Transbronchial lung cryobiopsy and pulmonary fibrosis: A never-ending story?

Barbara Ruaro; Stefano Tavano; Paola Confalonieri; Riccardo Pozzan; Michael Hughes; Luca Braga; Maria Concetta Volpe; Giovanni Ligresti; Alessia Giovanna Andrisano; Selene Lerda; Pietro Geri; Marco Biolo; Elisa Baratella; Marco Confalonieri; Francesco Salton

doi:10.1016/j.heliyon.2023.e14768

Transbronchial lung cryobiopsy and pulmonary fibrosis: A never-ending story?

Heliyon. 2023 Mar 25;9(4):e14768. doi: 10.1016/j.heliyon.2023.e14768. eCollection 2023 Apr.

Authors

Affiliations

¹ Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy.
² Division of Musculoskeletal and Dermatological Sciences, The Univeristy of Manchester, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M6 8HD, UK.
³ ICGEB, Area Science Park, Padriciano, 34128 Trieste, Italy.
⁴ Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
⁵ 24ORE Business School, Via Monte Rosa, 91, 20149 Milano, Italy.
⁶ Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy.

Abstract

Background: The diagnostic process of pulmonary fibrosis (PF) is often challenging, requires a collaborative effort of several experts, and often requires bioptic material, which can be difficult to obtain, both in terms of quality and technique. The main procedures available to obtain such samples are transbronchial lung cryobiopsy (TBLC) and surgical lung biopsy (SLB).

Objective: The purpose of this paper is to review the evidence for the role of TBLC in the diagnostic-therapeutic process of PF.

Methods: A comprehensive review was performed to identify articles to date that addressed the role of TBLC in the diagnostic-therapeutic process of PF using the PubMed® database.

Results: The reasoned search identified 206 papers, including 21 manuscripts (three reviews, one systematic review, two guidelines, two prospective studies, three retrospective studies, one cross-sectional study, one original article, three editorials, three clinical trials, and two unclassifiable studies), which were included in the final review.

Conclusions: TBLC is gaining increasing efficacy and improving safety profile; however, there are currently no clear data demonstrating its superiority over SLB. Therefore, the two techniques should be considered with careful rationalization on a case-by-case basis. Further research is needed to further optimize and standardize the procedure and to thoroughly study the histological and molecular characteristics of PF.

Keywords: Bronchoscopy; Idiopathic pulmonary fibrosis (IPF); Interstitial lung disease (ILD); Pulmonary fibrosis (PF); Surgical lung biopsy (SLB); Transbronchial lung cryobiopsy (TBLC).