Analysis of pathological diagnosis in patients undergoing transbronchial cryobiopsy_West China Medical Journal

Authors：

ZHOU Wenwen , LU Haiyan , WANG Faping , LI Ping , ZHANG Yuchen , LAN Lan , LI Liangyuan , WANG Yujun , ZHU Min , WU Wentao , ZHOU Liang , XÜ Linrui ,  LUO Fengming ,  SHEN Yongchun

Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LUO Fengming, Email: fengmingluo@outlook.com; SHEN Yongchun, Email: shen_yongchun@126.com

Keywords：

Lung disease; biopsy; cryobiopsy; bronchoscopy; diagnosis

DOI：

10.7507/1002-0179.202502044

Video：

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Objective To explore the clinical diagnostic value of transbronchial cryobiopsy (TBCB) for lung diseases. Methods All patients who underwent TBCB in the bronchoscopy room of West China Hospital, Sichuan University from November 5, 2020 to August 7, 2024 were consecutively included. Clinical information of the patients was collected, and the distribution of pathological diagnosis, clinical diagnosis, and the consistency between the two were statistically analyzed. The distribution of diagnosis and the consistency with pathological diagnosis of interstitial lung disease (ILD) were analyzed. The distribution of diagnosis of patients who underwent more than two lung biopsies was summarized. Results A total of 351 TBCB patients were included. The concordance rate between the overall pathological diagnosis and the clinical diagnosis was 68.66%. Among 351 patients who underwent TBCB, 199 cases were diagnosed as ILD by pathological diagnosis, and the consistency rate with the clinical diagnosis was 90.45%. 22 cases were pathologically suggested or suspected of tumor by pathology, and the final consistency rate with clinical diagnosis was 95.45%. Descriptive pathological conclusions were found in 74 cases. The clinical diagnosis of ILD was 255 cases, and the diagnostic rate of TBCB was 71.76%. 83 cases of immune-related ILD (diagnostic rate 83.13%); 75 cases of idiopathic interstitial pneumonia (diagnostic rate 44.00%); There were 59 cases of ILD with cysts and/or air Spaces (diagnostic rate 83.05%). 33 cases of exposion-associated ILD (diagnostic rate 81.82%); 5 cases of pulmonary sarcoidosis (diagnostic rate 100.00%). Among them, 28 patients underwent lung biopsy more than twice, and the disease distribution was mainly ILD. Conclusion TBCB has significant value in the auxiliary clinical diagnosis of lung diseases, especially interstitial lung diseases, with the greatest advantages in the auxiliary diagnosis of PAP, tumors, and IIP.

1.	Kheir F, Uribe Becerra JP, Bissell B, et al. Transbronchial lung cryobiopsy in patients with interstitial lung disease: a systematic review. Ann Am Thorac Soc, 2022, 19(7): 1193-1202.
2.	Iftikhar IH, Alghothani L, Sardi A, et al. 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, 2017, 14(7): 1197-1211.
3.	中国医师协会呼吸医师分会呼吸病理工作组, 中华医学会病理学分会胸部疾病学组. 间质性肺疾病冷冻肺活检标本病理诊断中国专家共识. 中华结核和呼吸杂志, 2024, 47(8): 704-715.
4.	Hetzel J, Maldonado F, Ravaglia C, et al. 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, 2018, 95(3): 188-200.
5.	中华医学会呼吸病学分会介入呼吸病学学组, 中国医师协会呼吸医师分会介人呼吸病学工作委员会. 经支气管冷冻活检技术临床应用专家共识. 中华结核和呼吸杂志, 2019, 42(6): 405-412.
6.	Raghu G, Remy-Jardin M, Richeldi L, et al. Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med, 2022, 205(9): e18-e47.
7.	Nicholson AG, Tsao MS, Beasley MB, et al. The 2021 WHO classification of lung tumors: impact of advances since 2015. J Thorac Oncol, 2022, 17(3): 362-387.
8.	Freund O, Wand O, Schneer S, et al. Transbronchial cryobiopsy is superior to forceps biopsy for diagnosing both fibrotic and non-fibrotic interstitial lung diseases. Respiration, 2023, 102(9): 852-860.
9.	Serra C, Torrego A, Pajares V, et al. Bronchoalveolar lavage complements transbronchial cryobiopsy diagnosis in diffuse interstitial lung diseases. J Bronchology Interv Pulmonol, 2022, 29(1): 39-47.
10.	She S, Steinfort DP, Ing AJ, et al. Transbronchial cryobiopsy in interstitial lung disease: safety of a standardized procedure. J Bronchology Interv Pulmonol, 2020, 27(1): 36-41.
11.	阳胜, 朱娅琳, 肖奎. 经支气管冷冻肺活检后按需手术肺活检对比即刻手术肺活检诊断间质性肺疾病(COLD 研究): 一项随机对照临床试验. 中华结核和呼吸杂志, 2024, 47(9): 826.
12.	Maldonado F, Danoff SK, Wells AU, et al. Transbronchial cryobiopsy for the diagnosis of interstitial lung diseases: chest guideline and expert panel report. Chest, 157 (4): 1030-1042.
13.	刘春平, 顾莹莹, 李时悦, 等. 173 例经支气管镜冷冻肺活检在弥漫性肺疾病中的病理诊断分析. 中华结核和呼吸杂志, 2020, 43(3): 228-233.
14.	Fortin M, Liberman M, Delage A, et al. Transbronchial lung cryobiopsy and surgical lung biopsy: a prospective multi-centre agreement clinical trial (CAN-ICE). Am J Respir Crit Care Med, 2023, 207(12): 1612-1619.
15.	Castellani C, Castellani H, Benn BS. Transbronchial lung cryobiopsy is safe and effective for diagnosing acutely ill hospitalized patients with new diffuse parenchymal lung disease. Lung, 2022, 200(2): 153-159.
16.	Jee AS, Sheehy R, Hopkins P, et al. Diagnosis and management of connective tissue disease-associated interstitial lung disease in Australia and New Zealand: a position statement from the Thoracic Society of Australia and New Zealand. Respirology, 2021, 26(1): 23-51.
17.	Maher TM. Interstitial lung disease: a review. JAMA, 2024, 331(19): 1655-1665.
18.	Zaizen Y, Kohashi Y, Kuroda K, et al. Concordance between sequential transbronchial lung cryobiopsy and surgical lung biopsy in patients with diffuse interstitial lung disease. Diagn Pathol, 2019, 14(1): 131.
19.	Sharp C, McCabe M, Adamali H, et al. Use of transbronchial cryobiopsy in the diagnosis of interstitial lung disease-a systematic review and cost analysis. QJM, 2017, 110(4): 207-214.
20.	Raghu G, Remy-Jardin M, Myers JL, et al. Diagnosis of idiopathic pulmonary fibrosis. An official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med, 2018, 198(5): e44-e68.
21.	Mononen M, Saari E, Hasala H, et al. Risk factors of clinically significant complications in transbronchial lung cryobiopsy: a prospective multi-center study. Respir Med, 2022, 200: 106922.

1. Kheir F, Uribe Becerra JP, Bissell B, et al. Transbronchial lung cryobiopsy in patients with interstitial lung disease: a systematic review. Ann Am Thorac Soc, 2022, 19(7): 1193-1202.
2. Iftikhar IH, Alghothani L, Sardi A, et al. 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, 2017, 14(7): 1197-1211.
3. 中国医师协会呼吸医师分会呼吸病理工作组, 中华医学会病理学分会胸部疾病学组. 间质性肺疾病冷冻肺活检标本病理诊断中国专家共识. 中华结核和呼吸杂志, 2024, 47(8): 704-715.
4. Hetzel J, Maldonado F, Ravaglia C, et al. 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, 2018, 95(3): 188-200.
5. 中华医学会呼吸病学分会介入呼吸病学学组, 中国医师协会呼吸医师分会介人呼吸病学工作委员会. 经支气管冷冻活检技术临床应用专家共识. 中华结核和呼吸杂志, 2019, 42(6): 405-412.
6. Raghu G, Remy-Jardin M, Richeldi L, et al. Idiopathic pulmonary fibrosis (an update) and progressive pulmonary fibrosis in adults: an official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med, 2022, 205(9): e18-e47.
7. Nicholson AG, Tsao MS, Beasley MB, et al. The 2021 WHO classification of lung tumors: impact of advances since 2015. J Thorac Oncol, 2022, 17(3): 362-387.
8. Freund O, Wand O, Schneer S, et al. Transbronchial cryobiopsy is superior to forceps biopsy for diagnosing both fibrotic and non-fibrotic interstitial lung diseases. Respiration, 2023, 102(9): 852-860.
9. Serra C, Torrego A, Pajares V, et al. Bronchoalveolar lavage complements transbronchial cryobiopsy diagnosis in diffuse interstitial lung diseases. J Bronchology Interv Pulmonol, 2022, 29(1): 39-47.
10. She S, Steinfort DP, Ing AJ, et al. Transbronchial cryobiopsy in interstitial lung disease: safety of a standardized procedure. J Bronchology Interv Pulmonol, 2020, 27(1): 36-41.
11. 阳胜, 朱娅琳, 肖奎. 经支气管冷冻肺活检后按需手术肺活检对比即刻手术肺活检诊断间质性肺疾病(COLD 研究): 一项随机对照临床试验. 中华结核和呼吸杂志, 2024, 47(9): 826.
12. Maldonado F, Danoff SK, Wells AU, et al. Transbronchial cryobiopsy for the diagnosis of interstitial lung diseases: chest guideline and expert panel report. Chest, 157 (4): 1030-1042.
13. 刘春平, 顾莹莹, 李时悦, 等. 173 例经支气管镜冷冻肺活检在弥漫性肺疾病中的病理诊断分析. 中华结核和呼吸杂志, 2020, 43(3): 228-233.
14. Fortin M, Liberman M, Delage A, et al. Transbronchial lung cryobiopsy and surgical lung biopsy: a prospective multi-centre agreement clinical trial (CAN-ICE). Am J Respir Crit Care Med, 2023, 207(12): 1612-1619.
15. Castellani C, Castellani H, Benn BS. Transbronchial lung cryobiopsy is safe and effective for diagnosing acutely ill hospitalized patients with new diffuse parenchymal lung disease. Lung, 2022, 200(2): 153-159.
16. Jee AS, Sheehy R, Hopkins P, et al. Diagnosis and management of connective tissue disease-associated interstitial lung disease in Australia and New Zealand: a position statement from the Thoracic Society of Australia and New Zealand. Respirology, 2021, 26(1): 23-51.
17. Maher TM. Interstitial lung disease: a review. JAMA, 2024, 331(19): 1655-1665.
18. Zaizen Y, Kohashi Y, Kuroda K, et al. Concordance between sequential transbronchial lung cryobiopsy and surgical lung biopsy in patients with diffuse interstitial lung disease. Diagn Pathol, 2019, 14(1): 131.
19. Sharp C, McCabe M, Adamali H, et al. Use of transbronchial cryobiopsy in the diagnosis of interstitial lung disease-a systematic review and cost analysis. QJM, 2017, 110(4): 207-214.
20. Raghu G, Remy-Jardin M, Myers JL, et al. Diagnosis of idiopathic pulmonary fibrosis. An official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med, 2018, 198(5): e44-e68.
21. Mononen M, Saari E, Hasala H, et al. Risk factors of clinically significant complications in transbronchial lung cryobiopsy: a prospective multi-center study. Respir Med, 2022, 200: 106922.

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