Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: A randomized trial

Respirology - Tập 19 Số 6 - Trang 900-906 - 2014
Virginia Pajares1,2, Carmen Puzo2, Diego Castillo2, Enrique Lerma3, M. Angeles Montero4, David Ramos‐Barbón2, Óscar Amor-Carro2, Angels Gil de Bernabé5, Tomás Franquet6, Vicente Plaza2, Jürgen Hetzel7, J. Sanchís2, Alfons Torrego2
1Department of Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
2Department of Respiratory Medicine, Biomedical Research Institute Sant Pau (IIb Sant Pau), Barcelona, Spain
3Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
4Department of Histopathology Royal Brompton & Harefield NHS Trust London UK
5Department of Anaesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
6Department of Radiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
7Department of Internal Medicine 2 University of Tübingen Tübingen Germany

Tóm tắt

AbstractBackground and objectiveTransbronchial lung biopsy (TBLB) is required for evaluation in selected patients with interstitial lung disease (ILD). The diagnostic yield of histopathologic assessment is variable and is influenced by factors such as the size of samples and the presence of crush artefacts left by conventional biopsy forceps. We compared the diagnostic yield and safety of TBLB with cryoprobe sampling versus conventional forceps sampling.MethodsThis randomized clinical trial analysed data for 77 patients undergoing TBLB for evaluation of ILD; patients were assigned to either a conventional‐forceps group or a cryoprobe group. Two pathologists assessed the tissue samples and agreed on histopathologic diagnoses. We also compared the duration of procedures, complications and sample‐quality variables.ResultsThe most frequent diagnosis observed in the cryoprobe group was non‐specific interstitial pneumonia. Histopathologic diagnoses were identified in more cases in the cryoprobe group (74.4%) than in the conventional‐forceps group (34.1%) (P < 0.001), and the diagnostic yield was higher in the cryoprobe group (51.3% vs 29.1% in the conventional forceps group; P = 0.038). A larger mean area of tissue was harvested by cryoprobe (14.7 ± 11 mm2) than by conventional forceps (3.3 ± 4.1 mm2) (P < 0.001). More grade 2 bleeding (not statistically significant) occurred in the cryoprobe group (56.4%) than in the conventional‐forceps group (34.2%). No differences in other complications were observed.ConclusionsTBLB by cryoprobe is safe and potentially useful in the diagnosis of ILD. Larger multisite randomized trials are required to confirm the potential benefits of this procedure.Clinical trial registration at ClinicalTrials.gov: NCT01064609.

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Respirology

Tập 19 Số 6

900-906

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