title: Safety and Diagnostic Yield of Transbronchial Lung Cryobiopsy in Diffuse Parenchymal Lung Diseases: A Comparative Study versus Video-Assisted Thoracoscopic Lung Biopsy and a Systematic Review of the Literature.
abstract: BACKGROUND
  A diagnosis of interstitial lung diseases (ILDs) may include surgical lung biopsy (SLB), which is associated with significant morbidity and mortality and also appreciable costs. Transbronchial lung cryobiopsy (TBLC) is adopting an important role.
  
  
  OBJECTIVE
  The aim of this study was to compare the diagnostic yield (DY) and safety of TBLC and SLB in a large cohort of patients and to perform a systematic review of the literature as well as a meta-analysis.
  
  
  METHODS
  We performed a retrospective analysis of 447 cases with ILD undergoing TBLC and/or SLB and a systematic review of the literature (MEDLINE and Embase for all original articles on the DY and safety of TBLC in ILDs up to July 2015).
  
  
  RESULTS
  A total of 150 patients underwent SLB and 297 underwent TBLC. The median time of hospitalization was 6.1 days (SLB) and 2.6 days (TBLC; p < 0.0001). Mortality due to adverse events was observed for 2.7% (SLB) and 0.3% (TBLC) of the patients. Pneumothorax was the most common complication after TBLC (20.2%). No severe bleeding was observed. TBLC was diagnostic for 246 patients (82.8%), SLB for 148 patients (98.7%, p = 0.013). A meta-analysis of 15 investigations including 781 patients revealed an overall DY of 0.81 (0.75-0.87); the overall pooled probability of developing a pneumothorax, as retrieved from 15 studies including 994 patients, was 0.06 (95% CI 0.02-0.11).
  
  
  CONCLUSIONS
  Cryobiopsy is safe and has lower complication and mortality rates compared to SLB. TBLC might, therefore, be considered the first diagnostic approach for obtaining tissue in ILDs, reserving the surgical approach for cases in which TBLC is not diagnostic.
authors.affiliation: Pulmonology Unit, Department of Thoracic Diseases, G.B. Morgagni - L. Pierantoni Hospital, Forlx00EC;, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ravaglia
authors.forename: Martina
authors.initials: M
authors.lastname: Bonifazi
authors.forename: Athol U
authors.initials: AU
authors.lastname: Wells
authors.forename: Sara
authors.initials: S
authors.lastname: Tomassetti
authors.forename: Carlo
authors.initials: C
authors.lastname: Gurioli
authors.forename: Sara
authors.initials: S
authors.lastname: Piciucchi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Dubini
authors.forename: Paola
authors.initials: P
authors.lastname: Tantalocco
authors.forename: Stefano
authors.initials: S
authors.lastname: Sanna
authors.forename: Eva
authors.initials: E
authors.lastname: Negri
authors.forename: Irene
authors.initials: I
authors.lastname: Tramacere
authors.forename: Valentina Anna
authors.initials: VA
authors.lastname: Ventura
authors.forename: Alberto
authors.initials: A
authors.lastname: Cavazza
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.forename: Marco
authors.initials: M
authors.lastname: Chilosi
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
authors.forename: Stefano
authors.initials: S
authors.lastname: Gasparini
authors.forename: Venerino
authors.initials: V
authors.lastname: Poletti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000009:adverse effects / Q000401:mortality; D001999:Bronchoscopy / Q000009:adverse effects / Q000401:mortality*; D003452:Cryosurgery / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology / Q000601:surgery*; D008171:Lung Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality*; D055815:Young Adult