title: Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: a randomized trial.
abstract: OBJECTIVE
  Transbronchial lung biopsy (TBLB) is required for evaluation in selected patients with interstitial lung disease (ILD). The diagnostic yield of histopathologic assessment is variable and is influenced by factors such as the size of samples and the presence of crush artefacts left by conventional biopsy forceps. We compared the diagnostic yield and safety of TBLB with cryoprobe sampling versus conventional forceps sampling.
  
  
  METHODS
  This randomized clinical trial analysed data for 77 patients undergoing TBLB for evaluation of ILD; patients were assigned to either a conventional-forceps group or a cryoprobe group. Two pathologists assessed the tissue samples and agreed on histopathologic diagnoses. We also compared the duration of procedures, complications and sample-quality variables.
  
  
  RESULTS
  The most frequent diagnosis observed in the cryoprobe group was non-specific interstitial pneumonia. Histopathologic diagnoses were identified in more cases in the cryoprobe group (74.4%) than in the conventional-forceps group (34.1%) (P < 0.001), and the diagnostic yield was higher in the cryoprobe group (51.3% vs 29.1% in the conventional forceps group; P = 0.038). A larger mean area of tissue was harvested by cryoprobe (14.7 ± 11 mm(2) ) than by conventional forceps (3.3 ± 4.1 mm(2)) (P < 0.001). More grade 2 bleeding (not statistically significant) occurred in the cryoprobe group (56.4%) than in the conventional-forceps group (34.2%). No differences in other complications were observed.
  
  
  CONCLUSIONS
  TBLB by cryoprobe is safe and potentially useful in the diagnosis of ILD. Larger multisite randomized trials are required to confirm the potential benefits of this procedure. Clinical trial registration at ClinicalTrials.gov: NCT01064609.
authors.affiliation: Department of Respiratory Medicine, Biomedical Research Institute Sant Pau (IIb Sant Pau), Barcelona, Spain; Department of Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Pajares
authors.forename: Carmen
authors.initials: C
authors.lastname: Puzo
authors.forename: Diego
authors.initials: D
authors.lastname: Castillo
authors.forename: Enrique
authors.initials: E
authors.lastname: Lerma
authors.forename: M Angeles
authors.initials: MA
authors.lastname: Montero
authors.forename: David
authors.initials: D
authors.lastname: Ramos-Barbón
authors.forename: Oscar
authors.initials: O
authors.lastname: Amor-Carro
authors.forename: Angels
authors.initials: A
authors.lastname: Gil de Bernabé
authors.forename: Tomás
authors.initials: T
authors.lastname: Franquet
authors.forename: Vicente
authors.initials: V
authors.lastname: Plaza
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hetzel
authors.forename: Joaquin
authors.initials: J
authors.lastname: Sanchis
authors.forename: Alfons
authors.initials: A
authors.lastname: Torrego
mesh_terms: D000368:Aged; D001706:Biopsy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001999:Bronchoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D015925:Cryopreservation / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006652:Histological Techniques / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D015994:Incidence; D008168:Lung / Q000473:pathology; D017563:Lung Diseases, Interstitial / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015203:Reproducibility of Results; D013525:Surgical Instruments
keywords: bronchoscopy; cryobiopsy; cryoprobe; interstitial lung disease; transbronchial lung biopsy