- To synthesize current literature on the diagnostic performance and safety of TBLC.
- To focus on the impact of procedural and sampling techniques on TBLC outcomes.
- To identify factors influencing the diagnostic yield and complication rates of TBLC.
Main Methods:
- A systematic meta-analysis of studies published up to April 11, 2022, was conducted.
- Included studies focused on adults with unclassifiable ILD, reporting diagnostic yield, complications, and TBLC techniques.
- Meta-analyses were performed for diagnostic yield, pneumothorax, and bleeding, with subgroup analyses assessing methodological variables.
Main Results:
- The overall diagnostic yield of TBLC was 81% (95% CI 79-83%), with improved yield associated with general anesthesia, multidisciplinary ILD meetings, a 2.4 mm cryoprobe, and higher lung function parameters.
- Pneumothorax occurred in 5% (95% CI 4-5%) of cases, with increased rates linked to the 2.4 mm cryoprobe, routine post-procedure imaging, and multiple lobe sampling.
- Moderate-to-severe bleeding occurred in 12% (11-14%) of cases, with higher rates associated with the 2.4 mm cryoprobe and specific bleeding score selections.
Conclusions:
- Patient characteristics and modifiable factors, including procedural and anesthetic techniques, significantly influence TBLC's diagnostic yield and safety in unclassifiable ILD.
- These variables contribute to the heterogeneity of clinical outcomes observed with TBLC.
- Individualized clinical decision-making and future guideline development should consider these factors, and routine reporting in research is warranted.
Background:
Transbronchial lung cryobiopsy (TBLC) is an alternative to surgical lung biopsy for histopathological evaluation of unclassifiable interstitial lung disease (ILD) or ILD diagnosed with low confidence. This meta-analysis synthesised current literature regarding cryobiopsy diagnostic performance and safety, focusing on procedural and sampling techniques.
Methods:
Medline and Embase were searched on 11 April 2022. Studies included adults with unclassifiable ILD, reporting diagnostic yield, complications and methodological techniques of TBLC. Meta-analyses were performed for diagnostic yield, pneumothorax and bleeding. Subgroup analyses and meta-regression assessed methodological variables. PROSPERO registration: CRD42022312386.
Results:
70 studies were included with 6183 participants. Diagnostic yield of TBLC was 81% (95% CI 79-83%, I2=97%), with better yield being observed with general anaesthesia (p=0.007), ILD multidisciplinary meeting prior to cryobiopsy (p=0.02), 2.4 mm cryoprobe (p=0.04), higher mean forced vital capacity (p=0.046) and higher mean diffusing capacity for carbon monoxide (p=0.023). Pneumothorax rate was 5% (95% CI 4-5%, I2=91%), with higher rates associated with a 2.4 mm cryoprobe (p<0.00001), routine post-procedure imaging (p<0.00001), multiple lobe sampling (p<0.0001), reduced mean diffusing capacity for carbon monoxide (p=0.028) and general anaesthesia (p=0.05). Moderate-to-severe bleeding rate was 12% (11-14%, I2=95%) and higher rates were associated with a 2.4 mm cryoprobe (p=0.001) and bleeding score selection (p=0.04).
Interpretation:
Patient characteristics and modifiable factors, including procedural methods and anaesthetic techniques, impacted diagnostic yield and safety outcomes of TBLC in people with unclassifiable ILD and contributed to heterogeneity of clinical outcomes. These variables should be considered for individualised clinical decision making and guideline development and warrant routine reporting in future research.
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