Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases.
<h4>Background</h4>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 wel...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2014-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0086716&type=printable |
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| author | Gian Luca Casoni Sara Tomassetti Alberto Cavazza Thomas V Colby Alessandra Dubini Jay H Ryu Elisa Carretta Paola Tantalocco Sara Piciucchi Claudia Ravaglia Christian Gurioli Micaela Romagnoli Carlo Gurioli Marco Chilosi Venerino Poletti |
| author_facet | Gian Luca Casoni Sara Tomassetti Alberto Cavazza Thomas V Colby Alessandra Dubini Jay H Ryu Elisa Carretta Paola Tantalocco Sara Piciucchi Claudia Ravaglia Christian Gurioli Micaela Romagnoli Carlo Gurioli Marco Chilosi Venerino Poletti |
| author_sort | Gian Luca Casoni |
| collection | DOAJ |
| description | <h4>Background</h4>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.<h4>Objectives</h4>To evaluate safety, feasibility and diagnostic yield of TBLC in f-DPLD.<h4>Method</h4>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.<h4>Results</h4><h4>Safety</h4>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.<h4>Conclusions</h4>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. |
| first_indexed | 2024-12-20T02:35:11Z |
| format | Article |
| id | doaj.art-79250b8f3a59492884f75f26253863fa |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2025-03-17T00:28:28Z |
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| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-79250b8f3a59492884f75f26253863fa2025-02-21T05:37:18ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0192e8671610.1371/journal.pone.0086716Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases.Gian Luca CasoniSara TomassettiAlberto CavazzaThomas V ColbyAlessandra DubiniJay H RyuElisa CarrettaPaola TantaloccoSara PiciucchiClaudia RavagliaChristian GurioliMicaela RomagnoliCarlo GurioliMarco ChilosiVenerino Poletti<h4>Background</h4>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.<h4>Objectives</h4>To evaluate safety, feasibility and diagnostic yield of TBLC in f-DPLD.<h4>Method</h4>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.<h4>Results</h4><h4>Safety</h4>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.<h4>Conclusions</h4>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.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0086716&type=printable |
| spellingShingle | Gian Luca Casoni Sara Tomassetti Alberto Cavazza Thomas V Colby Alessandra Dubini Jay H Ryu Elisa Carretta Paola Tantalocco Sara Piciucchi Claudia Ravaglia Christian Gurioli Micaela Romagnoli Carlo Gurioli Marco Chilosi Venerino Poletti Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases. PLoS ONE |
| title | Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases. |
| title_full | Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases. |
| title_fullStr | Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases. |
| title_full_unstemmed | Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases. |
| title_short | Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases. |
| title_sort | transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0086716&type=printable |
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