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Transbronchial cryobiopsy increases diagnostic confidence in interstitial lung disease: a prospective multicentre trial
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Rabu, 16 Des 2020 14:48:51

Jürgen Hetzel, Athol U. Wells, Ulrich Costabel, Thomas V. Colby, Simon L.F. Walsh, Johny Verschakelen, Alberto Cavazza, Sara Tomassetti, Claudia Ravaglia, Michael Böckeler, Werner Spengler, Michael Kreuter, Ralf Eberhardt, Kaid Darwiche, Alfons Torrego, Virginia Pajares, Rainer Muche, Regina Musterle, Marius Horger, Falko Fend, Arne Warth, Claus Peter Heußel, Sara Piciucchi, Alessandra Dubini, Dirk Theegarten, Tomas Franquet, Enrique Lerma, Venerino Poletti, Maik Häntschel

European Respiratory Journal 2020 56: 1901520; DOI: 10.1183/13993003.01520-2019

Abstract

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 is the current recommended tissue sampling technique according to the most recent guidelines. Transbronchial lung cryobiopsy (TBLC) has been proposed as an alternative to surgical lung biopsy.

Methods This prospective, multicentre, international study analysed the impact of TBLC on the diagnostic assessment of 128 patients with suspected idiopathic interstitial pneumonia by a central MDTD board (two clinicians, two radiologists, two pathologists). The level of confidence for the first-choice diagnoses were evaluated in four steps, as follows: 1) clinicoradiological data alone; 2) addition of bronchoalveolar lavage (BAL) findings; 3) addition of TBLC interpretation; and 4) surgical lung biopsy 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 patients nondiagnostic 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% of patients, and 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 noninvasive diagnosis, with manageable side-effects. These data support the integration of TBLC into the diagnostic algorithm for ILD.

Transbronchial cryobiopsy increases diagnostic likelihood of the first-choice diagnosis and confirms specified ILD diagnosis in a clinically relevant number of patients https://bit.ly/3hmd7HX

Footnotes

  • This article has supplementary material available from erj.ersjournals.com

  • Authors’ contribution: J. Hetzel, A.U. Wells, V. Poletti, U. Costabel and M. Häntschel designed the study. J. Hetzel, R. Musterle and M. Häntschel did the data analysis. A.U. Wells, T.V. Colby, U. Costabel and V. Poletti contributed to the data interpretation. R. Muche supervised the statistical analysis process. J. Hetzel, A.U. Wells, U. Costabel, T.V. Colby, R. Musterle, V. Poletti and M. Häntschel wrote the manuscript. A.U. Wells, U. Costabel, T.V. Colby, S.L.F. Walsh, J. Verschakelen, A. Cavazza, S. Tomassetti, C. Ravaglia and V. Poletti participated in the multidisciplinary team discussion or presented the data during the multidisciplinary team discussion. J. Hetzel, V. Poletti, R. Musterle and M. Häntschel presented the data during the multidisciplinary team discussion, S. Tomassetti and C. Ravaglia managed the data acquisition during the multidisciplinary team discussion. T.V. Colby and A. Cavazza did central evaluation of digitalised pathology data, S.L.F. Walsh and J. Verschakelen did central evaluation of the high-resolution computed tomography scans. J. Hetzel, S. Tomassetti, C. Ravaglia, M. Böckeler, W. Spengler, M. Kreuter, R. Eberhardt, K. Darwiche, A. Torrego, V. Poletti, V. Pajares and M. Häntschel performed the cryobiopsies at the participating centres. F. Fend, A. Warth, A. Dubini, D. Theegarten and E. Lerma did local pathology evaluation. M. Horger, C.P. Heußel, S. Piciucchi, T. Franquet did local evaluation of the high-resolution computed tomography scans.

  • Conflict of interest: J. Hetzel reports grants from ERBE Elektromedizin GmbH, during the conduct of the study; and personal fees from Erbe Elektromedizin GmbH, outside the submitted work.

  • Conflict of interest: A.U. Wells reports grants from ERBE Elektromedizin GmbH, during the conduct of the study.

  • Conflict of interest: U. Costabel reports grants from ERBE Elektromedizin GmbH during the conduct of the study, covering travel and accommodation costs for the central multidisciplinary team discussion. There was no payment for participation.

  • Conflict of interest: T.V. Colby reports grants from ERBE Elektromedizin GmbH during the conduct of the study, covering travel and accommodation costs for the central multidisciplinary team discussion. There was no payment for participation.

  • Conflict of interest: S.L.F. Walsh reports grants from ERBE Elektromedizin GmbH, personal fees from Boehringer Ingelheim, Roche, The Open Source Imaging Consortium, Intermmune, Sanofi-Genzyme and Bracco; and 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 multidisciplinary team discussion. There was no payment for participation.

  • Conflict of interest: A. Cavazza reports grants from ERBE Elektromedizin GmbH during the conduct of the study, covering accommodation costs for the central multidisciplinary team discussion. There was no payment for participation.

  • Conflict of interest: S. Tomassetti has nothing to disclose.

  • Conflict of interest: C. Ravaglia has nothing to disclose.

  • Conflict of interest: M. Böckeler reports personal fees from Erbe Elektromedizin GmbH, outside the submitted work.

  • Conflict of interest: W. Spengler has nothing to disclose.

  • Conflict of interest: M. Kreuter reports grants and personal fees from Roche and Boehringer Ingelheim outside the submitted work.

  • Conflict of interest: R. Eberhardt reports personal fees from Olympus Europa, Pulmonx, Broncus/Uptake medical and BTG/PneumRx, outside the submitted work.

  • Conflict of interest: K. Darwiche received speakers fee and travel grants from ERBE Elektromedizin GmbH, outside the submitted work.

  • Conflict of interest: A. Torrego has nothing to disclose.

  • Conflict of interest: V. Pajares has nothing to disclose.

  • Conflict of interest: R. Muche has nothing to disclose.

  • Conflict of interest: R. Musterle reports grants from ERBE Elektromedizin GmbH, during the conduct of the study.

  • Conflict of interest: M. Horger has nothing to disclose.

  • Conflict of interest: F. Fend has nothing to disclose.

  • Conflict of interest: A. Warth has nothing to disclose.

  • Conflict of interest: C.P. Heußel reports personal fees from Novartis, Basilea and 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: GSK).

  • Conflict of interest: S. Piciucchi has nothing to disclose.

  • Conflict of interest: A. Dubini has nothing to disclose.

  • Conflict of interest: D. Theegarten has nothing to disclose.

  • Conflict of interest: T. Franquet has nothing to disclose.

  • Conflict of interest: E. Lerma has nothing to disclose.

  • Conflict of interest: V. Poletti reports personal fees from ERBE Elektromedizin GmbH, outside the submitted work.

  • Conflict of interest: M. Häntschel reports grants from ERBE Elektromedizin GmbH, during the conduct of the study; and personal fees from Erbe Elektromedizin GmbH, outside the submitted work.

  • Support statement: Travel and accommodation costs of the multidisciplinary team discussion participants (J. Hetzel, A.U. Wells, U. Costabel, T.V. Colby, S.L.F. Walsh, J. Verschakelen, A. Cavazza, R. Musterle, M. Häntschel) were covered by Erbe Elektromedizin GmbH. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Received July 31, 2019.
  • Accepted July 15, 2020.
  • Copyright ©ERS 2020