Cryobiopsy

Transbronchial Lung Cryobiopsy and Video-assisted Thoracoscopic Lung Biopsy in the Diagnosis of Diffuse Parenchymal Lung Disease. A Meta-analysis of Diagnostic Test Accuracy

https://www.ncbi.nlm.nih.gov/pubmed/28399377

Review 

Reference: Iftikhar IH, Alghothani L, Sardi A, Berkowitz D, Musani AI. Transbronchial Lung Cryobiopsy and Video-assisted Thoracoscopic Lung Biopsy in the Diagnosis of Diffuse Parenchymal Lung Disease. A Meta-analysis of Diagnostic Test Accuracy. Ann Am Thorac Soc. 2017;14(7):1197-1211.

Summary: This study evaluated the diagnostic accuracy of transbronchial lung cryobiopsy (TBLC) and video-assisted thoracoscopic (VATS) lung biopsy in the diagnosis of diffuse parenchymal lung disease. TBLC pooled diagnostic yield 83.7% (76.9-88.8%), pooled sensitivity 87% (85-89%), and pooled specificity 57% (40-73%). VATS pooled diagnostic yield 92.7% (87.6-95.8%), pooled sensitivity 91.0% (89-92%), and pooled specificity 58% (31-81%). The incidence of grade 2 (moderate to severe) endobronchial bleeding after TBLC and of post-procedural pneumothorax was 4.9% (2.2-10.7%) and 9.5% (5.9-14.9%), respectively. Although the diagnostic test accuracy measures of TBLC lag behind those of VATS, with an acceptable safety profile and potential cost savings, the former could be considered as an alternative in the evaluation of patients with diffuse parenchymal lung diseases.


Poor Concordance between Sequential Transbronchial Lung Cryobiopsy and Surgical Lung Biopsy in the Diagnosis of Diffuse Interstitial Lung Diseases

https://www.ncbi.nlm.nih.gov/pubmed/30864813

Clinical Trial 

Reference: Romagnoli M, Colby TV, Berthet JP, et al. Poor Concordance between Sequential Transbronchial Lung Cryobiopsy and Surgical Lung Biopsy in the Diagnosis of Diffuse Interstitial Lung Diseases. Am J Respir Crit Care Med. 2019;199(10):1249-1256.

Background: A two-center prospective study comparing cryobiopsy to surgical lung biopsy in interstitial lung disease (ILD).

PICO:

Populations:

  • 21 patients with ILD on HRCT.

Intervention:

  • TBLC followed by Surgical Lung Biopsy (SLB) from the same sites with pathology read by blinded external site expert pathologists.

Comparison:

  • TBLC vs SLB from same sites for ILD diagnosis

Outcome:

  • Median TBLC biopsy size (longest axis) was 7 mm (IQR, 5-8 mm). SLB biopsy sizes averaged 46.1 ± 13.8 mm.
  • Concordance coefficients and percentage agreement were: TBLC versus SLB: κ = 0.22 (95% CI, 0.01-0.44)
  • 2 pneumothoraces (9.5%) were recorded during TBLC.
  • TBLC would have led to a different treatment if SLB was not performed in 11/21 (52%) of cases.

Take Home: Pathological results from TBLC and SLB were poorly concordant in the assessment of ILD. SLBs were more frequently concordant with the final diagnosis.


Diagnostic accuracy of transbronchial lung cryobiopsy for interstitial lung disease diagnosis (COLDICE): a prospective, comparative study

https://www.ncbi.nlm.nih.gov/pubmed/31578168

Clinical Trial

Reference: Troy LK, Grainge C, Corte TJ, et al. Diagnostic accuracy of transbronchial lung cryobiopsy for interstitial lung disease diagnosis (COLDICE): a prospective, comparative study. Lancet Respir Med. 2020;8(2):171-181.

Background: The largest blinded, prospective, multicenter trial evaluating cyrobiopsy in the diagnosis of ILD.

PICO:

Populations:

  • ILD patients from 9 Australian hospital sites recruited for TBLC and SLB for a diagnosis

Intervention:

  • Sequential TBLC and SLB under one anesthesia event

Comparison:

  • TBLC vs SLB from same sites for ILD diagnosis by blinded pathologists

Outcome:

  • Good agreement between TBLC and SLB histopathologically (70%). Good consensus between TBLC and SLB clinical radiological pathological diagnosis (76%)

Take Home: There is data to suggest parity of TBLC when compared to SLB in making a diagnosis in ILD