Abstract
IntroductionThe accurate diagnosis of individual interstitial lung diseases (ILD) is often challenging, but is a critical determinant of appropriate management. If a diagnosis cannot be made after multidisciplinary team discussion (MDTD), surgical lung biopsy is the current recommended tissue sampling technique according to the most recent guidelines. Transbronchial lung cryobiopsy (TBLC) has been proposed as an alternative to surgical lung biopsy.
MethodsThis prospective, multicentre, international study analysed the impact of TBLC on the diagnostic assessment of 128 patients with suspected idiopathic interstitial pneumonia by a central MDTD board (two clinicians, two radiologists, two pathologists). The level of confidence for the first-choice diagnoses were evaluated in four steps, as follows: 1) clinicoradiological data alone; 2) addition of bronchoalveolar lavage (BAL) findings; 3) addition of TBLC interpretation; and 4) surgical lung biopsy findings (if available). We evaluated the contribution of TBLC to the formulation of a confident first-choice MDTD diagnosis.
Resultspercenta TBLC导致显著增加ge of cases with confident diagnoses or provisional diagnoses with high confidence (likelihood ≥70%) from 60.2% to 81.2%. In 32 out of 52 patients nondiagnostic after BAL, TBLC provided a diagnosis with a likelihood ≥70%. The percentage of confident diagnoses (likelihood ≥90%) increased from 22.7% after BAL to 53.9% after TBLC. Pneumothoraces occurred in 16.4% of patients, and moderate or severe bleeding in 15.7% of patients. No deaths were observed within 30 days.
InterpretationTBLC increases diagnostic confidence in the majority of ILD patients with an uncertain noninvasive diagnosis, with manageable side-effects. These data support the integration of TBLC into the diagnostic algorithm for ILD.
Abstract
Transbronchial cryobiopsy increases diagnostic likelihood of the first-choice diagnosis and confirms specified ILD diagnosis in a clinically relevant number of patientshttps://bit.ly/3hmd7HX
Footnotes
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Authors’ contribution: J. Hetzel, A.U. Wells, V. Poletti, U. Costabel and M. Häntschel designed the study. J. Hetzel, R. Musterle and M. Häntschel did the data analysis. A.U. Wells, T.V. Colby, U. Costabel and V. Poletti contributed to the data interpretation. R. Muche supervised the statistical analysis process. J. Hetzel, A.U. Wells, U. Costabel, T.V. Colby, R. Musterle, V. Poletti and M. Häntschel wrote the manuscript. A.U. Wells, U. Costabel, T.V. Colby, S.L.F. Walsh, J. Verschakelen, A. Cavazza, S. Tomassetti, C. Ravaglia and V. Poletti participated in the multidisciplinary team discussion or presented the data during the multidisciplinary team discussion. J. Hetzel, V. Poletti, R. Musterle and M. Häntschel presented the data during the multidisciplinary team discussion, S. Tomassetti and C. Ravaglia managed the data acquisition during the multidisciplinary team discussion. T.V. Colby and A. Cavazza did central evaluation of digitalised pathology data, S.L.F. Walsh and J. Verschakelen did central evaluation of the high-resolution computed tomography scans. J. Hetzel, S. Tomassetti, C. Ravaglia, M. Böckeler, W. Spengler, M. Kreuter, R. Eberhardt, K. Darwiche, A. Torrego, V. Poletti, V. Pajares and M. Häntschel performed the cryobiopsies at the participating centres. F. Fend, A. Warth, A. Dubini, D. Theegarten and E. Lerma did local pathology evaluation. M. Horger, C.P. Heußel, S. Piciucchi, T. Franquet did local evaluation of the high-resolution computed tomography scans.
反对flict of interest: J. Hetzel reports grants from ERBE Elektromedizin GmbH, during the conduct of the study; and personal fees from Erbe Elektromedizin GmbH, outside the submitted work.
反对flict of interest: A.U. Wells reports grants from ERBE Elektromedizin GmbH, during the conduct of the study.
反对flict of interest: U. Costabel reports grants from ERBE Elektromedizin GmbH during the conduct of the study, covering travel and accommodation costs for the central multidisciplinary team discussion. There was no payment for participation.
反对flict of interest: T.V. Colby reports grants from ERBE Elektromedizin GmbH during the conduct of the study, covering travel and accommodation costs for the central multidisciplinary team discussion. There was no payment for participation.
反对flict of interest: S.L.F. Walsh reports grants from ERBE Elektromedizin GmbH, personal fees from Boehringer Ingelheim, Roche, The Open Source Imaging Consortium, Intermmune, Sanofi-Genzyme and Bracco; and grants from National Institute for Health and Research, during the conduct of the study.
反对flict of interest: J. Verschakelen reports grants from ERBE Elektromedizin GmbH during the conduct of the study, covering travel and accommodation costs for the central multidisciplinary team discussion. There was no payment for participation.
反对flict of interest: A. Cavazza reports grants from ERBE Elektromedizin GmbH during the conduct of the study, covering accommodation costs for the central multidisciplinary team discussion. There was no payment for participation.
反对flict of interest: S. Tomassetti has nothing to disclose.
反对flict of interest: C. Ravaglia has nothing to disclose.
反对flict of interest: M. Böckeler reports personal fees from Erbe Elektromedizin GmbH, outside the submitted work.
反对flict of interest: W. Spengler has nothing to disclose.
反对flict of interest: M. Kreuter reports grants and personal fees from Roche and Boehringer Ingelheim outside the submitted work.
反对flict of interest: R. Eberhardt reports personal fees from Olympus Europa, Pulmonx, Broncus/Uptake medical and BTG/PneumRx, outside the submitted work.
反对flict of interest: K. Darwiche received speakers fee and travel grants from ERBE Elektromedizin GmbH, outside the submitted work.
反对flict of interest: A. Torrego has nothing to disclose.
反对flict of interest: V. Pajares has nothing to disclose.
反对flict of interest: R. Muche has nothing to disclose.
反对flict of interest: R. Musterle reports grants from ERBE Elektromedizin GmbH, during the conduct of the study.
反对flict of interest: M. Horger has nothing to disclose.
反对flict of interest: F. Fend has nothing to disclose.
反对flict of interest: A. Warth has nothing to disclose.
利益冲突:C.P.高浓缩铀ßel个人报告fees from Novartis, Basilea and Bayer, outside the submitted work. In addition, Dr Heußel has a patent Method and Device For Representing the Microstructure of the Lungs (IPC8 Class: AA61B5055FI, PAN: 20080208038 issued and Stock ownership in medical industry: GSK).
反对flict of interest: S. Piciucchi has nothing to disclose.
反对flict of interest: A. Dubini has nothing to disclose.
反对flict of interest: D. Theegarten has nothing to disclose.
反对flict of interest: T. Franquet has nothing to disclose.
反对flict of interest: E. Lerma has nothing to disclose.
反对flict of interest: V. Poletti reports personal fees from ERBE Elektromedizin GmbH, outside the submitted work.
反对flict of interest: M. Häntschel reports grants from ERBE Elektromedizin GmbH, during the conduct of the study; and personal fees from Erbe Elektromedizin GmbH, outside the submitted work.
Support statement: Travel and accommodation costs of the multidisciplinary team discussion participants (J. Hetzel, A.U. Wells, U. Costabel, T.V. Colby, S.L.F. Walsh, J. Verschakelen, A. Cavazza, R. Musterle, M. Häntschel) were covered by Erbe Elektromedizin GmbH. Funding information for this article has been deposited with theCrossref Funder Registry.
- ReceivedJuly 31, 2019.
- AcceptedJuly 15, 2020.
- Copyright ©ERS 2020