Diagnostic value of transbronchial cryobiopsy compared to surgical lung biopsy

Abstract

Background Transbronchial Cryobiopsy (TCB) is an endoscopy technique which can be applied for tissue sampling in diagnosis of interstitial lung diseases (ILD). We could show that this method results in a definitive clinical diagnosis in 70% of cases (Clin Respir J. 2015 Jan 26, Epub ahead of print). It remains unclear how often surgical lung biopsy (SLB) either leads to a change or a confirmation of histological diagnosis when TCB results are non-definitive. Methods: Data of 12 ILD patients (8 retrospective, 4 prospective) were analyzed in whom TCB resulted in a non-definitive diagnosis and therefore SLB was done (step-up procedure). Before each intervention there was an interdisciplinary evaluation (pneumologist, radiologist, pathologist if applicable) to verify indication. This was repeated later to determine final diagnosis. Results: TCB resulted in 1 definitive, 4 probable and 7 possible histological findings. SLB led to 7 definitive, 3 probable and 2 possible histological results. In 11 of 12 cases, the TCB result was confirmed by SLB. Only in 1 case the histological TCB finding was changed after SLB The interdisciplinary evaluation after SLB led to 10 definitive and 2 probable clinical diagnoses. Conclusion: Definitive TCB results are reliable. When TCB lead to unclear results, the suspected diagnosis is confirmed by SLB in most cases. Only rarely, the latter leads to a change of diagnosis.