Introduction of cryobiopsies in the diagnostics of interstitial lung diseases – experiences in a referral center

Figures & data

Table 1. Patient characteristics at time of inclusion

Patients demographics
No. of patients	38
Gender (F/M)	16/22
Age, median, (range)	61 (29–80)
Smoking status (former, current, never, unknown)	21/9/7/1
Pulmonary function
FEV1 (L)	2.3 ± 0.7
FEV1 % predicted	79% ± 22
FVC (L)	3.2 ± 1.06
FVC % predicted	87% ± 27
DLCO predicted	60% ±15
6MWTD (meters)	477 ± 141

FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; DLCO: diffusing capacity of the lungs for carbon monoxide; 6MWTD: six-minute walk test distance.

Table 2. HRCT findings at time of inclusion

HRCT hypothesis	No. (%)
NSIP/possible UIP	19 (50)
Subacute HP/DIP	3 (7,9)
EP/NSIP	3 (7,9)
Chronic HP/NSIP	2 (5,3)
Cystic lung disease	2 (5,3)
Alveolar hemorrhage/vasculitis	1 (2,6)
PAP/alveolar hemorrhage	1 (2,6)
PAP/granulomatous lung disease	1 (2,6)
Subacute HP/sarcoidosis	1 (2,6)
NSIP/COP	1 (2,6)
Chronic HP/possible UIP	1 (2,6)
Chronic HP/unclassifiable interstitial fibrosis	1 (2,6)
DIP/RB-ILD	1 (2,6)
NSIP/RB-ILD	1 (2,6)

NSIP: non-specific interstitial pneumonia; UIP: usual interstitial pneumonia; HP: hypersensitivity pneumonia; DIP: desquamative interstitial pneumonia; EP: eosinophilic pneumonia; PAP: pulmonary alveolar proteinosis; COP: cryptogenic organizing pneumonia; RB-ILD: respiratory bronchiolitis related interstitial lung disease.

Table 3. Histological diagnosis based on cryobiopsies

Histological diagnosis	No. (%)
UIP	10 (26,3)
– High confidence	7 (70)
– Low confidence	3 (30)
HP	6 (15,8)
– Subacute	3 (50)
– Chronic	3 (50)
Cellular NSIP	5 (13,2)
RB-ILD	3 (7,9)
Fibrotic NSIP	3 (7,9)
Sarcoidosis	2 (5,3)
Lymphoid hyperplasia	1 (2,6)
Nodular bone metaplasia	1 (2,6)
OP/DIP	1 (2,6)
No diagnosis	6 (15,8)

UIP: usual interstitial pneumonia; HP: hypersensitivity pneumonitis; NSIP: non-specific interstitial pneumonia; RB-ILD: respiratory bronchiolitis interstitial lung disease; OP: organizing pneumonia; DIP: desquamative interstitial pneumonia.

Table 4. Clinical diagnosis after a multidisciplinary team discussion

Clinical diagnosis	No. (%)
IPF
– High confidence	8 (21,1)
– Low confidence	2 (5,3)
HP
– Subacute	3 (7,9)
– Chronic	3 (7,9)
SR-ILD	5 (13,2)
Possible NSIP/possible IPF	2 (5,3)
Idiopathic NSIP	2 (5,3)
Sarcoidosis	2 (5,3)
Drug induced-ILD	2 (5,3)
Vasculitis (ANCA associated)	1 (2,6)
Scleroderma-associated ILD	1 (2,6)
Organizing pneumonia	1 (2,6)
Histiocytosis X	1 (2,6)
LAM	1 (2,6)
Pulmonary nodular lymphoid hyperplasia	1 (2,6)
Dendriform metaplasia	1 (2,6)
Antisynthetase syndrome	1 (2,6)
No diagnosis	1 (2,6)

IPF: idiopathic pulmonary fibrosis; HP: hypersensitivity pneumonitis; SR-ILD: smoking-related interstitial lung disease, including bronchiolitis and RB-ILD; NSIP: non-specific interstitial pneumonitis; ANCA: antineutrophilic antibodies; LAM: lymphangioleiomyomatosis.

Figure 1. 71-year-old male referred for dyspnea. HRCT showing reticulation, ground glass opacity and traction bronchiectasies with basal predominance. Cryobiopsies showing patchy fibrosis, fibroblastic foci and chronic inflammation. The patient was diagnosed with idiopathic pulmonary fibrosis, high confidence

Figure 2. 51-year-old male referred for increasing dyspnea and cough. HRCT showing diffuse reticulation, ground glass opacity, traction bronchiectasies and consolidations. Cryobiopsies showing chronic inflammation, fibrosis and granulomas/giant cells. The patient was diagnosed with chronic hypersensitivity pneumonitis

Table 5. Cryobiopsy complications

Cryobiopsy complications	No. (%)
Pneumothorax	10 (26)
– Chest tube	2 (5)
+ Chest tube	8 (21)
Bleeding	6 (15)
Infection	2 (5)