An entertaining debate on whether cryobiopsy is an essential diagnostic tool for a tertiary ILD service ultimately went unanswered at the TSANZSRS meeting, as there was no audience vote.
Associate Professor Chris Grainge, from the Hunter Medical Research Institute, did his best to convince delegates that transbronchial lung cryobiopsy was ‘quicker, cheaper, better and safer’ than video-assisted thoracoscopic surgical (VATS) lung biopsy.
He said the 30-day mortality of 2.4% after a VATS biopsy was hardly impressive for an elective, diagnostic procedure.
He referenced a recent systematic review and meta-analysis that found cryobiopsies had a good diagnostic yield of 72.9% and had an overall reported mortality of 0.3%.
The meta-analysis found the overall complication rate following cryobiopsy was 23.1%, with bleeding (14.2%) and pneumothorax (9.4%) the most commonly reported events.
It also concluded that further research was needed to help standardise the procedure between centres and improve its safety profile.
That process is already underway at some levels with progress towards standardised pathology reports and procedural modifications such as the use of a prophylactic bronchus blocking balloon.
Dr Lauren Troy attempted to hold the line against cryobiopsy in the absence of ‘procedural, safety or competency standards’ for the procedure.
She noted recent evidence of poor concordance between the findings of cryobiopsy and surgical lung biopsy taken from the same patients.
The European study found surgical lung biopsy was more concordant with the final diagnosis as determined by multidisciplinary assessment and that there was no role for cryobiopsy in the two-thirds of patients where histopathology was required for a definitive diagnosis of diffuse interstitial lung diseases.
She noted that ILD experts said in a recent editorial that a thorough history and physical exam, recognised patterns of HRCT images obtained with proper technique, broad serologic testing, BAL cellular profile, and multidisciplinary discussion can often yield the specific diagnosis of ILD without the need for biopsy.