The role of transbronchial cryobiopsy and surgical lung biopsy in the diagnostic algorithm of interstitial lung disease

Background and Aims It is not yet known if transbronchial cryobiopsy ( TCB ) is a reliable and safe diagnostic tool in the investigation of interstitial lung disease ( ILD ). To date, there have been no studies directly comparing the value of TCB with that of surgical lung biopsy ( SLB ). The study was initiated to determine whether the samples taken by TCB lead to a reliable diagnosis and whether SLB can be avoided in a relevant percentage of cases. Methods We analyzed 32 subjects with suspected ILD who underwent a TCB . Subjects' baseline characteristics, pathological findings after TCB and SLB , and complication rates were analyzed. The pathological inter‐rater agreement was quantified statistically. Results The overall inter‐rater agreement concerning TCB sample evaluation was good with a kappa value of 0.80. In 23/32 cases (72%), the findings from the TCB showed a strong congruence with all other clinical data, thereby enabling a definitive diagnosis. Eight of the remaining nine subjects gave their consent for an SLB , which led to a definitive histological diagnosis in six cases (75%). Following TCB , pneumothorax occurred in 6/32 subjects (19%) and endobronchial bleeding was moderate in 8/32 (25%) and was severe in 17/32 cases (53%). Conclusion This is the first study to correlate histological results and complications following TCB and SLB in ILD subjects, some of whom underwent both procedures. TCB is a suitable diagnostic tool in ILD , potentially completely dispensing with the need for an SLB in some cases. In all cases, an interdisciplinary case evaluation is necessary as a final step.