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 - Tập 91 Số 3 - Trang 215-227 - 2016
Claudia Ravaglia1, Martina Bonifazi2, Athol U. Wells3, Sara Tomassetti1, Carlo Gurioli1, Sara Piciucchi4, Alessandra Dubini5, Paola Tantalocco1, Stefano Sanna6, Carlo La Vecchia7, Irene Tramacere8, Valentina Ventura9, Alberto Cavazza10, Andrea Rossi11, Marco Chilosi12, Stefano Gasparini2, Venerino Poletti1
1Pulmonology Unit and
2Pulmonology Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria ‘Ospedali Riuniti', Foggia,
3Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
4Radiology and
5Pathology, G.B. Morgagni - L. Pierantoni Hospital, Forlì,
6Thoracic Surgery Unit, Department of Thoracic Diseases, and Departments of
7Department of Epidemiology, ‘Mario Negri' Institute for Pharmacological Research-IRCCS,
8Neuroepidemiology Units, IRCCS Foundation, ‘Carlo Besta' Neurological Institute, and
9Physiopathology Respiratory Unit, General Hospital F. Miulli, Acquaviva delle Fonti,
10Pathology Unit, Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, and
11Pulmonary Unit and
12Department of Pathology, University of Verona, Verona, Italy

Tóm tắt

<b><i>Background:</i></b> A diagnosis of interstitial lung diseases (ILDs) may include surgical lung biopsy (SLB), which is associated with significant morbidity and mortality and also appreciable costs. Transbronchial lung cryobiopsy (TBLC) is adopting an important role. <b><i>Objectives:</i></b> The aim of this study was to compare the diagnostic yield (DY) and safety of TBLC and SLB in a large cohort of patients and to perform a systematic review of the literature as well as a meta-analysis. <b><i>Methods:</i></b> We performed a retrospective analysis of 447 cases with ILD undergoing TBLC and/or SLB and a systematic review of the literature (MEDLINE and Embase for all original articles on the DY and safety of TBLC in ILDs up to July 2015). <b><i>Results:</i></b> A total of 150 patients underwent SLB and 297 underwent TBLC. The median time of hospitalization was 6.1 days (SLB) and 2.6 days (TBLC; p < 0.0001). Mortality due to adverse events was observed for 2.7% (SLB) and 0.3% (TBLC) of the patients. Pneumothorax was the most common complication after TBLC (20.2%). No severe bleeding was observed. TBLC was diagnostic for 246 patients (82.8%), SLB for 148 patients (98.7%, p = 0.013). A meta-analysis of 15 investigations including 781 patients revealed an overall DY of 0.81 (0.75-0.87); the overall pooled probability of developing a pneumothorax, as retrieved from 15 studies including 994 patients, was 0.06 (95% CI 0.02-0.11). <b><i>Conclusion:</i></b> Cryobiopsy is safe and has lower complication and mortality rates compared to SLB. TBLC might, therefore, be considered the first diagnostic approach for obtaining tissue in ILDs, reserving the surgical approach for cases in which TBLC is not diagnostic.

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Respiration

Tập 91 Số 3

215-227

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