PT - JOURNAL ARTICLE AU - Jürgen Hetzel AU - Athol U. Wells AU - Ulrich Costabel AU - Thomas V. Colby AU - Simon L.F. Walsh AU - Johny Verschakelen AU - Alberto Cavazza AU - Sara Tomassetti AU - Claudia Ravaglia AU - Michael Böckeler AU - Werner Spengler AU - Michael Kreuter AU - Ralf Eberhardt AU - Kaid Darwiche AU - Alfons Torrego AU - Virginia Pajares AU - Rainer Muche AU - Regina Musterle AU - Marius Horger AU - Falko Fend AU - Arne Warth AU - Claus Peter Heußel AU - Sara Piciucchi AU - Alessandra Dubini AU - Dirk Theegarten AU - Tomas Franquet AU - Enrique Lerma AU - Venerino Poletti AU - Maik Häntschel TI - Transbronchial cryobiopsy increases diagnostic confidence in interstitial lung disease: a prospective multicenter trial AID - 10.1183/13993003.01520-2019 DP - 2020 Jan 01 TA - European Respiratory Journal PG - 1901520 4099 - http://erj.ersjournals.com/content/early/2020/07/16/13993003.01520-2019.short 4100 - http://erj.ersjournals.com/content/early/2020/07/16/13993003.01520-2019.full AB - Introduction The accurate diagnosis of individual interstitial lung diseases (ILD) is often challenging, but is a critical determinant of appropriate management. If a diagnosis cannot be made after multidisciplinary team discussion (MDTD) surgical lung biopsy (SLB) is the current recommended tissue sampling technique according to the most recent guidelines. Transbronchial lung cryobiopsy (TBLC) has been proposed as an alternative to SLB.Methods This prospective, multicenter, international study analysed the impact of TBLC on the diagnostic assessment of 128 patients with suspected idiopathic intersitital pneumonia by a central MDTD board (two both clinicians, radiologists, pathologists). The level of confidence for the first-choice diagnoses were evaluated in four steps: 1. clinicoradiological data alone, 2. addition of BAL findings, 3. addition of TBLC interpretation, and 4. SLB findings (if available). We evaluated the contribution of TBLC to the formulation of a confident first-choice MDTD diagnosis.Results TBLC led to a significant increase in the percentage of cases with confident diagnoses or provisional diagnoses with high confidence (likelihood ≥70%) from 60.2% to 81.2%. In 32 out of 52 nondiagnostic patients after BAL TBLC provided a diagnosis with a likelihood≥70%. The percentage of confident diagnoses (likelihood≥90%) increased from 22.7% after BAL to 53.9% after TBLC. Pneumothoraces occurred in 16.4%, moderate or severe bleeding in 15.7% of patients. No deaths were observed within 30 days.Interpretation TBLC increases diagnostic confidence in the majority of ILD patients with an uncertain non-invasive diagnosis, with manageable side effects. These data support the integration of TBLC in the diagnostic algorithm for ILD.FootnotesThis 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.Conflict of interest: Dr. Hetzel reports grants from ERBE Elektromedizin GmbH, during the conduct of the study; personal fees from Erbe Elektromedizin GmbH, outside the submitted work.Conflict of interest: Dr. Wells reports grants from ERBE Elektromedizin GmbH, during the conduct of the study.Conflict of interest: Ulrich Costabel reports grants from ERBE Elektromedizin GmbH during the conduct of the study, covering travel and accommodation costs for the central multidiciplinary team discussion. There was no payment for participation.Conflict of interest: T. Colby reports grants from ERBE Elektromedizin GmbH during the conduct of the study, covering travel and accommodation costs for the central multidiciplinary team discussion. There was no payment for participation.Conflict of interest: Dr. Walsh reports grants from ERBE Elektromedizin GmbH, personal fees from Boehringer Ingelheim, personal fees from Boehringer Ingelheim, personal fees from Roche, personal fees from The Open Source Imaging Consortium, from Intermmune, personal fees from Sanofi-Genzyme, personal fees from Bracco, grants from National Institute for Health and Research, during the conduct of the study.Conflict of interest: J. Verschakelen reports grants from ERBE Elektromedizin GmbH during the conduct of the study, covering travel and accommodation costs for the central multidiciplinary team discussion. There was no payment for participation.Conflict of interest: Alberto Cavazza reports grants from ERBE Elektromedizin GmbH during the conduct of the study, covering accommodation costs for the central multidiciplinary team discussion. There was no payment for participation.Conflict of interest: Sara Tomassetti has nothing to disclose.Conflict of interest: Dr. Ravaglia has nothing to disclose.Conflict of interest: Dr. Böckeler reports personal fees from Erbe Elektromedizin GmbH, outside the submitted work.Conflict of interest: Dr. Spengler has nothing to disclose.Conflict of interest: M. Kreuter reports grants and personal fees from Roche, grants and personal fees from Boehringer Ingelheim outside the submitted work.Conflict of interest: R. Eberhardt reports personal fees from Olympus Europa, personal fees from Pulmonx, personal fees from Broncus/Uptake medical, personal fees from BTG/PneumRx, outside the submitted work.Conflict of interest: K Darwiche received speakers fee and travel grants from ERBE Elektromedizin GmbH.Conflict of interest: Dr. Torrego has nothing to disclose.Conflict of interest: Dr. Pajares has nothing to disclose.Conflict of interest: Rainer MucheConflict of interest: Dr. Musterle reports grants from ERBE Elektromedizin GmbH, during the conduct of the study.Conflict of interest: Dr. Horger has nothing to disclose.Conflict of interest: Dr. Fend has nothing to disclose.Conflict of interest: Arne Warth has nothing to disclose.Conflict of interest: Dr. Heußel reports personal fees from Novartis, personal fees from Basilea, personal fees from Bayer, outside the submitted work; In addition, Dr. Heußel has a patent Method and Device For Representing the Microstructure of the Lungs. IPC8 Class: AA61B5055FI, PAN: 20080208038 issued and Stock ownership in medical industry: GSKConflict of interest: Sara Piciucchi has nothing to disclose.Conflict of interest: Alessandra Dubini has nothing to disclose.Conflict of interest: Dr. Theegarten has nothing to disclose.Conflict of interest: Dr. Franquet has nothing to disclose.Conflict of interest: Dr. Lerma has nothing to disclose.Conflict of interest: Dr. VENERINO reports personal fees from ERBE Elektromedizin GmbH, outside the submitted work.Conflict of interest: Dr. Häntschel reports grants from ERBE Elektromedizin GmbH, during the conduct of the study; personal fees from Erbe Elektromedizin GmbH, outside the submitted work.