Chest
Volume 151, Issue 2, February 2017, Pages 400-408
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Original Research: Diffuse Lung Disease
Transbronchial Cryobiopsy in Diffuse Parenchymal Lung Disease: Retrospective Analysis of 74 Cases

https://doi.org/10.1016/j.chest.2016.09.002Get rights and content

Background

Diagnostic evaluation of patients with diffuse parenchymal lung disease (DPLD) is best achieved by a multidisciplinary team correlating clinical, radiological, and pathologic features. Surgical lung biopsy remains the gold standard for histopathologic diagnosis of idiopathic interstitial pneumonias. Emerging data suggest an increasing role for transbronchial cryobiopsy (TBC) in DPLD evaluation. We describe our experience with TBC in patients with DPLD.

Methods

We retrospectively reviewed medical records of patients with radiographic features of DPLD who underwent TBC at Mayo Clinic in Rochester, Minnesota from June 2013 to September 2015.

Results

Seventy-four patients (33 women [45%]) with a mean age of 63 years (SD, 13.8) were included. The mean maximal diameter of the samples was 9.2 mm (range, 2-20 mm [SD, 3.9]). The median number of samples per procedure was three (range, one to seven). Diagnostic yield was 51% (38 of 74 specimens). The most frequent histopathologic patterns were granulomatous inflammation (12 patients) and organizing pneumonia (OP) (11 patients), resulting in the final diagnoses of hypersensitivity pneumonitis (six patients), cryptogenic OP (six patients), connective tissue disease-associated OP (three patients), drug toxicity (three patients), infection-related OP (two patients), sarcoidosis (two patients), and aspiration (one patient). Other histopathologic patterns included respiratory bronchiolitis (three patients), acute fibrinous and organizing pneumonia (two patients), desquamative interstitial pneumonia (1 patient), diffuse alveolar damage (one patient), pulmonary alveolar proteinosis (one patient), amyloidosis (one patient), eosinophilic pneumonia (one patient), necrotizing vasculitis (one patient), bronchiolitis with food particles (one patient), and malignancy (three patients). Pneumothorax developed in one patient (1.4%), and bleeding occurred in 16 patients (22%).

Conclusions

Our single-center cohort demonstrated a 51% diagnostic yield from TBC; the rates of pneumothorax and bleeding were 1.4% and 22%, respectively. The optimal use of TBC needs to be determined.

Section snippets

Methods

The study was approved by the Mayo Clinic Institutional Review Board (IRB 15-008652). We conducted a retrospective review of the clinical records of patients with DPLD from June 2013 to September 2015 at the Mayo Clinic in Rochester, Minnesota. Over the period examined, 200 cryobiopsies in 187 patients were performed at our institution. The medical records were analyzed, and demographic data, chest CT scans, procedure details and complications, diagnostic results, and pathologic features were

Results

Seventy-four patients were included in the study cohort: 33 were women (45%), with a mean age of 63 years (range, 20-89 years [SD, 13.8]) (Table 1). The mean maximal diameter of samples was 9.2 mm (range, 2-20 mm [SD, 3.9]). Most of the patients (59 patients) had biopsy samples obtained from one lobe; the remaining 15 patients had biopsy samples obtained from two lobes. The median number of samples per procedure was three (range, one to seven). Histologic slides were available for review by a

Discussion

The role of TBC in DPLD evaluation is still evolving. Previous studies from multiple centers have demonstrated the feasibility of the technique,6, 7, 8, 9, 11, 12, 17, 18, 19, 20 but there is a lack of consensus on the indications, contraindications, and diagnostic accuracy. Thus, its role remains controversial.

Our study demonstrated a diagnostic yield of 51% when a positive biopsy result was defined as diagnostic histologic findings, histologic findings that supported a final diagnosis, or

Conclusions

Our single-center cohort demonstrated a 51% diagnostic yield from TBC, which was lower than that of previously published data from other centers. Nevertheless, it was considered helpful in 78% of patients when histopathologic data were integrated with clinical-radiological data in a multidisciplinary approach. Potential bleeding, pneumothorax, and delayed complications remain a concern. Optimal patient selection and the technique of TBC still need to be determined.

Acknowledgments

Author contributions: K. U. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. K. U. contributed to the conception and design; collection, analysis, and interpretation of data; drafting and critical revision of the article; and collection/generation of the images. R. M. K. contributed to the experiments, collection of the data, and critical revision of the article. A. C. R. contributed to the collection,

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    FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

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