Transbronchial biopsy results according to diffuse interstitial lung disease classification. Cryobiopsy versus forceps: MULTICRIO study.

Virginia Pajares,Gloria Bonet,Noelia Cubero,Carlos Disdier,Raquel Martínez,Manuel Núñez-Delgado,Rosa Cordovilla,Javier Flandes,Txomin Zabala,Alfons Torrego,Javier Pérez-Pallarés,Minghua Wu

doi:10.1371/journal.pone.0239114

Abstract

BackgroundIn recent years, transbronchial cryobiopsy (TBCB) has come to be increasingly used in interventional pulmonology units as it obtains larger and better-quality samples than conventional transbronchial lung biopsy (TBLB) with forceps. No multicenter studies have been performed, however, that analyse and compare TBCB and TBLB safety and yield according to the interstitial lung disease (ILD) classification.ObjectivesWe compared the diagnostic yield and safety of TBCB with cryoprobe sampling versus conventional TBLB forceps sampling in the same patient.MethodProspective multicenter clinical study of patients with ILD indicated for lung biopsy. Airway management with orotracheal tube, laryngeal mask and rigid bronchoscope was according to the protocol of each centre. All procedures were performed using fluoroscopy and an occlusion balloon. TBLB was followed by TBCB. Complications were recorded after both TBLB and TBCB.ResultsIncluded were 124 patients from 10 hospitals. Airway management was orotracheal intubation in 74% of cases. Diagnostic yield according to multidisciplinary committee results for TBCB was 47.6% and for TBLB was 19.4% (p<0.0001). Diagnostic yield was higher for TBCB compared to TBLB for two groups: idiopathic interstitial pneumonias (IIPs) and ILD of known cause or association (OR 2.5; 95% CI: 1.4–4.2 and OR 5.8; 95% CI: 2.3–14.3, respectively). Grade 3 (moderate) bleeding after TBCB occurred in 6.5% of patients compared to 0.8% after conventional TBLB.ConclusionsDiagnostic yield for TBCB was higher than for TBLB, especially for two disease groups: IIPs and ILD of known cause or association. The increased risk of bleeding associated with TBCB confirms the need for safe airway management and prophylactic occlusion-balloon use.Trial registrationclinicaltrials.gov identifier: NCT02464592.

Highlights

Transbronchial cryobiopsy (TBCB), which uses modified cryotherapy probes, resulted from the need to improve the diagnostic yield of conventional transbronchial lung biopsy (TBLB)
Diagnostic yield was higher for transbronchial cryobiopsy (TBCB) compared to TBLB for two groups: idiopathic interstitial pneumonias (IIPs) and interstitial lung disease (ILD) of known cause or association
Grade 3 bleeding after TBCB occurred in 6.5% of patients compared to 0.8% after conventional TBLB

Summary

Introduction

Transbronchial cryobiopsy (TBCB), which uses modified cryotherapy probes, resulted from the need to improve the diagnostic yield of conventional transbronchial lung biopsy (TBLB). Studies that have analysed histological material obtained by cryoprobe for endobronchial tumours have observed that, since samples are both larger than those obtained using a conventional biopsy and histologically better preserved, they facilitate histological diagnosis and the application of immunohistochemical techniques [1, 2] Those observations have led to increased use of the cryoprobe as an alternative to the conventional biopsy technique for the purpose of studying diffuse lung diseases [3,4,5,6]. Only one randomized clinical trial (conducted in a single centre) has compared TBCB and TBLB and analysed the complications associated with each [6], while no prospective multicenter study has assessed diagnostic yield according to diffuse interstitial lung disease (ILD) classes or has assessed the risk-benefit profile of both techniques performed in turn in the same patient. No multicenter studies have been performed, that analyse and compare TBCB and TBLB safety and yield according to the interstitial lung disease (ILD) classification.

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