title: The role of transbronchial cryobiopsy and surgical lung biopsy in the diagnostic algorithm of interstitial lung disease.
abstract: OBJECTIVE
  It is not yet known if transbronchial cryobiopsy (TCB) is a reliable and safe diagnostic tool in the investigation of interstitial lung disease (ILD). To date, there have been no studies directly comparing the value of TCB with that of surgical lung biopsy (SLB). The study was initiated to determine whether the samples taken by TCB lead to a reliable diagnosis and whether SLB can be avoided in a relevant percentage of cases.
  
  
  METHODS
  We analyzed 32 subjects with suspected ILD who underwent a TCB. Subjects' baseline characteristics, pathological findings after TCB and SLB, and complication rates were analyzed. The pathological inter-rater agreement was quantified statistically.
  
  
  RESULTS
  The overall inter-rater agreement concerning TCB sample evaluation was good with a kappa value of 0.80. In 23/32 cases (72%), the findings from the TCB showed a strong congruence with all other clinical data, thereby enabling a definitive diagnosis. Eight of the remaining nine subjects gave their consent for an SLB, which led to a definitive histological diagnosis in six cases (75%). Following TCB, pneumothorax occurred in 6/32 subjects (19%) and endobronchial bleeding was moderate in 8/32 (25%) and was severe in 17/32 cases (53%).
  
  
  CONCLUSIONS
  This is the first study to correlate histological results and complications following TCB and SLB in ILD subjects, some of whom underwent both procedures. TCB is a suitable diagnostic tool in ILD, potentially completely dispensing with the need for an SLB in some cases. In all cases, an interdisciplinary case evaluation is necessary as a final step.
authors.affiliation: Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany. lars.hagmeyer@klinik-bethanien.de.
authors.forename: Lars
authors.initials: L
authors.lastname: Hagmeyer
authors.affiliation: Institute for Pathology and Neuropathology, University Hospital Essen, University Duisburg-Essen, Duisburg-Essen, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Theegarten
authors.affiliation: Institute for Pathology and Neuropathology, University Hospital Essen, University Duisburg-Essen, Duisburg-Essen, Germany.
authors.forename: Jeremias
authors.initials: J
authors.lastname: Wohlschläger
authors.affiliation: Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Treml
authors.affiliation: Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany.
authors.forename: Sandhya
authors.initials: S
authors.lastname: Matthes
authors.affiliation: Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Priegnitz
authors.affiliation: Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany.
authors.forename: Winfried J
authors.initials: WJ
authors.lastname: Randerath
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001706:Biopsy / Q000009:adverse effects / Q000379:methods; D001980:Bronchi / Q000473:pathology* / Q000601:surgery*; D003452:Cryosurgery / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
keywords: bronchoscopy; diagnostic accuracy; histology; interstitial lung disease; surgical lung biopsy; transbronchial cryobiopsy