The safety and efficacy of different methods for obtaining transbronchial lung cryobiopsy in diffuse lung diseases

Introduction: Most data on transbronchial lung cryobiopsy (TBLC) are from single centers, with little evidence on the outcome of different methods for performing TBLC. Objective: To report the diagnostic yield and safety of TBLC with different procedural techniques. Methods: Retrospective multicenter study of subjects who underwent TBLC for the diagnosis of diffuse parenchymal lung diseases (DPLDs). The procedure was performed using various methods: flexible or rigid bronchoscopy, with or without the use of fluoroscopy or occlusion balloon. Results: 128 subjects (59% women) with a mean age of 48.9 years were included. The overall diagnostic yield of TBLC was 78.1%, with a definite multidisciplinary diagnosis made in 57 (44.5%) subjects. On a multivariate analysis, the diagnostic yield was associated with number of biopsies taken (aOR [95% CI], 2.17 [1.29-3.67]). The incidence of pneumothorax was lower in subjects who underwent TBLC with fluoroscopic guidance (5.9% vs. 20.9%), (aOR [95% CI], 0.26 [0.07-0.94]). Moderate-to-severe bleeding occurred less frequently when an occlusion balloon was used (1.8% vs. 35.7%; aOR [95% CI], 0.02 [0.001-0.18]), after adjusting for age, use of fluoroscopy, number of biopsies obtained and number of lobes sampled. Four deaths occurred; two because of acute exacerbation of idiopathic pulmonary fibrosis. Conclusion: TBLC was found to offer a reasonable yield in the diagnosis of DPLDs. The incidence of pneumothorax and moderate-to-severe bleeding were lower with the use of fluoroscopy and an occlusion balloon, respectively. This article is protected by copyright. All rights reserved.