Diagnostic value of TBLC in idiopathic pulmonary fibrosis

Abstract

Over the past 5 years, evidence has been growing for the use of transbronchial lung cryobiopsy (TBLC) in the diagnostic evaluation of interstitial lung disease. 1 Maldonado F Danoff SK Wells AU et al. Transbronchial cryobiopsy for the diagnosis of interstitial lung diseases: CHEST Guideline and Expert Panel Report. Chest. 2020; 157: 1030-1042 Summary Full Text Full Text PDF PubMed Scopus (43) Google Scholar , 2 Lentz RJ Argento AC Colby TV Rickman OB Maldonado F Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges. J Thorac Dis. 2017; 9: 2186-2203 Crossref PubMed Scopus (72) Google Scholar , 3 Troy LK Grainge C Corte TJ et al. Diagnostic accuracy of transbronchial lung cryobiopsy for interstitial lung disease diagnosis (COLDICE): a prospective, comparative study. Lancet Respir Med. 2020; 8: 171-181 Summary Full Text Full Text PDF PubMed Scopus (96) Google Scholar In The Lancet Respiratory Medicine, Sara Tomassetti and colleagues 4 Tomassetti S Ravaglia C Wells AU et al. Prognostic value of transbronchial lung cryobiopsy for the multidisciplinary diagnosis of idiopathic pulmonary fibrosis: a retrospective validation study. Lancet Respir Med. 2020; 8: 786-794 Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar report the long-term outcomes of patients with interstitial lung disease diagnosed by TBLC or surgical lung biopsy (SLB) and hypothesise that if diagnostic accuracy were similar between the two modalities, prognostic outcome would also be similar, and further would be distinct for idiopathic pulmonary fibrosis versus other interstitial lung diseases. A well-designed, single-centre, retrospective study was done of 426 consecutive patients with interstitial lung disease, of whom 160 had undergone SLB and 266 had undergone TBLC. The primary study conclusion was that idiopathic pulmonary fibrosis cases diagnosed by TBLC had (expectedly) poorer clinical outcomes compared with patients with an alternative diagnosis (transplant-free survival adjusted HR 2·98, 95% CI 1·19–7·47; p=0·02), and therefore TBLC, similarly to SLB, could be relied on to provide accurate histopathological information to multidisciplinary team (MDT) discussions in the work-up of undifferentiated interstitial lung disease. Additionally, the investigators found that adjusted comparative survival in idiopathic pulmonary fibrosis appeared worse for those diagnosed by SLB compared with those diagnosed by TBLC (adjusted HR 4·07, 95% CI 2·01–8·24; p<0·0001). Prognostic value of transbronchial lung cryobiopsy for the multidisciplinary diagnosis of idiopathic pulmonary fibrosis: a retrospective validation studyTBLC makes an important diagnostic contribution in interstitial lung disease, on the basis of the prognostic distinction between idiopathic pulmonary fibrosis and other interstitial lung diseases when TBLC findings are included in multidisciplinary diagnosis. Full-Text PDF