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. 2021 Feb 25;21(1):67.
doi: 10.1186/s12890-021-01438-1.

Implementation of transbronchial lung cryobiopsy in a tertiary referral center for interstitial lung diseases: a cohort study on diagnostic yield, complications, and learning curves

Jesper Rømhild Davidsen  1   2   3   4 , Inge Raadal Skov  5   6 , Ida Guldbæk Louw  5 , Christian B Laursen  5   7   6
Affiliations

Implementation of transbronchial lung cryobiopsy in a tertiary referral center for interstitial lung diseases: a cohort study on diagnostic yield, complications, and learning curves

Jesper Rømhild Davidsen et al. BMC Pulm Med. .

Abstract

Background: Transbronchial lung cryobiopsy (TBLC) has been introduced as an alternative to surgical lung biopsy (SLB) in the diagnostics of interstitial lung diseases (ILD). Despite controversy on safety, TBLC is increasingly implemented in ILD centers with an apparent diagnostic yield comparable to SLB. The aim of this study was to assess TBLC implementation experiences from a tertiary Danish ILD center regarding diagnosis, complications, and learning curves for TBLC performance.

Methods: TBLC was prospectively performed in a cohort of patients with unclassifiable ILD based on a preceding multidisciplinary clinical and radiological revision. TBLC was performed as an outpatient procedure with the patients in general anesthesia using a flexible bronchoscope with 1.9 or 2.4 mm cryoprobes. Learning curves for TBLC performance were calculated using cumulated sum (CUSUM) scores for diagnostic yield, pneumothorax, and bleeding.

Results: From February 2017 to March 2020 141 patients (86 (61%) men, median age 69 years [IQR, 60-74 years]) had TBLC performed. A histological and confirmative diagnosis was made in 101 patients (75.2%) and 124 patients (87.9%, i.e. clinical diagnostic yield), respectively, in whom idiopathic interstitial pneumonias constituted the majority (67.3%) of the clinical diagnoses. We observed 2 deaths (1.4%) within 30 days of TBLC, but no procedure-related mortality or severe bleeding. Moderate bleeding occurred in 23 patients (16.3%), pneumothorax in 21 patients (14.9%) with only 14 patients (9.9%) requiring a pleural drain. Based on the CUSUM score analysis, the diagnostic yield obtained was satisfactory throughout the period.

Conclusion: This study reports experiences of outpatient TBLC implementation in a tertiary referral ILD center from the largest investigated TBLC cohort in Scandinavia The diagnostic yield and prevalence of complications obtained by TBLC from this single center study on unclassifiable ILD support outpatient TBLC as a valuable and safe alternative to SLB to diagnose ILD in well-selected patients. The learning curves for TBLC were acceptable in the hands of experienced bronchoscopists.

Keywords: Complications; Diagnostic yield; Interstitial lung diseases; Learning curves; Multidisciplinary discussion; Transbronchial lung cryobiopsy.

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Conflict of interest statement

JRD reports grants and personal fees from Roche, personal fees and non-financial support from Boehringer Ingelheim, outside the submitted work. CBL has received royalties from Munksgaard as author of medical textbooks and e-learning material, outside the submitted work. IRS reports grants from AstraZeneca, and personal fees from Roche, outside the submitted work. IGL reports no competing interests.

Figures

Fig. 1
Fig. 1
CUSUM curves for diagnostic yield, pneumothorax and bleeding for the two bronchoscopists. Decreasing values indicate a successful procedure whereas increasing values indicate procedure failure. None of the curves crossed the predefined decision interval of 2.71
See this image and copyright information in PMC

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