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Transbronchial cryobiopsy in fibrosing interstitial lung disease: modifications of the procedure lead to risk reduction
  1. Lars Hagmeyer1,
  2. Dirk Theegarten2,
  3. Jeremias Wohlschläger3,
  4. Thomas Hager2,
  5. Marcel Treml1,
  6. Simon Dominik Herkenrath1,
  7. Khosro Hekmat4,
  8. Matthias Heldwein4,
  9. Winfried J Randerath1
  1. 1Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Hospital Bethanien Solingen, Solingen, Germany
  2. 2Institute for Pathology and Neuropathology, University Hospital Essen, Essen, Germany
  3. 3Institute for Pathology, Diakonissen Hospital Flensburg, Flensburg, Germany
  4. 4Clinic for Cardiac and Thoracic Surgery, University Hospital Cologne, Cologne, Germany
  1. Correspondence to Dr Lars Hagmeyer, Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Hospital Bethanien Solingen, Solingen 42699, Germany; lars.hagmeyer{at}klinik-bethanien.de

Abstract

Sixty-one subjects with fibrosing interstitial lung disease were prospectively analysed to determine the efficacy of transbronchial cryobiopsy (CryoTBB) and the effect of procedural modifications which were introduced after an interim analysis of the first 19 subjects. The modifications significantly reduced complication rates from 84% to 14% (p<0.001). 30-day-mortality was 2%. The algorithm with initial CryoTBB and surgical lung biopsy (SLB) as optional step-up procedure was feasible. CryoTBB led to a confident diagnosis in 46/61 subjects (75%). Only 21% out of all subjects were forwarded for SLB. As the modified CryoTBB reduced but not eliminated the risk of severe complications, tissue sampling should be limited to patients where confident diagnosis enables life prolonging therapy. Trial registration number: NCT01714518.

  • bronchoscopy
  • interstitial fibrosis
  • idiopathic pulmonary fibrosis
  • thoracic surgery
  • hypersensitivity pneumonitis

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Footnotes

  • Contributors LH: substantial contributions to conception and design, analysis and interpretation of data, drafting the article and finalising the version to be published taking responsibility for the integrity of the work as a whole, from inception to published article. DT, JW, TH: acquisition of data, analysis and interpretation of data, revising the article critically for important intellectual content, final approval of the version to be published. MT, SDH: acquisition of data, analysis and interpretation of data, drafting statistics section and revising the article, final approval of the version to be published. KH, MH: acquisition of data, analysis and interpretation of data, revising the article, final approval of the version to be published. WJR: substantial contributions to conception and design, analysis and interpretation of data, drafting the article and finalising the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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