Abstract
Background In patients with interstitial lung diseases (ILD), histopathological input is often required to obtain a diagnosis. Surgical lung biopsy (SLB) is considered the reference standard, but many patients are clinically unfit to undergo this invasive procedure, and adverse events, length of hospitalization and costs are considerable. This guideline provides evidence-based clinical practice recommendations for the role of transbronchial lung cryobiopsy (TBLC) in obtaining tissue-based diagnosis in patients with undiagnosed ILD.
Materials and methods The European Respiratory Society task force consisted of clinical experts in the field of ILD and/or TBLC, and methodological experts. Four PICO questions and two narrative questions were formulated. Systematic literature searches were performed in Medline and Embase (up to June 2021). GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology was applied.
Results In patients with undiagnosed ILD and an indication to obtain histopathological data: 1) TBLC is suggested as replacement test in patients considered eligible to undergo SLB, 2) TBLC is suggested in patients not considered eligible to undergo SLB, 3) SLB is suggested as add-on test in patients with a non-informative TBLC, 4) no recommendation is made for or against second TBLC in patients with a non-informative TBLC, and 5) TBLC-operators should undergo training, but no recommendation is made for the type of training required.
Conclusion TBLC provides important diagnostic information in patients with undiagnosed ILD. Diagnostic yield is lower compared to SLB, at reduced serious adverse events and length of hospitalization. Certainty of the evidence is mostly “very low”.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflicts of interest (alphabetical)
Conflicts of interest: Daniël A. Korevaar has nothing to disclose.
Conflicts of interest: Sara Colella has nothing to disclose.
Conflicts of interest: Markus Fally has nothing to disclose.
Conflicts of interest: Juliette Camuset has nothing to disclose.
Conflicts of interest: Thomas V. Colby has nothing to disclose.
Conflicts of interest: Lars Hagmeyer has received honoraria for lectures and presentations from Boehringer Ingelheim and Roche, and participated in advisory boards for Boehringer Ingelheim and Roche.
Conflicts of interest: Juergen Hetzel has received honoraria for lectures and presentations from Erbe and GlaxoSmithKline, and research support from Boehringer Ingelheim and AstraZeneca.
Conflicts of interest: Fabien Maldonado has nothing to disclose.
Conflicts of interest: Antonio Morais has received honaria for presentations from Boehringer Ingelheim, Roche, Pfizer, AstraZeneca and Sanofi, and research grants from Roche, Boehringer Ingelheim and GlaxoSmithKline.
Conflicts of interest: Claudia Ravaglia has nothing to disclose.
Conflicts of interest: René Spijker has nothing to disclose.
Conflicts of interest: Sara Tomassetti has received honoraria for presentations from Roche and Boehringer Ingelheim.
Conflicts of interest: Lauren K. Troy has received honoraria for presentations from Boehringer Ingelheim, has been a member of an advisory board for Roche, and has received research support from Erbe.
Conflicts of interest: Johny A. Verschakelen has nothing to disclose.
Conflicts of interest: Athol U. Wells has received personal fees from Roche and Boehringer Ingelheim.
Conflicts of interest: Thomy Tonia acts as ERS Methodologist
Conflicts of interest: Jouke T. Annema has nothing to disclose.
Conflicts of interest: Venerino Poletti has received honoraria for lectures and presentations from Boehringer Ingelheim, Roche and Erbe, and participated in advisory boards for Boehringer Ingelheim, Roche and Ambu.
Conflicts of interest: The patient representatives have nothing to disclose.
This is a PDF-only article. Please click on the PDF link above to read it.
- Received February 25, 2022.
- Accepted May 7, 2022.
- Copyright ©The authors 2022. For reproduction rights and permissions contact permissions{at}ersnet.org
