Diagnostic evaluation of patients with diffuse parenchymal lung disease (DPLD) is best achieved by a multidisciplinary team correlating clinical, radiologic, and pathologic features. Surgical lung biopsies remain the gold standard for histopathologic diagnosis of idiopathic interstitial pneumonias. Emerging data suggest an increasing role for transbronchial cryobiopsy (TBC) in DPLD evaluation. We describe our experience with TBC in patients with DPLD.
We retrospectively reviewed medical records of patients with radiographic features of DPLD who underwent TBC at Mayo Clinic, Rochester, Minnesota in June 2013-September 2015.
Seventy-four patients (33 female, 45%) with a mean age of 63 years (SD 13.8) were included. Mean maximal diameter of samples was 9.2 mm (range 2-20, SD 3.9). The median number of samples per procedure was 3 (range 1-7). Diagnostic yield was 51% (38/74). The most frequent histopathologic patterns were granulomatous inflammation (12) and organizing pneumonia (OP) (11), resulting in the final diagnoses of hypersensitivity pneumonitis (6), cryptogenic OP (6), connective tissue disease-associated OP (3), drug toxicity (3), infection-related OP (2), sarcoidosis (2), and aspiration (1). Other histopathologic patterns included respiratory bronchiolitis (3), acute fibrinous and organizing pneumonia (2), desquamative interstitial pneumonia (1), diffuse alveolar damage (1), pulmonary alveolar proteinosis (1), amyloidosis (1), eosinophilic pneumonia (1), necrotizing vasculitis (1), bronchiolitis with food particle (1), and malignancy (3). Pneumothorax developed in one patient (1.4%), bleeding occurred in 16 (22%).
Our single center cohort demonstrated 51% diagnostic yield from TBC; the rates of pneumothorax and bleeding were 1.4% and 22%, respectively. Optimal use of TBC needs to be determined.