LATE-BREAKING ABSTRACT: Role of trans-bronchial lung cryobiopsies in interstitial lung diseases: Preliminary results of a Belgian prospective study

Abstract

INTRODUCTION Transbronchial lung cryobiopsies (TBLCs) are a promising diagnostic tool in the setting of interstitial lung diseases (ILD) when pathological analysis is requested. However, no direct comparison with surgical lung biopsy is available. METHOD The diagnostic yield, safety data, as well as the result of surgical lung biopsy performed after TBLCs were analysed in a multicentric belgian prospective trial. A surgical lung biopsy was performed after TBLCs if the diagnosis was uncertain or if a NSIP pattern was observed with discordant clinical and radiological features or suspicion of idiopathic pulmonary fibrosis. All cases were submitted to multidisciplinary discussions (MDD). RESULTS Between april 2015 and may 2016, 22 patients were included. The mean number of TBLCs per patient was 4,2. Frequent complications included pneumothorax (4/22, 18%; 50% requiring a thoracic tube) and bleeding (severe 5%, moderate in 33%, mild 62%). There was no mortality. The diagnostic yield was 73% (16/22). A NSIP pattern was observed in 6 patients and 1 patient had no histological diagnosis. After MDD, a surgical biopsy was performed in 5 patients changing the diagnosis to UIP pattern in 4 patients, and confirming NSIP in one. Mean hospitalisation time was 1,2 days after TBLC taking into account a mandatory overnight observation after the procedure. CONCLUSION TBLCs are usefull in the setting of ILD with an acceptable rate of complications and can diminsh the need for surgical lung biopsy. However, surgical biopsy performed as a second step provide complementary informations in 80% of patients with unspecific diagnosis or NSIP pattern resulting from TBLCs.