Usefulness of surgical lung biopsies after cryobiopsies when pathological results are unspecific or show a pattern suggestive of a nonspecific interstitial pneumonia

Abstract

Introduction: Transbronchial lung cryobiopsies (TBLCs) are useful in the setting of diffuse parenchymal lung diseases (DPLDs). However, no direct comparison with surgical lung biopsy (SLB) is available. The aim of this study was therefore to evaluate the benefit of SLBs performed in selected patients after TBLCs. Method: We conducted a multicentric Belgian prospective trial in which SLBs were performed after TBLCs if the pathological diagnosis was uncertain or if a nonspecific interstitial pneumonia (NSIP) pattern was observed hypothesizing that a co-existent UIP pattern could be missed. Results: Between April 2015 and January 2018, TBLCs were performed in 67 patients with DPLDs. The diagnostic yield was 69%. Among these 67 patients, no pathological diagnosis following TBLCs was noticed in 11 patients (16%) and a pattern suggestive of a NSIP observed in 10 patients (15%). 12 of these patients had SLBs after TBLCs. Interestingly, SLBs showed a UIP pattern in ten, a pattern suggestive of a hypersensitivity pneumonitis in one and a NSIP pattern in one patient. Moreover, among patients with pathological NSIP following TBLCs, six benefited from SLBs showing a UIP in five and confirming a NSIP in only one patient. Conclusion: TBLCs are useful in the setting of DPLDs with a good diagnostic yield. However, when pathological results are inconclusive or show a NSIP pattern, SLBs seem to provide additional information. Our data are preliminary and based on a relatively small number of patients. Therefore, further studies are required to definitely assess the indication of SLBs after TBLCs.