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Meta-Analysis
. 2022 Oct 5;31(166):210280.
doi: 10.1183/16000617.0280-2021. Print 2022 Dec 31.

Diagnostic yield and safety of transbronchial lung cryobiopsy and surgical lung biopsy in interstitial lung diseases: a systematic review and meta-analysis

Inês Rodrigues  1   2 , Ricardo Estêvão Gomes  3   2 , Lígia Maria Coutinho  4 , Maria Teresa Rego  4 , Firmino Machado  5   6   7 , António Morais  7   8 , Helder Novais Bastos  9   8   10
Affiliations
Meta-Analysis

Diagnostic yield and safety of transbronchial lung cryobiopsy and surgical lung biopsy in interstitial lung diseases: a systematic review and meta-analysis

Inês Rodrigues et al. Eur Respir Rev. .

Abstract

Introduction: Transbronchial lung cryobiopsy (TBLC) is increasingly being used as an alternative to video-assisted thoracoscopic surgery (VATS) biopsy to establish the histopathologic pattern in interstitial lung disease (ILD).

Methods: A systematic literature search of the PubMed and Embase databases, from October 2010 to October 2020, was conducted to identify studies that reported on diagnostic yield or safety of VATS or TBLC in the diagnosis of ILD.

Results: 43 studies were included. 23 evaluated the diagnostic yield of TBLC after multidisciplinary discussion, with a pooled diagnostic yield of 76.8% (95% confidence interval (CI) 70.6-82.1), rising to 80.7% in centres that performed ≥70 TBLC. 10 studies assessed the use of VATS and the pooled diagnostic yield was 93.5% (95% CI 88.3-96.5). In TBLC, pooled incidences of complications were 9.9% (95% CI 6.8-14.3) for significant bleeding (6.9% for centres with ≥70 TBLC), 5.6% (95% CI 3.8-8.2) for pneumothorax treated with a chest tube and 1.4% (95% CI 0.9-2.2) for acute exacerbation of ILD after TBLC. The mortality rates were 0.6% and 1.7% for TBLC and VATS, respectively.

Conclusions: TBLC has a fairly good diagnostic yield, an acceptable safety profile and a lower mortality rate than VATS. The best results are obtained from more experienced centres.

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Conflict of interest statement

Conflict of interest: H. Novais Bastos has received support from Sociedade Portuguesa de Pneumologia, as well as grants or contracts from Fundação para a Ciência e Tecnologia and Fundação Amélia de Mello/CUF; consulting fees from Boehringer-Ingelheim and Roche; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Boehringer-Ingelheim and Roche; support for attending meetings and/or travel from Boehringer-Ingelheim; and equipment, materials, drugs, medical writing, gifts or other services from Boehringer-Ingelheim, all outside the submitted work. The remaining authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Flowchart of study selection. ILD: interstitial lung disease; VATS: video-assisted thoracoscopic surgery.
FIGURE 2
FIGURE 2
Meta-analysis of the diagnostic yield of a) transbronchial lung cryobiopsy (TBLC) and b) video-assisted thoracoscopic surgery, according to diagnostic criteria. The diamonds indicate the pooled effects. CI: confidence interval; MDD: multidisciplinary discussion.
FIGURE 3
FIGURE 3
Complications related to the technique: a) moderate/severe bleeding after transbronchial lung cryobiopsy (TBLC); b) pneumothorax after TBLC and video-assisted thoracoscopic surgery (VATS). The diamonds indicate the pooled effects. CI: confidence interval.
See this image and copyright information in PMC

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