title: Histological diagnosis of interstitial lung diseases by cryo-transbronchial biopsy.
abstract: OBJECTIVE
  The gold standard for the histological diagnosis of interstitial lung diseases (ILD) is an open lung biopsy (OLB). Tissue samples obtained by forceps transbronchial lung biopsies (TBB) are usually too small. We aim to evaluate the efficacy and safety of cryo-TBB for the diagnosis of ILD and to explore its role as substitute for OLB.
  
  
  METHODS
  Seventy-five patients (mean age 56.2 years) with clinical and radiological features suggestive of ILD underwent cryo-TBB under moderate sedation. The diagnostic contribution on the work-up of suspected ILD was assessed.
  
  
  RESULTS
  No major complications occurred during cryo-TBB procedures. The mean cross-sectional area of the biopsy specimen obtained was 9 mm2 with an average of 70% alveolated tissue. The most common pathological diagnoses were idiopathic nonspecific interstitial pneumonitis (n = 22), cryptogenic organizing pneumonia (n = 11) and usual interstitial pneumonitis (n = 7). There were three patients of pulmonary Langerhans cell histiocytosis and one patient of pulmonary lymphangioleiomyomatosis. A definite and probable clinicopathological consensus diagnosis was possible in 70% and 28% of patients, respectively. In only 2% of patients' diagnosis could not be established.
  
  
  CONCLUSIONS
  Cryo-TBB is a safe and effective minimally invasive modality for the diagnosis of ILD. No OLB is needed in the majority of patients.
authors.affiliation: Institute of Pulmonary, Rabin Medical Center, Petah Tiqwa, Israel; The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: Oren
authors.initials: O
authors.lastname: Fruchter
authors.forename: Ludmila
authors.initials: L
authors.lastname: Fridel
authors.forename: Bayya Abed
authors.initials: BA
authors.lastname: El Raouf
authors.forename: Nader
authors.initials: N
authors.lastname: Abdel-Rahman
authors.forename: Dror
authors.initials: D
authors.lastname: Rosengarten
authors.forename: Mordechai R
authors.initials: MR
authors.lastname: Kramer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001706:Biopsy / Q000379:methods*; D001980:Bronchi / Q000473:pathology*; D001999:Bronchoscopy / Q000379:methods*; D003080:Cold Temperature; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D017563:Lung Diseases, Interstitial / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D061214:Patient Safety; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: alveolar proteinosis; bronchoscopy and interventional techniques; interstitial lung disease; nonspecific interstitial pneumonitis; usual interstitial pneumonitis