What is the key question?

• Transbronchial Lung Cryobiopsy (TBLC) is a relatively novel technique for obtaining lung tissue samples to aid in the diagnosis of Interstitial Lung Disease (ILD). Several studies have attempted to establish the correlation between TBLC and Surgical Lung Biopsy (SLB) but diagnostic accuracy has been debated, mainly due to samples being collected in different patient groups or at different points in time.

What is the bottom line?

• This study prospectively compared TBLC and SLB as sequential samples collected during a single procedure.
• After centralized Multi-Disciplinary Discussion (MDD), patients underwent a single anaesthetic with collection of TBLC and SLB. Samples were de-identified, randomized and analysed by pathologists blinded to the sample types. Further review by an MDD discussed specimens in random order and attempted to determine a diagnosis.
• Histopathological and clinical diagnosis of TBLC and SLB was analysed and found 70.8% agreement in histopathology and 76.9% diagnostic agreement at MDD. If the MDD was high or definite for diagnostic confidence on TBLC, there was 95% concordance between TBLC and SLB.
• Mild-moderate bleeding occurred in 22% of the TBLC group and 90-day mortality was 2%.

Why read on?

• This is the only trial comparing the accuracy of TBLC and SLB in the same patient at the same procedure.
• The study found significant agreement between TBLC and SLB in histopathology and at MDD. Results suggest TBLC is a reliable technique for diagnosing ILD when compared to the previously suggested gold standard of SLB. It was not powered to determine the safety of TBLC as a technique.