The diagnostic role of transbronchial lung cryobiopsy in inflammatory myeloid neoplasms
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Updated: Jun 6, 2026
Robotic-assisted Bronchoscopy Combined with Multimodal Imaging for Targeted Lung Cryobiopsies
Published on: July 19, 2024
Simone Petrarulo1, Claudia Ravaglia2, Fabio Sultani1
1Department of Medical Specialities, Pulmonology Unit, GB Morgagni-L. Pierantoni Hospital, Forlì, Italy.
Insights
Transbronchial lung cryobiopsy (TBLC) is a feasible diagnostic tool for inflammatory myeloid neoplasms (IMN). This less invasive procedure shows high diagnostic yield for pulmonary IMN, comparable to surgical lung biopsy.
Area of Science:
- Pulmonology
- Pathology
- Oncology
Background:
- Inflammatory myeloid neoplasms (IMN), such as Langerhans cell histiocytosis (LCH) and Erdheim-Chester disease (ECD), often require histological confirmation.
- Surgical lung biopsy (SLB) is the traditional diagnostic standard for IMN but is associated with significant morbidity.
- Transbronchial lung cryobiopsy (TBLC) presents a less invasive alternative, but its diagnostic utility in IMN requires further definition.
Purpose of the Study:
- To evaluate the diagnostic yield, safety, and feasibility of TBLC for pulmonary IMN.
- To compare TBLC with SLB in diagnosing IMN.
- To explore correlations between high-resolution computed tomography (HRCT) findings, pulmonary function, and procedural risks in IMN.
Main Methods:
- Retrospective analysis of patients diagnosed with pulmonary IMN between 2014 and 2025 who underwent TBLC or SLB.
- Collection of clinical, radiological, histopathological, and molecular data.
- Semi-quantitative HRCT scoring to assess cystic and nodular burden, correlated with pulmonary function and pneumothorax risk.
Main Results:
- TBLC achieved an 81% diagnostic yield (17/21 cases), while SLB was diagnostic in all seven cases.
- Next-generation sequencing (NGS) on cryobiopsy samples identified MAPK-pathway mutations in three patients.
- Cystic burden correlated with reduced FEV₁ and DLCO; higher nodular scores in the TBLC group suggested earlier disease stages. Pneumothorax occurred in 17% of TBLC cases, with shorter hospital stays compared to SLB.
Conclusions:
- TBLC is a feasible and effective diagnostic method for pulmonary IMN.
- Cystic burden in IMN correlates with functional impairment and may influence procedural risk.
- TBLC can be safely performed for pulmonary IMN when guided by multidisciplinary evaluation.
Background:
Inflammatory myeloid neoplasms(IMN), including Langerhans cell histiocytosis (LCH) and Erdheim-Chester disease (ECD),may require histological confirmation. Surgical lung biopsy(SLB) is the traditional diagnostic standard but carries notable morbidity. Transbronchial lung cryobiopsy(TBLC) has emerged as a less invasive alternative, though its role in IMN remains insufficiently defined.
Methods:
We retrospectively analyzed patients diagnosed with pulmonary IMN between 2014 and 2025 who underwent TBLC or SLB. Clinical, radiological, histopathological, and molecular data were collected. Diagnostic yield, complications, and feasibility of TBLC were compared with SLB. Semi-quantitative HRCT scoring was used to assess cystic and nodular burden and explore correlations with pulmonary function and pneumothorax risk.
Results:
Twenty-one patients underwent TBLC and seven underwent SLB. TBLC established a diagnosis in 17 of 21 cases(81%), while SLB was diagnostic in all seven. NGS was feasible in nine cryobiopsy samples, identifying MAPK-pathway mutations in three patients. Cystic burden correlated with reduced FEV₁ and showed a trend toward lower DLCO; nodular scores were higher in the TBLC group and associated with a significantly higher FEV₁/FVC ratio, suggesting earlier disease stages. Pneumothorax occurred in three PLCH patients (17%), all managed with chest tube placement. Although cystic scores were higher in these cases, no significant association was observed within the TBLC subgroup. Mean hospital stay after TBLC-related pneumothorax was shorter than that for SLB.
Conclusion:
TBLC is a feasible and effective diagnostic approach for pulmonary IMN. Cystic burden reflects functional impairment and may influence procedural risk but does not preclude TBLC when guided by multidisciplinary evaluation.