Is TBLC safe for patients with unclassifiable ILD?

Bronchoscopic transbronchial lung cryobiopsy (TBLC), when done by capable hands, is a safe procedure for adult patients with unclassifiable interstitial lung disease (ILD), suggests a study.

Of note, significant bleeding following TBLC is more likely to occur in those with radiological traction bronchiectasis and obesity.

Some 126 patients underwent TBLC (mean age 62.7 years, 68.3 percent male, FVC 86.2 percent, DLCO 54.5 percent). Of these, 10 (7.9 percent) experienced significant bleeding requiring balloon blocker reinflation for >20 min, admission to ICU, packed red blood cell transfusion, bronchial artery embolization, resuscitation, or procedural abandonment.

The following factors were associated with significant bleeding: traction bronchiectasis on high-resolution CT (odds ratio [OR], 7.1, 95 percent confidence interval [CI], 1.1‒59.1; p=0.042), a TBLC histological pattern of usual interstitial pneumonia (OR, 4.0, 95 percent CI, 1.1‒14; p=0.046), and the presence of medium-large vessels on histology (OR, 37.3, 95 percent CI, 6.5‒212; p<0.001).

In multivariate analysis, BMI ≥30 kg/m² (p=0.017) and traction bronchiectasis on high-resolution CT (p=0.025) significantly predicted longer total bleeding time (p=0.017).

Moreover, nine patients (7.1 percent) had pneumothorax, and none died within 30 days. The diagnostic yield was 80.6 percent.

“TBLC is a guideline-endorsed alternative to surgical lung biopsy for tissue diagnosis in unclassifiable ILD,” the researchers said.

This retrospective cohort study involved consecutive adult outpatients with unclassifiable ILD who underwent TBLC following multidisciplinary discussion at a single centre in the UK between July 2016 and December 2021. TBLC was carried out under general anaesthesia with fluoroscopic guidance and a prophylactic endobronchial balloon.