Abstract
Background: Transbronchial lung forceps biopsy (TBLF) is of limited value for the diagnosis of interstitial lung disease (ILD). However, in cases with predominantly peribronchial pathology, such as sarcoidosis, TBLF is considered to be diagnostic in most cases. The present study examines whether transbronchial lung cryobiopsy (TBLC) is superior to TBLF in terms of diagnostic yield in cases of sarcoidosis. Methods: In this post hoc analysis of a prospective, randomized, controlled, multicentre study, 359 patients with ILD requiring diagnostic bronchoscopic tissue sampling were included. TBLF and TBLC were both used for each patient in a randomized order. Histological assessment was undertaken on each biopsy and determined whether sarcoid was a consideration. Results: A histological diagnosis of sarcoidosis was established in 17 of 272 cases for which histopathology was available. In 6 out of 17 patients, compatible findings were seen with both TBLC and TBLF. In 10 patients, where the diagnosis of sarcoidosis was confirmed by TBLC, TBLF did not provide a diagnosis. In one patient, TBLF but not TBLC confirmed the diagnosis of sarcoidosis. Conclusions: In this post hoc analysis, the histological diagnosis of sarcoidosis was made significantly more often by TBLC than by TBLF. As in other idiopathic interstitial pneumonias (IIPs), the use of TBLC should be considered when sarcoidosis is suspected.
Highlights
The sampling technique used for histological diagnosis is usually determined by the localization of the characteristic pathology within the organ
A histological diagnosis compatible with sarcoidosis was made in 17 patients
We show here that significantly more cases of sarcoidosis could be diagnosed by transbronchial lung cryobiopsy (TBLC) compared to Transbronchial lung forceps biopsy (TBLF), and it would appear that this is due to the significantly increased biopsy size that is provided by TBLC compared to TBLF
Summary
The sampling technique used for histological diagnosis is usually determined by the localization of the characteristic pathology within the organ. In interstitial lung diseases (ILDs) where there is predominant involvement of the lung parenchyma, transbronchial cryobiopsy (TBLC) has been shown to be superior to transbronchial forceps biopsy (TBLF). It is often necessary to increase the level of diagnostic certainty by a tissue sample in order to justify a long-term and potentially side-effect-laden therapy for sarcoidosis. In such cases, TBLF is currently the diagnostic standard. Transbronchial lung forceps biopsy (TBLF) is of limited value for the diagnosis of interstitial lung disease (ILD). The present study examines whether transbronchial lung cryobiopsy (TBLC) is superior to TBLF in terms of diagnostic yield in cases of sarcoidosis.
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