Abstract
Objective
Transbronchial lung cryobiopsy (TBLC) has been recently introduced for diagnosing interstitial lung diseases. We aimed to assess the effectiveness and safety of TBLC by identifying the specific patterns of histology in the diagnosis of connective tissue disease–related interstitial lung disease (CTD-ILD) and interstitial pneumonia with autoimmune features (IPAF).
Methods
The clinical-radiological-pathological data from the Affiliated Hospital of Guilin Medical University between July 1, 2017, and October 31, 2020, of patients whose clinical-radiological or clinical-radiological-pathological diagnosis was CTD-ILD or IPAF and who underwent TBLC, transbronchial lung biopsy (TBLB), or surgical lung biopsy were retrospectively analyzed and summarized with review. The size of biopsy samples, complications, and diagnostic yield were compared.
Results
Fourteen patients met the inclusion criteria, of whom 12 underwent TBLC, 1 underwent TBLB, and 1 underwent each procedure at different times. Compared to the size of TBLB specimens (5.625 ± 0.479 mm2), the size of TBLC specimens (12.00 (12.00, 15.00) mm2) was much larger (Z = − 3.262, P = 0.001). The diagnostic yields of TBLC and TBLB were 100.00% (13/13) and 0.00% (2/2), respectively (P = 0.0095). The most frequent complication was mild bleeding. The risk of bleeding between TBLB (1/2, 50.00%) and TBLC (10/13, 76.92%) did not differ significantly (P = 0.469).
Conclusion
TBLC can add extra diagnostic value by effectively identifying specific types of histology for patients with suspected CTD-ILD or IPAF, with a procedure that is safe from adverse events.
Key Points • Transbronchial lung cryobiopsy has been introduced recently for diagnosing interstitial lung disease. • Transbronchial lung cryobiopsy was found to be effective and safe in the diagnosis for patients with suspected interstitial lung disease. It can be used as a preferred method for biopsy when the clinical-radiological diagnosis is uncertain. |
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References
Fischer A, Antoniou KM, Brown KK, Cadranel J, Corte TJ, du Bois RM, Lee JS, Leslie KO, Lynch DA, Matteson EL, Mosca M, Noth I, Richeldi L, Strek ME, Swigris JJ, Wells AU, West SG, Collard HR, Cottin V (2015) An official European Respiratory Society/American Thoracic Society research statement: interstitial pneumonia with autoimmune features. Eur Respir J 46(4):976–987. https://doi.org/10.1183/13993003.00150-2015
Guo B, Wang L, Xia S et al (2020) The interstitial lung disease spectrum under a uniform diagnostic algorithm: a retrospective study of 1,945 individuals. J Thorac Dis 12(7):3688–3696. https://doi.org/10.21037/jtd-19-4021
Chartrand S, Swigris JJ, Stanchev L, Lee JS, Brown KK, Fischer A (2016) Clinical features and natural history of interstitial pneumonia with autoimmune features: a single center experience. Respir Med 119:150–154. https://doi.org/10.1016/j.rmed.2016.09.002
Ahmad K, Barba T, Gamondes D, Ginoux M, Khouatra C, Spagnolo P, Strek M, Thivolet-Béjui F, Traclet J, Cottin V (2017) Interstitial pneumonia with autoimmune features: clinical, radiologic, and histological characteristics and outcome in a series of 57 patients. Respir Med 123:56–62. https://doi.org/10.1016/j.rmed.2016.10.017
McCoy SS, Mukadam Z, Meyer KC et al (2018) Mycophenolate therapy in interstitial pneumonia with autoimmune features: a cohort study. Ther Clin Risk Manag 14:2171–2181. https://doi.org/10.2147/TCRM.S173154
Lynch DA, Sverzellati N, Travis WD, Brown KK, Colby TV, Galvin JR, Goldin JG, Hansell DM, Inoue Y, Johkoh T, Nicholson AG, Knight SL, Raoof S, Richeldi L, Ryerson CJ, Ryu JH, Wells AU (2018) Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society White Paper. Lancet Respir Med 6(2):138–153. https://doi.org/10.1016/S2213-2600(17)30433-2
Babiak A, Hetzel J, Krishna G et al (2009) Transbronchial cryobiopsy: a new tool for lung biopsies. Respiration 78(2):203–208. https://doi.org/10.1159/000203987
Ravaglia C, Bonifazi M, Wells AU, Tomassetti S, Gurioli C, Piciucchi S, Dubini A, Tantalocco P, Sanna S, Negri E, Tramacere I, Ventura VA, Cavazza A, Rossi A, Chilosi M, la Vecchia C, Gasparini S, Poletti V (2016) Safety and diagnostic yield of transbronchial lung cryobiopsy in diffuse parenchymal lung diseases: a comparative study versus video-assisted thoracoscopic lung biopsy and a systematic review of the literature. Respiration 91(3):215–227. https://doi.org/10.1159/000444089
Johannson KA, Marcoux VS, Ronksley PE, Ryerson CJ (2016) Diagnostic yield and complications of transbronchial lung cryobiopsy for interstitial lung disease. a systematic review and metaanalysis. Ann Am Thorac Soc 13(10):1828–1838. https://doi.org/10.1513/AnnalsATS.201606-461SR
Raparia K, Aisner DL, Allen TC, Beasley MB, Borczuk A, Cagle PT, Capelozzi V, Dacic S, Hariri LP, Kerr KM, Lantuejoul S, Mino-Kenudson M, Rekhtman N, Roden AC, Roy-Chowdhuri S, Sholl L, Smith ML, Thunnissen E, Tsao MS, Yatabe Y (2016) Transbronchial lung cryobiopsy for interstitial lung disease diagnosis: a perspective from members of the pulmonary pathology society. Arch Pathol Lab Med 140(11):1281–1284. https://doi.org/10.5858/arpa.2016-0258-SA
Hetzel J, Maldonado F, Ravaglia C, Wells AU, Colby TV, Tomassetti S, Ryu JH, Fruchter O, Piciucchi S, Dubini A, Cavazza A, Chilosi M, Sverzellati N, Valeyre D, Leduc D, Walsh SLF, Gasparini S, Hetzel M, Hagmeyer L, Haentschel M, Eberhardt R, Darwiche K, Yarmus LB, Torrego A, Krishna G, Shah PL, Annema JT, Herth FJF, Poletti V (2018) Transbronchial cryobiopsies for the diagnosis of diffuse parenchymal lung diseases: expert statement from the cryobiopsy working group on safety and utility and a call for standardization of the procedure. Respiration 95(3):188–200. https://doi.org/10.1159/000484055
Walscher J, Gross B, Eberhardt R et al (2019) Transbronchial cryobiopsies for diagnosing interstitial lung disease: real-life experience from a tertiary referral center for interstitial lung disease. Respiration 97(4):348–354. https://doi.org/10.1159/000493428
Goldman L (2011) In: Schafer AI (2011) Goldman’s Cecil medicine, vol 2011, 24th edn. Elsevier Medicine, Amsterdam, pp 556–560
Connors GR, Christopher-Stine L, Oddis CV, Danoff SK (2010) Interstitial lung disease associated with the idiopathic inflammatory myopathies: what progress has been made in the past 35 years? Chest 138(6):1464–1474. https://doi.org/10.1378/chest.10-0180
Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, Rasmussen A, Scofield H, Vitali C, Bowman SJ, Mariette X, the International Sjögren's Syndrome Criteria Working Group (2017) 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjogren’s syndrome: a consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis 76(1):9–16. https://doi.org/10.1136/annrheumdis-2016-210571
Ryerson CJ, Corte TJ, Lee JS, Richeldi L, Walsh SLF, Myers JL, Behr J, Cottin V, Danoff SK, Flaherty KR, Lederer DJ, Lynch DA, Martinez FJ, Raghu G, Travis WD, Udwadia Z, Wells AU, Collard HR (2017) A standardized diagnostic ontology for fibrotic interstitial lung disease. an international working group perspective. Am J Respir Crit Care Med 196(10):1249–1254. https://doi.org/10.1164/rccm.201702-0400PP
Thomson CC, Duggal A, Bice T, Lederer DJ, Wilson KC, Raghu G (2019) 2018 Clinical practice guideline summary for clinicians: diagnosis of idiopathic pulmonary fibrosis. Ann Am Thorac Soc 16(3):285–290. https://doi.org/10.1513/AnnalsATS.201809-604CME
Jiang JY, Guo SL, Li YS (2017) Advance in transbronchial cryobiopsy. Zhonghua Jie He He Hu Xi Za Zhi 40(8):619–622. https://doi.org/10.3760/cma.j.issn.1001-0939.2017.08.015
Du Rand IA, Blaikley J, Booton R et al (2013) Summary of the British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults. Thorax 68(8):786–787. https://doi.org/10.1136/thoraxjnl-2013-203629
Jiang T, Guo S, Li Y (2019) Efficacy and safety of transbronchial cryobiopsy in diagnosis of interstitial pneumonia with autoimmune features. Acta Acad Med Militaris Tertiae 41:1682–1687. https://doi.org/10.16016/j.1000-5404.201904095
Travis WD, Costabel U, Hansell DM, King te Jr, Lynch DA, Nicholson AG, Ryerson CJ, Ryu JH, Selman M, Wells AU, Behr J, Bouros D, Brown KK, Colby TV, Collard HR, Cordeiro CR, Cottin V, Crestani B, Drent M, Dudden RF, Egan J, Flaherty K, Hogaboam C, Inoue Y, Johkoh T, Kim DS, Kitaichi M, Loyd J, Martinez FJ, Myers J, Protzko S, Raghu G, Richeldi L, Sverzellati N, Swigris J, Valeyre D, ATS/ERS Committee on Idiopathic Interstitial Pneumonias (2013) An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 188(6):733–748. https://doi.org/10.1164/rccm.201308-1483ST
Iftikhar IH, Alghothani L, Sardi A, Berkowitz D, Musani AI (2017) 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 14(7):1197–1211. https://doi.org/10.1513/AnnalsATS.201701-086SR
Hetzel J, Wells AU, Costabel U, Colby TV, Walsh SLF, Verschakelen J, Cavazza A, Tomassetti S, Ravaglia C, Böckeler M, Spengler W, Kreuter M, Eberhardt R, Darwiche K, Torrego A, Pajares V, Muche R, Musterle R, Horger M, Fend F, Warth A, Heußel CP, Piciucchi S, Dubini A, Theegarten D, Franquet T, Lerma E, Poletti V, Häntschel M (2020) Transbronchial cryobiopsy increases diagnostic confidence in interstitial lung disease: a prospective multicenter trial. Eur Respi J 56:1901520. https://doi.org/10.1183/13993003.01520-2019
Raghu G, Remy-Jardin M, Myers JL, Richeldi L, Ryerson CJ, Lederer DJ, Behr J, Cottin V, Danoff SK, Morell F, Flaherty KR, Wells A, Martinez FJ, Azuma A, Bice TJ, Bouros D, Brown KK, Collard HR, Duggal A, Galvin L, Inoue Y, Jenkins RG, Johkoh T, Kazerooni EA, Kitaichi M, Knight SL, Mansour G, Nicholson AG, Pipavath SNJ, Buendía-Roldán I, Selman M, Travis WD, Walsh S, Wilson KC, American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Society (2018) Diagnosis of idiopathic pulmonary fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 198(5):e44–e68. https://doi.org/10.1164/rccm.201807-1255ST
Griff S, Schonfeld N, Ammenwerth W et al (2014) Diagnostic yield of transbronchial cryobiopsy in non-neoplastic lung disease: a retrospective case series. BMC Pulm Med 14:171. https://doi.org/10.1186/1471-2466-14-171
Pajares V, Puzo C, Castillo D, Lerma E, Montero MA, Ramos-Barbón D, Amor-Carro O, Gil de Bernabé A, Franquet T, Plaza V, Hetzel J, Sanchis J, Torrego A (2014) Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: a randomized trial. Respirology 19(6):900–906. https://doi.org/10.1111/resp.12322
Li Y, Guo S, Yi X (2017) Efficacy and safety of transbronchial cryobiopsy in the etiologic diagnosis of diffuse lung disease. Natl Med J China 97(46):3617–3623
Troy LK, Grainge C, Corte TJ, Williamson JP, Vallely MP, Cooper WA, Mahar A, Myers JL, Lai S, Mulyadi E, Torzillo PJ, Phillips MJ, Jo HE, Webster SE, Lin QT, Rhodes JE, Salamonsen M, Wrobel JP, Harris B, Don G, Wu PJC, Ng BJ, Oldmeadow C, Raghu G, Lau EMT, Arnold D, Cao C, Cashmore A, Cleary S, Evans TJ, French B, Geis M, Glenn L, Hibbert M, Ing A, James A, Meredith G, Merry C, Pudipeddi A, Saghaie T, Thomas R, Thomson C, Twaddell S (2020) Diagnostic accuracy of transbronchial lung cryobiopsy for interstitial lung disease diagnosis (COLDICE): a prospective, comparative study. Lancet Respir Med 8(2):171–181. https://doi.org/10.1016/S2213-2600(19)30342-X
Fisher JH, Shapera S, To T et al (2019) Procedure volume and mortality after surgical lung biopsy in interstitial lung disease. Eur Respir J 53(2):1801164. https://doi.org/10.1183/13993003.01164-2018
Hutchinson JP, Fogarty AW, McKeever TM et al (2016) In-hospital mortality after surgical lung biopsy for interstitial lung disease in the united states. 2000 to 2011. Am J Respir Crit Care Med 193(10):1161–1167. https://doi.org/10.1164/rccm.201508-1632OC
Acknowledgements
We would like to express our gratitude to our colleagues at The Affiliated Hospital of Guilin Medical University and to the associate editor and the reviewers for their useful feedback that improved this paper.
Funding
This work was supported by funds from the National Natural Science Foundation of China Grant 81760298 and the 139 Program for the High-Level Medical Talents in Guangxi Province.
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Wu, Wj., Mo, HY. & Liu, H. Transbronchial lung cryobiopsy for connective tissue disease–related interstitial lung disease and interstitial pneumonia with autoimmune features: a single center retrospective case series. Clin Rheumatol 40, 3765–3772 (2021). https://doi.org/10.1007/s10067-021-05671-1
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DOI: https://doi.org/10.1007/s10067-021-05671-1