Diagnostic yield and safety of trans-bronchial lung biopsy with forceps, cryo-biopsy or thoracoscopic lung biopsy in interstitial lung diseases

Abstract

Interstitial lung diseases (ILDs) are characterized by alveolar epithelial damage and lung parenchymal distortion, associated with ultimate extensive parenchymal fibrosis. So, we aimed to assess the appropriate method for tissue diagnosis of ILD with the least complications, either with conventional tranbronchial bronchoscopic forceps biopsy(TBLB), cryo-biopsy(TBCB), or thoracoscopic lung biopsy. Sixty patients, with clinical, laboratory and radiological criteria of ILD, were randomly categorized into 3groups, group (1) included patients underwent bronchoscopic transbronchial forceps biopsy, group (2) included patients underwent Bronchoscopic lung cryobiopsy and group (3) included patients underwent thoracoscopic lung biopsy. A specific pathological diagnosis was achieved in only 8/20 patients (40%) in bronchoscopic forceps biopsy group, compared to 19/20 patient (95%) in bronchoscopic lung cryobiopsy group and 20/20 patients (100%) in thoracoscopic lung biopsy group, with a significant difference (p < 0.001). Whereas the difference between groups (2) and (3) wasn’t significant (p = 0.311). Regarding safety, pneumothorax documented in 5% in cryobiopsy group with no significant difference among the groups (p = 0.362) and bleeding was higher for the cryobiopsy group (55%) vs. 15% in bronchoscopic forceps biopsy group (p = 0.008) and 5% in thoracoscopic lung biopsy group (p = 0.001). Howerver bleeding was mild self-limited and did not need any interventions. This study demonstrated that both transbronchial cryobiopsy (TBCB) and thoracoscopic biopsy offer a dramatically superior diagnostic yield for Interstitial lung diseases (ILDs) compared to conventional TBLB, While TBCB, minimally invasive alternative that nearly matches the diagnostic gold standard of surgery. ClinicalTrials.gov (NCT07432503).