Our Summary

This research paper is about a study conducted by the European Respiratory Society (ERS) on a method called transbronchial lung cryobiopsy (TBLC) used to diagnose interstitial lung diseases (ILD). ILD refers to a group of lung diseases that affect the tissue and spaces around the air sacs in the lungs.

Previously, the standard method for diagnosing ILD was through a surgical lung biopsy (SLB). However, this procedure is invasive, costly, can lead to complications, and requires hospitalisation. Also, many patients are too ill to undergo this procedure.

The ERS team, which included clinical and methodological experts, conducted a study to determine if TBLC could be a better method for diagnosing ILD. They reviewed existing research literature up to June 2021 and applied the GRADE methodology, a system used to evaluate the quality of evidence in healthcare.

Their study suggests that TBLC could be used as a replacement for SLB in patients who are fit enough to undergo SLB. In patients not fit for SLB, TBLC is suggested as the preferred method. If the initial TBLC doesn’t give enough information, then SLB is recommended. The study doesn’t make a recommendation on whether a second TBLC should be done if the first one doesn’t provide enough information. The study also suggests that those performing TBLC should have training, but doesn’t specify what kind of training.

The study concludes that TBLC can provide important diagnostic information for undiagnosed ILD. The process has less serious side effects and requires a shorter hospital stay compared to SLB. However, the certainty of the evidence is graded as “very low”, meaning there is still much uncertainty and more research is needed.

FAQs

  1. What is the recommended method for obtaining a tissue-based diagnosis in patients with undiagnosed ILD according to the ERS guideline?
  2. How does the diagnostic yield and risk of serious adverse events of TBLC compare to SLB in patients with undiagnosed ILD?
  3. What is the recommendation regarding a second TBLC in patients with a non-informative first TBLC?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lung biopsy is to follow all pre-procedure instructions provided by the healthcare team, such as fasting before the procedure and avoiding certain medications. It is also important to discuss any concerns or questions with the healthcare team before the procedure to ensure a smooth and safe experience.

Suitable For

Patients with interstitial lung diseases (ILD) who require histopathological input for diagnosis are typically recommended to undergo lung biopsy. In particular, patients with undiagnosed ILD and an indication to obtain histopathological data may be recommended for lung biopsy. In cases where patients are clinically unfit to undergo surgical lung biopsy (SLB), transbronchial lung cryobiopsy (TBLC) may be considered as an alternative. TBLC may also be suggested for patients who are not eligible for SLB. In cases where TBLC results are non-informative, SLB may be recommended as an additional test. It is important for TBLC operators to undergo training to ensure safe and effective procedures.

Timeline

Before lung biopsy:

  1. Patient presents with symptoms of interstitial lung disease (ILD) such as shortness of breath, cough, and fatigue.
  2. Patient undergoes imaging tests such as chest X-ray, CT scan, and pulmonary function tests to evaluate the extent of lung involvement.
  3. Patient may undergo bronchoscopy with bronchoalveolar lavage and transbronchial biopsy to obtain samples for analysis.
  4. If a definitive diagnosis is not obtained, patient may be considered for a surgical lung biopsy (SLB).

After lung biopsy:

  1. Patient undergoes a transbronchial lung cryobiopsy (TBLC) as a less invasive alternative to SLB, if deemed eligible.
  2. Histopathological analysis of the biopsy samples is performed to provide a diagnosis of the underlying lung disease.
  3. Treatment plan is developed based on the biopsy results, which may include medications, oxygen therapy, or other interventions.
  4. Patient may experience less serious adverse events and shorter hospitalization compared to SLB.
  5. Follow-up appointments are scheduled to monitor the patient’s response to treatment and disease progression.

What to Ask Your Doctor

  1. What is the purpose of the lung biopsy in my case?
  2. What are the different types of lung biopsy procedures available, and why is transbronchial lung cryobiopsy (TBLC) being recommended for me?
  3. What are the potential risks and complications associated with TBLC?
  4. How will the tissue sample obtained from the biopsy be analyzed and what information will it provide about my condition?
  5. What are the chances of obtaining a definitive diagnosis with TBLC compared to surgical lung biopsy (SLB)?
  6. Will I need to stay in the hospital after the procedure, and if so, for how long?
  7. How should I prepare for the TBLC procedure?
  8. How experienced is the healthcare provider who will be performing the TBLC?
  9. What happens if the TBLC does not provide a conclusive diagnosis?
  10. Are there any alternative diagnostic tests or procedures that could be considered in my case?

Reference

Authors: Korevaar DA, Colella S, Fally M, Camuset J, Colby TV, Hagmeyer L, Hetzel J, Maldonado F, Morais A, Ravaglia C, Spijker R, Tomassetti S, Troy LK, Verschakelen JA, Wells AU, Tonia T, Annema JT, Poletti V. Journal: Eur Respir J. 2022 Nov 10;60(5):2200425. doi: 10.1183/13993003.00425-2022. Print 2022 Nov. PMID: 35710261