Transbronchial cryobiopsy in immunocompromised patients with pulmonary infiltrates: a pilot study.
BACKGROUND
In immunocompromised patients with pulmonary infiltrates, transbronchial lung biopsies (TBB) obtained by forceps has been shown to increase the diagnostic yield over simple bronchoalveolar lavage. Cryo-TBB is a novel modality for obtaining lung biopsies. We aimed to evaluate for the first time the efficacy and safety of cryo-TBB in immunocompromised patients.


METHODS
Fifteen immunocompromised patients with pulmonary infiltrates underwent cryo-TBB. During the procedure two to three biopsy samples were taken. Procedure characteristics, complications, and the diagnostic yield were retrospectively evaluated.


RESULTS
Most patients (n = 11) were immunocompromised due to hematological malignancies. The remaining four patients were receiving chronic immunosuppressive treatment due to previous solid-organ transplantation (n = 2) or collagen-vascular disease (n = 2). No major complications occurred in the cryo-TBB group. The mean surface area of the specimen taken by cryo-TBB was 9 mm(2). The increase in surface area and quality of biopsy samples translated to a high percentage of alveolated tissue (70 %) that enabled a clear histological detection of the following diagnoses: noncaseating granulomatous inflammation (n = 2), acute interstitial pneumonitis consistent with drug reaction (n = 5), nonspecific interstitial pneumonia fibrotic variant (n = 1), diffuse alveolar damage (n = 3), organizing pneumonia (n = 3), and pulmonary cryptococcal pneumonia (n = 1). Diagnostic information obtained by cryo-TBB led to change in the management of 12 patients (80 %).


CONCLUSIONS
Cryo-TBB in immunocompromised patients with pulmonary infiltrates provides clinically important diagnostic data with a low complication rate. These advantages should be further compared with traditional forceps TBB in a prospective randomized trial.
The Pulmonary Division, Rabin Medical Center, Beilinson Hospital, 49100, Petah Tikva, Israel, orenfr@clalit.org.il.
Oren
O
Fruchter
Ludmila
L
Fridel
Dror
D
Rosengarten
Nader Abed-el
NA
Rahman
Mordechai R
MR
Kramer
D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D001999:Bronchoscopy; D005260:Female; D005615:Freezing; D006801:Humans; D016867:Immunocompromised Host; D008168:Lung / Q000276:immunology / Q000473:pathology*; D008171:Lung Diseases / Q000276:immunology / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies