Cyrobiopsy versus VATS in managment of patients with UIP possible

Introduction: Cryobiopsy is a recently introduced method for the diagnosis of pulmonary interstitial disorders. Aim of this study is to compare cryobiopsy and surgical lung biopsy performed in VATS, in terms of diagnostic yield, complication and cost in management of patients with UIP possible patter at CT scan. Material and Methods: The cryobiopsy was performed under general anesthesia, after intubation with a rigid bronchoscope, using a cryosonde (Herbs 2.8 mm). The SLB was performed under general anesthesia by means of a VATS biportal access. The type of procedure was chosen after discussing the risks and benefits of each method with patients. Results: 15 (9F/6M) cryobiopsy procedures were performed compared to 10 (3F/7M) biopsies in VATS. The age of the patients was matched (70 ± 7.9 vs 67 ± 6.0; p= 0.54) as well as the functional indices (FVC% 85.3±14.6 vs 89.1± 27.3; DLCO% 65.5±2.6 vs 62.3±16.7). The diagnostic yield was 79% for the cryobiopsies and 100% for the SLB (UIP definitive in all cases). Among the complications of cryobiopsy there was 2 cases of pneumothorax (13%) that required drainage (removed on the second day) and a 1 (6%) significant bleeding controlled with the endobronchial application of Fogarty catheter. For the SLB, all patients required chest drainage, and in one case there was a persistence of fever for over 15 days, resolved with antibiotic therapy. The average post-procedure hospital stay was 2 day for cryobiopsy and 5 days for SLB. Conclusion: Cryobiopsy is a safe practice with a good diagnostic yield that allows to reduce the surgical trauma compared to the SLB. However, the SLB guarantees more accurate diagnostic results, therefore it may be reserved for selected cases.