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Published on: July 19, 2024
Learning Curve for Transbronchial Lung Cryobiopsy in Interstitial Lung Disease Diagnosis: A Multicenter Experience
Run Tong1, Shuliang Guo2, Yang Xia3
1National Centre for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Centre for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Centre of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
Insights
Transbronchial lung cryobiopsy (TBLC) is a safe method for diagnosing interstitial lung disease (ILD). Proficiency in TBLC requires extensive training, with senior physicians reaching competency faster than junior ones.
Area of Science:
- Pulmonology
- Interventional Pulmonology
- Diagnostic Procedures
Background:
- Transbronchial lung cryobiopsy (TBLC) is an emerging technique for diagnosing interstitial lung disease (ILD).
- The learning curve and experience required for TBLC proficiency are not well-defined.
- Understanding the learning curve is crucial for safe and effective implementation of TBLC.
Purpose of the Study:
- To evaluate the learning curve associated with transbronchial lung cryobiopsy (TBLC) for diagnosing interstitial lung disease (ILD).
- To determine the diagnostic yield and complication rates during the initial learning phase of TBLC.
- To compare the proficiency acquisition between chief and attending physicians.
Main Methods:
- Retrospective analysis of the first 100 TBLC procedures performed by six physicians across three centers.
- Comparison of diagnostic yield, procedural details, and complications between consecutive patient groups.
- Logistic regression analysis of diagnostic yields across experience intervals to delineate the learning curve.
Main Results:
- The overall multidisciplinary discussion (MDD)-based diagnostic rate for ILD was 75%.
- Diagnostic yield improved with increasing operator experience.
- Chief physicians achieved proficiency around 60 procedures, while attending physicians required approximately 90 procedures.
Conclusions:
- Transbronchial lung cryobiopsy (TBLC) is a safe and effective method for ILD diagnosis.
- Extensive training and structured programs are essential for TBLC proficiency.
- Senior physicians demonstrated a faster learning curve compared to junior colleagues.
Introduction:
Transbronchial lung cryobiopsy (TBLC) is increasingly used to diagnose interstitial lung disease (ILD). However, the learning curve associated with this technique remains unclear.
Methods:
This retrospective analysis included the first 100 patients suspected of having ILD for whom TBLC was performed by six physicians (three chief physicians and three attending physicians) across three centers in China. The diagnostic yield, procedural information, and complications were compared between consecutive groups of patients. Logistic regression was employed to analyze the median diagnostic yields across ten subgroups of operative experience, categorized in intervals of 10 patients, to delineate the learning curve.
Results:
The overall multidisciplinary discussion (MDD)-based diagnostic rate for ILD after TBLC was 75% (450 of 600 procedures). The diagnostic yield increased with time. Learning curves revealed that chief physicians achieved proficiency after approximately 60 procedures and attending physicians after approximately 90. The sample biopsy was larger for chief physicians than for attending physicians (median, 19 mm2 vs. 15.25 mm2, p < 0.001). The complication rates were acceptable, with no significant difference between the chief and attending physicians over their first 100 procedures.
Conclusion:
TBLC is a safe and effective diagnostic approach for ILD, but operators require extensive training to achieve proficiency. Senior physicians reached competency earlier than junior colleagues (after several dozen procedures), underscoring the importance of structured training programs and standardized protocols for facilitating safe implementation.
