title: Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases.
abstract: BACKGROUND
  Histology is a key element for the multidisciplinary diagnosis of fibrotic diffuse parenchymal lung diseases (f-DPLD) when the clinical-radiological picture is nondiagnostic. Transbronchial lung cryobiopsy (TBLC) have been shown to be useful for obtaining large and well-preserved biopsies of lung parenchyma, but experience with TBLC in f-DPLD is limited.
  
  
  OBJECTIVE
  To evaluate safety, feasibility and diagnostic yield of TBLC in f-DPLD.
  
  
  METHODS
  Prospective study of 69 cases of TBLC using flexible cryoprobe in the clinical-radiological setting of f-DPLD with nondiagnostic high resolution computed tomography (HRCT) features.
  
  
  RESULTS
  
  
  
  RESULTS
  pneumothorax occurred in 19 patients (28%). One patient (1.4%) died of acute exacerbation. Feasibility: adequate cryobiopsies were obtained in 68 cases (99%). The median size of cryobiopsies was 43.11 mm(2) (range, 11.94-76.25). Diagnostic yield: among adequate TBLC the pathologists were confident ("high confidence") that histopathologic criteria sufficient to define a specific pattern in 52 patients (76%), including 36 of 47 with UIP (77%) and 9 nonspecific interstitial pneumonia (6 fibrosing and 3 cellular), 2 desquamative interstitial pneumonia/respiratory bronchiolitis-interstitial lung disease, 1 organizing pneumonia, 1 eosinophilic pneumonia, 1 diffuse alveolar damage, 1 hypersensitivity pneumonitis and 1 follicular bronchiolitis. In 11 diagnoses of UIP the pathologists were less confident ("low confidence"). Agreement between pathologists in the detection of UIP was very good with a Kappa coefficient of 0.83 (95% CI, 0.69-0.97). Using the current consensus guidelines for clinical-radiologic-pathologic correlation 32% (20/63) of cases were classified as Idiopathic Pulmonary Fibrosis (IPF), 30% (19/63) as possible IPF, 25% (16/63) as other f-DPLDs and 13% (8/63) were unclassifiable.
  
  
  CONCLUSIONS
  TBLC in the diagnosis of f-DPLD appears safe and feasible. TBLC has a good diagnostic yield in the clinical-radiological setting of f-DPLD without diagnostic HRCT features of usual interstitial pneumonia. Future studies should consider TBLC as a potential alternative to SLBx in f-DPLD.
authors.affiliation: Department of Diseases of the Thorax, G.B Morgagni Hospital, Forlì, Italy.
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Casoni
authors.affiliation: Department of Diseases of the Thorax, G.B Morgagni Hospital, Forlì, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Tomassetti
authors.affiliation: Department of Pathology, S. Maria Nuova Hospital-I.R.C.C.S, Reggio Emilia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cavazza
authors.affiliation: Department of Pathology, Mayo Clinic, Scottsdale, Arizona, United States of America.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Colby
authors.affiliation: Department of Pathology, G.B Morgagni Hospital, Forlì, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Dubini
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America.
authors.forename: Jay H
authors.initials: JH
authors.lastname: Ryu
authors.affiliation: Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola Forlì-Cesena, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Carretta
authors.affiliation: Department of Diseases of the Thorax, G.B Morgagni Hospital, Forlì, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Tantalocco
authors.affiliation: Department of Radiology, G.B Morgagni Hospital, Forlì, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Piciucchi
authors.affiliation: Department of Diseases of the Thorax, G.B Morgagni Hospital, Forlì, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ravaglia
authors.affiliation: Department of Diseases of the Thorax, G.B Morgagni Hospital, Forlì, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Gurioli
authors.affiliation: Department of Diseases of the Thorax, G.B Morgagni Hospital, Forlì, Italy.
authors.forename: Micaela
authors.initials: M
authors.lastname: Romagnoli
authors.affiliation: Department of Diseases of the Thorax, G.B Morgagni Hospital, Forlì, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Gurioli
authors.affiliation: Department of Pathology, Verona University, Verona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Chilosi
authors.affiliation: Department of Diseases of the Thorax, G.B Morgagni Hospital, Forlì, Italy.
authors.forename: Venerino
authors.initials: V
authors.lastname: Poletti
mesh_terms: D001706:Biopsy / Q000379:methods*; D030342:Genetic Diseases, Inborn / Q000175:diagnosis*; D006801:Humans; D008168:Lung / Q000473:pathology*; D017563:Lung Diseases, Interstitial / Q000175:diagnosis*; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity