European Respiratory Society guidelines on transbronchial lung cryobiopsy in the diagnosis of interstitial lung diseases

Daniël A Korevaar¹, Sara Colella², Markus Fally³, Juliette Camuset⁴, Thomas V Colby⁵, Lars Hagmeyer^{6

7}, Juergen Hetzel^{8

9}, Fabien Maldonado¹⁰, Antonio Morais^{11

12

13}, Claudia Ravaglia^{14

15}, René Spijker^{16

17}, Sara Tomassetti^{15

18}, Lauren K Troy^{19

20}, Johny A Verschakelen²¹, Athol U Wells^{22

23}, Thomy Tonia²⁴, Jouke T Annema^{1

25}, Venerino Poletti^{26

15

25}

Affiliations

¹ Dept of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
² Pulmonary Unit, "G. Mazzini" Hospital, Teramo, Italy.
³ Dept of Respiratory Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
⁴ Dept of Thoracic and Vascular Surgery, Tenon Hospital, AP-HP, Paris, France.
⁵ Dept of Laboratory Medicine and Pathology (Emeritus), Mayo Clinic, Scottsdale, AZ, USA.
⁶ Bethanien Hospital Solingen, Clinic for Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Solingen, Germany.
⁷ Institute of Pneumology, University of Cologne, Solingen, Germany.
⁸ Dept of Medical Oncology and Pulmonary Medicine, University Hospital Tuebingen, Tuebingen, Germany.
⁹ Dept of Internal Medicine, Division of Pneumology, Kantonssiptal Winterthur, Winterthur, Switzerland.
¹⁰ Vanderbilt University Medical Center, Nashville, TN, USA.
¹¹ Dept of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal.
¹² Faculty of Medicine, University of Porto, Porto, Portugal.
¹³ Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
¹⁴ Dept of Thoracic Diseases, G.B. Morgagni Hospital and University of Bologna, Forlì, Italy.
¹⁵ ERN-LUNG member.
¹⁶ Medical Library, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
¹⁷ Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
¹⁸ Dept of Experimental and Clinical Medicine, Careggi University Hospital and University of Florence, Florence, Italy.
¹⁹ Royal Prince Alfred Hospital, Camperdown, Australia.
²⁰ Sydney Medical School, University of Sydney, Sydney, Australia.
²¹ Dept of Radiology, Pulmonary Radiology, University Hospitals Leuven, Leuven, Belgium.
²² Interstitial Lung Disease Unit, Pulmonary Medicine, Royal Brompton Hospital, London, UK.
²³ Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK.
²⁴ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
²⁵ Shared senior authorship.
²⁶ Dept of Thoracic Diseases, G.B. Morgagni Hospital and University of Bologna, Forlì, Italy venerino.poletti@gmail.com.

PMID: 35710261
DOI: 10.1183/13993003.00425-2022

Free article

Practice Guideline

European Respiratory Society guidelines on transbronchial lung cryobiopsy in the diagnosis of interstitial lung diseases

Daniël A Korevaar et al. Eur Respir J. 2022.

Free article

. 2022 Nov 10;60(5):2200425.

doi: 10.1183/13993003.00425-2022. Print 2022 Nov.

Authors

Affiliations

¹ Dept of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
² Pulmonary Unit, "G. Mazzini" Hospital, Teramo, Italy.
³ Dept of Respiratory Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
⁴ Dept of Thoracic and Vascular Surgery, Tenon Hospital, AP-HP, Paris, France.
⁵ Dept of Laboratory Medicine and Pathology (Emeritus), Mayo Clinic, Scottsdale, AZ, USA.
⁶ Bethanien Hospital Solingen, Clinic for Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Solingen, Germany.
⁷ Institute of Pneumology, University of Cologne, Solingen, Germany.
⁸ Dept of Medical Oncology and Pulmonary Medicine, University Hospital Tuebingen, Tuebingen, Germany.
⁹ Dept of Internal Medicine, Division of Pneumology, Kantonssiptal Winterthur, Winterthur, Switzerland.
¹⁰ Vanderbilt University Medical Center, Nashville, TN, USA.
¹¹ Dept of Pulmonology, Centro Hospitalar e Universitário São João, Porto, Portugal.
¹² Faculty of Medicine, University of Porto, Porto, Portugal.
¹³ Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.
¹⁴ Dept of Thoracic Diseases, G.B. Morgagni Hospital and University of Bologna, Forlì, Italy.
¹⁵ ERN-LUNG member.
¹⁶ Medical Library, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
¹⁷ Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
¹⁸ Dept of Experimental and Clinical Medicine, Careggi University Hospital and University of Florence, Florence, Italy.
¹⁹ Royal Prince Alfred Hospital, Camperdown, Australia.
²⁰ Sydney Medical School, University of Sydney, Sydney, Australia.
²¹ Dept of Radiology, Pulmonary Radiology, University Hospitals Leuven, Leuven, Belgium.
²² Interstitial Lung Disease Unit, Pulmonary Medicine, Royal Brompton Hospital, London, UK.
²³ Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK.
²⁴ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
²⁵ Shared senior authorship.
²⁶ Dept of Thoracic Diseases, G.B. Morgagni Hospital and University of Bologna, Forlì, Italy venerino.poletti@gmail.com.

PMID: 35710261
DOI: 10.1183/13993003.00425-2022

Abstract

Background: In patients with interstitial lung diseases (ILD), histopathological input is often required to obtain a diagnosis. Surgical lung biopsy (SLB) is considered the reference standard, but many patients are clinically unfit to undergo this invasive procedure, and adverse events, length of hospitalisation and costs are considerable. This European Respiratory Society (ERS) guideline provides evidence-based clinical practice recommendations for the role of transbronchial lung cryobiopsy (TBLC) in obtaining tissue-based diagnosis in patients with undiagnosed ILD.

Methods: The ERS Task Force consisted of clinical experts in the field of ILD and/or TBLC and methodological experts. Four PICO (Patient, Intervention, Comparator, Outcomes) questions and two narrative questions were formulated. Systematic literature searches were performed in MEDLINE and Embase (up to June 2021). GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology was applied.

Results: In patients with undiagnosed ILD and an indication to obtain histopathological data: 1) TBLC is suggested as a replacement test in patients considered eligible to undergo SLB, 2) TBLC is suggested in patients not considered eligible to undergo SLB, 3) SLB is suggested as an add-on test in patients with a non-informative TBLC, 4) no recommendation is made for or against a second TBLC in patients with a non-informative TBLC and 5) TBLC operators should undergo training, but no recommendation is made for the type of training required.

Conclusions: TBLC provides important diagnostic information in patients with undiagnosed ILD. Diagnostic yield is lower compared to SLB, at reduced serious adverse events and length of hospitalisation. Certainty of the evidence is mostly "very low".

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Conflict of interest statement

Conflict of interest: L. Hagmeyer has received honoraria for lectures and presentations from Boehringer Ingelheim and Roche, and participated in advisory boards for Boehringer Ingelheim and Roche. J. Hetzel has received honoraria for lectures and presentations from Erbe and GlaxoSmithKline, and research support from Boehringer Ingelheim and AstraZeneca. A. Morais has received honoraria for presentations from Boehringer Ingelheim, Roche, Pfizer, AstraZeneca and Sanofi, and research grants from Roche, Boehringer Ingelheim and GlaxoSmithKline. S. Tomassetti has received honoraria for presentations from Roche and Boehringer Ingelheim. L.K. Troy has received honoraria for presentations from Boehringer Ingelheim, has been a member of an advisory board for Roche, and has received research support from Erbe. A.U. Wells has received personal fees from Roche and Boehringer Ingelheim. T. Tonia acts as an ERS methodologist. V. Poletti has received honoraria for lectures and presentations from Boehringer Ingelheim, Roche and Erbe, and participated in advisory boards for Boehringer Ingelheim, Roche and Ambu. The remaining authors have nothing to disclose.

Comment in

Transbronchial cryobiopsy: the right procedure for the right patient in the right place at the right time.
Myers JL, Costabel U. Myers JL, et al. Eur Respir J. 2022 Nov 10;60(5):2201648. doi: 10.1183/13993003.01648-2022. Print 2022 Nov. Eur Respir J. 2022. PMID: 36356976 No abstract available.

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European Respiratory Society guidelines on transbronchial lung cryobiopsy in the diagnosis of interstitial lung diseases

Affiliations

European Respiratory Society guidelines on transbronchial lung cryobiopsy in the diagnosis of interstitial lung diseases

Authors

Affiliations

Abstract

Conflict of interest statement

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Medical