Are Transbronchial Cryobiopsies Ready for Prime Time? A Systematic Review and Meta-Analysis

Jaskaran S et al.

JOBIP Volume 26, Issue 1, January 2019 Pages 22-32;

Abstract 

What is the key question?

  • Is there enough evidence at present to support widespread safe use of transbronchial cryobiopsy (TBCB) in the diagnosis of Diffuse Parenchymal Lung Diseases (DPLD)?

What is the bottom line?

  • Meta-analysis of TBCB in DPLD are all hindered by a lack of prospective randomized data and variation in procedural technique and definition of side effects due to current lack of international consensus statements (CHEST guideline and expert panel report and International Conference on TCLB in DPLD publications in development/ pre-publication).
  • Nevertheless, this well-structured and largest meta-analysis to date including 31 studies identified a diagnostic yield of 72.9% [95% confidence interval (CI), 67.9%-77.7%]. This compares favorably to historical transbronchial forceps (TBFB) biopsy yield of 20-30%.
  • The pooled mean specimen size obtained by cryobiopsies was 23.4 mm2 (95% CI, 9.6-37.3 mm2) in comparison to historical TBFB small size with crushed artifact.
  • The overall complication rate was 23.1% with bleeding and pneumothorax being the most commonly reported complications.
  • The incidence of significant bleeding was 14.2% (95% CI, 7.9%-21.9%), whereas pneumothorax was seen in 9.4% (95% CI, 6.7%-12.5%) of patients. These are higher than TBFB historical published rates (0.7-2% pneumothorax and 1-4% bleeding).
  •  Overall reported mortality was 0.3%, lower than historical mortality related to surgical lung biopsy (SLB) in DPLD (3-10.6%)

Why read on?

  • The authors further analyze heterogeneity in practice and performance of TBCB in DPLD subtypes.