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259 low but significant mortality risk.6,7 Considering all these complications, it is necessary to develop minimally invasive methods of LB in ILD with pulmonary fibrosis. A biopsy with the use of a flexible cryoprobe was introduced to clinical practice a few years ago and initially proved its diagnostic value both in endobronchial and transbronchial tissue sampling.8,9 Studies published to date have suggested that the diagnostic yield of transbronchial lung cryobiopsy (TBLC) in establishing proper diagnosis of ILD reaches 70% to 80%.10 A review of cryobiopsy literature revealed that there are no established standards for TBLC procedure. While the basic technique of TBLC is nearly the same, the approach differs as to prevention and management of the most common complications: pneumothorax and severe bleeding. The risk of pneumothorax increases when the cryoprobe is inserted too far into the bronchi and freezing hurts the visceral pleura. On the other hand, when the cryoprobe is too close to the pulmonary vessels, the risk of severe bleeding is higher. There is no doubt that choosing a correct site for LB and controlling the cryoprobe’s position during the procedure is crucial both for its efficacy and safety. The most common method of controlling the position of cryoprobe’s tip is fluoroscopy.11 In our center, a radial endobronchial ultrasound miniature probe (r-EBUS) is routinely used for diagnosing peripheral solid and semisolid lung lesions. A few years ago, we introduced Introduction Interstitial lung diseases (ILD), also known as diffuse parenchymal lung diseases, are a heterogeneous group of diseases. Their common pathological mechanism is the presence of inflammation and/or fibrosis in the lung parenchyma. When clinical outcome and radiology findings (especially on high-resolution computed tomography [HRCT]) are not sufficient to establish proper diagnosis, a pathological assessment of the involved lung tissue may be necessary in selected patients. A transbronchial lung biopsy (TBLB) with endoscopic forceps is the most common approach. While its high value in diagnosing a few ILDs (such as sarcoidosis) is well established,1,2 it is not recommended for diagnosing pulmonary fibrosis. According to American Thoracic Society / European Respiratory Society guidelines on the management of idiopathic pulmonary fibrosis, surgical lung biopsy (LB; usually video-assisted thoracic surgery LB [VATS-LB]) is recommended if HRCT results are inconclusive.3 Another important indication for LB in patients with diffuse lung infiltrations is to exclude malignancy. Considering that the most common primary lung cancer, adenocarcinoma, is quite often diagnosed among patients with no smoking history and with radiological appearance of diffuse lung infiltrates mimicking ILD, a histological assessment is crucial in many cases.4,5 Patients after VATS-LB require a few days of hospitalization and may develop complications, such as prolonged air leak and bronchopleural fistula, which in some cases necessitates reoperation and is associated with RESEARCH ARTICLE

polskie archiwum medycyny wewnętrznej

Transbronchial lung cryobiopsy guided by endobronchial ultrasound radial miniprobe in interstitial lung diseases: preliminary results of a prospective study