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PLoS One. 2014 Feb 28;9(2):e86716. doi: 10.1371/journal.pone.0086716. eCollection 2014.

Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases.

Author information

1
Department of Diseases of the Thorax, G.B Morgagni Hospital, Forlì, Italy.
2
Department of Pathology, S. Maria Nuova Hospital-I.R.C.C.S, Reggio Emilia, Italy.
3
Department of Pathology, Mayo Clinic, Scottsdale, Arizona, United States of America.
4
Department of Pathology, G.B Morgagni Hospital, Forlì, Italy.
5
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.
6
Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola Forlì-Cesena, Italy.
7
Department of Radiology, G.B Morgagni Hospital, Forlì, Italy.
8
Department of Pathology, Verona University, Verona, Italy.

Abstract

BACKGROUND:

Histology is a key element for the multidisciplinary diagnosis of fibrotic diffuse parenchymal lung diseases (f-DPLD) when the clinical-radiological picture is nondiagnostic. Transbronchial lung cryobiopsy (TBLC) have been shown to be useful for obtaining large and well-preserved biopsies of lung parenchyma, but experience with TBLC in f-DPLD is limited.

OBJECTIVES:

To evaluate safety, feasibility and diagnostic yield of TBLC in f-DPLD.

METHOD:

Prospective study of 69 cases of TBLC using flexible cryoprobe in the clinical-radiological setting of f-DPLD with nondiagnostic high resolution computed tomography (HRCT) features.

RESULTS:

SAFETY:

pneumothorax occurred in 19 patients (28%). One patient (1.4%) died of acute exacerbation. Feasibility: adequate cryobiopsies were obtained in 68 cases (99%). The median size of cryobiopsies was 43.11 mm(2) (range, 11.94-76.25). Diagnostic yield: among adequate TBLC the pathologists were confident ("high confidence") that histopathologic criteria sufficient to define a specific pattern in 52 patients (76%), including 36 of 47 with UIP (77%) and 9 nonspecific interstitial pneumonia (6 fibrosing and 3 cellular), 2 desquamative interstitial pneumonia/respiratory bronchiolitis-interstitial lung disease, 1 organizing pneumonia, 1 eosinophilic pneumonia, 1 diffuse alveolar damage, 1 hypersensitivity pneumonitis and 1 follicular bronchiolitis. In 11 diagnoses of UIP the pathologists were less confident ("low confidence"). Agreement between pathologists in the detection of UIP was very good with a Kappa coefficient of 0.83 (95% CI, 0.69-0.97). Using the current consensus guidelines for clinical-radiologic-pathologic correlation 32% (20/63) of cases were classified as Idiopathic Pulmonary Fibrosis (IPF), 30% (19/63) as possible IPF, 25% (16/63) as other f-DPLDs and 13% (8/63) were unclassifiable.

CONCLUSIONS:

TBLC in the diagnosis of f-DPLD appears safe and feasible. TBLC has a good diagnostic yield in the clinical-radiological setting of f-DPLD without diagnostic HRCT features of usual interstitial pneumonia. Future studies should consider TBLC as a potential alternative to SLBx in f-DPLD.

PMID:
24586252
PMCID:
PMC3938401
DOI:
10.1371/journal.pone.0086716
[Indexed for MEDLINE]
Free PMC Article

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