Transbronchial cryobiopsy for the diagnosis of interstitial lung disease (ILD) – The UK experience

Introduction: Despite radiological advancements histology may be needed for diagnosis of ILD. Transbronchial cryobiopsy (TBCB) offers an alternative to surgical lung biopsy Aim: To evaluate the UK9s first minimally invasive, day case TBCB service for the diagnosis of ILD Methods: Patients were selected for TBCB following discussion at an ILD Multidisciplinary meeting. Only patients in whom significant diagnostic doubt remained after thorough clinical-radiological work up were considered. All procedures were performed with the patient self-ventilating under deep sedation with propofol using a flexible bronchoscope and 2.4mm cryoprobe (ERBE). The last 8 cases were performed following intubation with an uncuffed ET tube (Bronchoflex, Rusch). We introduced IV tranexamic acid 1g as premedication and endobronchial adrenaline routinely as part of our protocol after 5 cases. 1-5 samples were taken from sub-segments of a lobe pre-selected by CT imaging. Results: 10 procedures were carried out on 9 patients (7 male). Median age 66; mean number of biopsies 2.6; mean aggregate biopsy size 587 mm3. A pathological diagnosis was made in 89%. Complications: 1 pneumothorax (10%); 1 case of moderate bleeding managed with endobronchial adrenaline and suction. Conclusions: Our TBCB service is the first in the UK, and combines the high diagnostic yield with low complication rates seen in other centres.