Transbronchial lung cryobiopsy
In a comparative, multicenter, prospective COLDICE study, the diagnostic yield of SLB (surgical lung biopsy) was compared to that of TBLC (transbronchial lung cryobiopsy) in 65 patients. The biopsies were obtained sequentially from the same patient under anesthesia with the following result:
When the diagnosis was based on histopathological results alone, there was a 70.8% agreement between the two methods. However, when a multidisciplinary diagnosis was made, agreement increased to 76.9%. Particularly in cases of a definitive diagnosis or one that could be made with a high degree of certainty, the methods were comparable and agreed in 95% of cases.
SLB, the gold standard to date, is associated with significant morbidity. Complications include: postoperative pneumothorax, pneumonia and respiratory failure, and a significant mortality rate of 1.7% as compared to 0.2% for TBLC.
In light of these study results, minimally invasive TBLC, when performed by experienced bronchoscopists, is recommended as the first option for patients with ILD requiring a lung biopsy. Whenever possible, surgical lung biopsy should be limited to patients for whom cryobiopsy is not a viable diagnostic option.
These recommendations were published in the latest CHEST Guideline and Expert Panel Report (2019).