LAUSR

Introduction: Transbronchial cryobiopsy (cTBB) may offer an alternative to surgical lung biopsy (SLB) for diagnosing ILDs. However, real world experiences are limited. We therefore aimed to evaluate the value of cTBB under real world conditions of a tertiary care center for ILDs. Methods: Patients who received cTBB as workup for suspected ILD were evaluated retrospectively for clinical characteristics. Also, bronchoscopy associated factors were assessed and results in the context of multidisciplinary team discussion (MDT) interpreted. Results: From 10/2015-01/2017 115 patients (mean age 64 years, 65% male, 37% never smokers) were examined. Mean FVC was 79% (range (r) 41-141% pred.), mean DLCO 51% (r 20-86% pred.). On average, 4 samples were taken, in 70% from 2 lobes. Mean sample diameter was 50mm (r 10-180mm). Complications were pneumothorax in 11%, mild to moderate bleeding in 28%, no acute exacerbations. Pathologists judged specimen as diagnostic in 64%. Histopathologic patterns were: NSIP (22%), UIP (10%), HP (12%), smoking-related ILD (10%), unspecific fibrosis (9%), sarcoidosis (4%). In the context of MDT including BAL final diagnoses were possible in 86%: HP (24%), idiopathic NSIP (9%), drug toxicity (11%), IPF (8%), CDT-ILD (6%), smoking related ILD (10%) and sarcoidosis (2%). SLB was indicated in 14%, 4 patients could not be assessed by SLB due to functional limitations. Conclusions: In the real world setting, cTBB has a meaningful diagnostic value in the context of a multidisciplinary team and may also enable histopathogical assessment in more advanced disease.