title: Use of transbronchial cryobiopsy in the diagnosis of interstitial lung disease-a systematic review and cost analysis.
abstract: BACKGROUND
  Histological diagnosis by surgical lung biopsy for interstitial lung disease (ILD) is currently limited. Transbronchial cryobiopsy via flexible bronchoscope may this for more patients. The relative costs, diagnostic yields and safety of this approach and more traditional approaches have not been determined.
  
  
  OBJECTIVE
  To perform a systematic review and meta-analysis of transbronchial cryobiopsy, forceps transbronchial biopsy and video assisted (VATS) surgical lung biopsy assessing their relative diagnostic yields and safety. To perform a cost analysis to demonstrate any savings through change to the newer technique.
  
  
  METHODS
  We performed a systematic review of the literature using MEDLINE and EMBASE for all original articles on the diagnostic yield and safety of transbronchial cryobiopsy, forceps transbronchial biopsy and VATS-biopsy in ILD up to February 2016. Data were extracted on yield and complication rates, in addition to study characteristics. Theoretical cost analysis was performed from local institution financial data, 2015-16 reimbursement tariffs and results of the systematic review.
  
  
  RESULTS
  A meta-analysis of 11 investigations for transbronchial cryobiopsy, 11 for forceps transbronchial biopsy and 24 for VATS-biopsy revealed diagnostic yields of 84.4% (75.9-91.4%), 64.3% (52.6-75.1%) and 91.1% (84.9-95.7%), respectively. Pneumothorax occurred in 10% (5.4-16.1%) of transbronchial cryobiopsy procedures, moderate bleeding in 20.99% (5.6-42.8%), with three deaths reported. Surgical mortality was 2.3% (1.3-3.6%). Cost analysis demonstrated potential savings of £210 per patient in the first year and £647 in subsequent years.
  
  
  CONCLUSIONS
  Transbronchial cryobiopsy represents a potentially cost-saving approach to improve histological diagnosis in ILD, however is accompanied by a significant risk of moderate bleeding.
authors: From the Academic Respiratory Group, University of Bristol, Bristol, UK.|North Bristol Lung Centre, Southmead Hospital, Bristol, UK.
authors: C
authors: C
authors: Sharp
authors: Research Department, University of Cambridge Local Examinations Syndicate, University of Cambridge, Cambridge, UK.
authors: M
authors: M
authors: McCabe
authors: North Bristol Lung Centre, Southmead Hospital, Bristol, UK.
authors: H
authors: H
authors: Adamali
authors: North Bristol Lung Centre, Southmead Hospital, Bristol, UK.
authors: A R
authors: AR
authors: Medford
mesh_terms: D001706:Biopsy / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D001999:Bronchoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D003452:Cryosurgery / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D004739:England; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008168:Lung / Q000473:pathology; D017563:Lung Diseases, Interstitial / Q000175:diagnosis* / Q000473:pathology; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000191:economics / Q000379:methods