Transbronchial lung cryobiopsy in smoking-related interstitial lung diseases

Transbronchial lung cr onchial lung cryobiopsy for the diagnosis of diffuse obiopsy for the diagnosis of diffuse parenchymal lung disease: Pitfalls and challenges, a single center experience

BACKGROUND

: Transbronchial lung cryobiopsy (TBLC) is a minimally invasive technique of the diagnosis of diffuse parenchymal lung diseases (DPLD). The aim of this study is to determine the clinical-radiological and histopathological characteristics of patients in whom cryobiopsy contributes to the diagnosis.

METHODS

: In this retrospective study, we searched for the medical records of patients who underwent TBLC from July 2015 to March 2020 at the pulmonology department of our university hospital clinic. Radiological images were evaluated by a chest radiologist experienced in DPLD. Prediagnosis was indicated by clinical-radiological findings. The final diagnosis was determined by the contribution of histopathological diagnosis. The agreement of pretest/posttest diagnosis and the diagnostic yield of TBLC were calculated.

RESULTS

Sixty-one patients with female predominance (59.0%) and current or ex-smoker (49.2%) made up the study population. We found the diagnostic yield of TBLC 88.5%. The most common radiological and clinical-radiological diagnosis was idiopathic pulmonary fibrosis (IPF) (n = 12, 19.6%) while the most common multidisciplinary final diagnosis was cryptogenic organizing pneumonia (COP) (n = 14, %22.9). The concordance of pre/posttests was significant (p < 0.001) with a kappa agreement = 0.485. The usual interstitial pneumonia (UIP) diagnosis was detected in six patients among 12 who were prediagnosed as IPF having also a suspicion of other DPLD by clinical-radiological evaluation (p < 0.001). After the contribution of TBLC, the multidisciplinary final diagnosis of 22(36.1) patients changed. The histopathological diagnosis in which the clinical-radiological diagnosis changed the most was nonspecific interstitial pneumonia (NSIP).

DISCUSSION

We found the overall diagnostic yield of TBLC high. The pretest clinical-radiological diagnosis was often compatible with the multidisciplinary final diagnosis. However, TBLC is useful for the confirmation of clinical radiological diagnosis as well as clinical entities such as NSIP which is difficult to diagnose clinical-radiological. We also suggest that TBLC should be considered in patients whose clinicopathological IPF diagnosis is not precise.

The associations of radiological features of high-resolution computed tomography with the outcomes of transbronchial cryobiopsy in interstitial lung diseases: A cohort study

Background

Transbronchial cryobiopsy (TBCB) is a critical procedure in the diagnosis of interstitial lung diseases (ILD). The associations between high-resolution computed tomography (HRCT) features and outcomes of TBCB were unknown.

Methods

This study was conducted as a single-center prospective cohort study between September 2018 and January 2020 (NCT04047667). HRCT was obtained before performing TBCB. The clinical and radiological characteristics, complications, pathological and multidisciplinary discussion (MDD) diagnoses were recorded. The relationships between HRCT features and outcomes of TBCB were analyzed.

Results

TBCB was performed on 216 ILD patients. The radiological features usually interstitial pneumonia (UIP) or probable UIP, indeterminate for UIP, ground-glass opacities (GGO) and cysts were found in 55 (25.5%), 38 (17.6%), 84 (38.9%) and 9 (4.2%) patients, respectively. And 118 (54.6%) patients had high HRCT score (involved lung proportion ≥50%) in the biopsied lobe. Multivariate analysis suggested radiological probable UIP pattern may be an independent risk factor for moderate bleeding (OR = 4.304; 95% CI: 1.383–13.393; P = 0.012), while GGO may be a protective factor from moderate bleeding (OR = 0.173, 95% CI: 0.043–0.687; P = 0.013). The pathological diagnostic yield in patients presenting cysts on HRCT was significantly lower than others (44.4 vs. 87.9%; P = 0.009). While performing TBCB in the lobe with high HRCT score increased pathological diagnostic yield (91.5 vs. 79.6%; P = 0.022). Neither pneumothorax nor MDD diagnostic yields were found to be associated with HRCT features.

Conclusions

HRCT features were associated with moderate bleeding and pathological diagnosis. Pre-TBCB assessments of HRCT pattern and scores were helpful for bronchoscopists to make a better patient selection and procedure planning.

Safety and accuracy of transbronchial lung cryobiopsy in diagnosing desquamative interstitial pneumonia

INTRODUCTION

Transbronchial lung cryobiopsy (TBLC) is a new technique to obtain specimens for diagnosis of interstitial lung disease (ILD) in recent years. The objective of this study is to evaluate the safety and the diagnostic accuracy of TBLC in patients of desquamative interstitial pneumonia (DIP).

METHODS

In this study twelve patients confirmed with DIP were selected from January 2019 to December 2020 at the department of pulmonary and critical care medicine in China-Japan Friendship Hospital. All cases underwent TBLC in a hybrid cone beam CT (CBCT) operation room with a single general anesthesia. The definitive diagnosis was made by a multidisciplinary team that involved clinicians, radiologists and pathologists. This study analyzed the biopsy sample surface areas, main complications and the consistency between TBLC pathology and multidisciplinary discussion (MDD) diagnosis for DIP.

RESULTS

An average of 3.1 ± 1.1 specimens were obtained per patient. The mean surface area of the specimen was 23.7 ± 6.1 mm² . None of the cases had pneumothorax or massive hemorrhage. Ten cases (83.3%) had no or mild bleeding and two cases (16.7%) had moderate bleeding. All cases had the typical pathologic characteristics of DIP, which was highly consistent with the diagnosis of MDD.

CONCLUSION

TBLC can obtain sufficient samples for the pathological diagnosis of DIP, which has high security and accuracy in experienced specialist centers.