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Meta-Analysis
. 2024 Aug 14;33(173):240035.
doi: 10.1183/16000617.0035-2024. Print 2024 Jul.

A systematic review of procedural and sampling techniques for cryobiopsy in interstitial lung disease

Julia A Lachowicz  1   2 , Natasha E Smallwood  3   4 , Jyotika D Prasad  5   4   6   7 , Purab Patel  8 , Catherine Voutier  9 , Yet H Khor  2   10   11   12 , Daniel P Steinfort  5   2
Affiliations
Meta-Analysis

A systematic review of procedural and sampling techniques for cryobiopsy in interstitial lung disease

Julia A Lachowicz et al. Eur Respir Rev. .

Abstract

Background: Transbronchial lung cryobiopsy (TBLC) is an alternative to surgical lung biopsy for histopathological evaluation of unclassifiable interstitial lung disease (ILD) or ILD diagnosed with low confidence. This meta-analysis synthesised current literature regarding cryobiopsy diagnostic performance and safety, focusing on procedural and sampling techniques.

Methods: Medline and Embase were searched on 11 April 2022. Studies included adults with unclassifiable ILD, reporting diagnostic yield, complications and methodological techniques of TBLC. Meta-analyses were performed for diagnostic yield, pneumothorax and bleeding. Subgroup analyses and meta-regression assessed methodological variables. PROSPERO registration: CRD42022312386.

Results: 70 studies were included with 6183 participants. Diagnostic yield of TBLC was 81% (95% CI 79-83%, I2=97%), with better yield being observed with general anaesthesia (p=0.007), ILD multidisciplinary meeting prior to cryobiopsy (p=0.02), 2.4 mm cryoprobe (p=0.04), higher mean forced vital capacity (p=0.046) and higher mean diffusing capacity for carbon monoxide (p=0.023). Pneumothorax rate was 5% (95% CI 4-5%, I2=91%), with higher rates associated with a 2.4 mm cryoprobe (p<0.00001), routine post-procedure imaging (p<0.00001), multiple lobe sampling (p<0.0001), reduced mean diffusing capacity for carbon monoxide (p=0.028) and general anaesthesia (p=0.05). Moderate-to-severe bleeding rate was 12% (11-14%, I2=95%) and higher rates were associated with a 2.4 mm cryoprobe (p=0.001) and bleeding score selection (p=0.04).

Interpretation: Patient characteristics and modifiable factors, including procedural methods and anaesthetic techniques, impacted diagnostic yield and safety outcomes of TBLC in people with unclassifiable ILD and contributed to heterogeneity of clinical outcomes. These variables should be considered for individualised clinical decision making and guideline development and warrant routine reporting in future research.

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Conflict of interest statement

Conflict of interest: J.A. Lachowicz reports grants from University of Melbourne, and payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca. N.E. Smallwood reports grants from NHMRC, MRFF, Cancer Council Australia, Fisher & Paykel Healthcare (FPH), Windermere Foundation, Lung Foundation Australia and Lord Mayor's Foundation Melbourne, consultancy fees from The Limbic and Orchard Consulting, payment or honoraria for lectures, presentations, manuscript writing or educational events from GlaxoSmithKline, Boehringer Ingelheim, AstraZeneca, FPH and Health Ed, support for attending meetings from Chiesi and Boehringer Ingelheim, leadership roles with the Thoracic Society of Australia and New Zealand (Board Director and past state president), Victorian Doctors’ Program (Board Director), European Respiratory Society (Co-chair guidelines committee), and receipt of equipment, materials, drugs, medical writing, gifts or other services from FPH. J.D. Prasad, P. Patel and C. Voutier have nothing to disclose. Y.H. Khor reports grants from NHMRC, MRFF, Air Liquide Healthcare, Austin Medical Research Foundation, Lung Foundation Australia/Thoracic Society of Australia and New Zealand and RACP, and leadership roles with the Thoracic Society of Australia and New Zealand (Board director, Special Interest Group Convenor), American Thoracic Society (Clinical Problems Assembly Program Committee; guideline methodologist) and European Respiratory Society (Associate editor for European Respiratory Journal). D.P. Steinfort reports grants from the Australian National Health and Medical Research Council (Leadership Investigator Grant (#2008317)).

Figures

FIGURE 1
FIGURE 1
Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) diagram. ILD: interstitial lung disease
See this image and copyright information in PMC

References

    1. Cottin V, Hirani NA, Hotchkin DL, et al. . Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases. Eur Respir Rev 2018; 27: 180076. doi:10.1183/16000617.0076-2018 - DOI - PMC - PubMed
    1. Prasad JD, Mahar A, Bleasel J, et al. . The interstitial lung disease multidisciplinary meeting: a position statement from the Thoracic Society of Australia and New Zealand and the Lung Foundation Australia. Respirology 2017; 22: 1459–1472. doi:10.1111/resp.13163 - DOI - PubMed
    1. Raghu G, Remy-Jardin M, Richeldi L, et al. . Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med 2022; 205: e18–e47. doi:10.1164/rccm.202202-0399ST - DOI - PMC - PubMed
    1. Korevaar DA, Colella S, Fally M, et al. . European Respiratory Society guidelines on transbronchial lung cryobiopsy in the diagnosis of interstitial lung diseases. Eur Respir J 2022; 60: 2200425. doi:10.1183/13993003.00425-2022 - DOI - PubMed
    1. Raghu G, Remy-Jardin M, Ryerson CJ, et al. . Diagnosis of hypersensitivity pneumonitis in adults. An Official ATS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med 2020; 202: e36–e69. doi:10.1164/rccm.202005-2032ST - DOI - PMC - PubMed

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