REVIEW  COMPETENCE IN INTERVENTIONAL PULMONOLOGY Free access

Panminerva Medica 2019 September;61(3):290-7

DOI: 10.23736/S0031-0808.18.03567-X

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Competence in transbronchial cryobiopsy

Emanuela BARISIONE ¹ ✉, Mario SALIO ¹, Micaela ROMAGNOLI ², Alessia PRATICÒ ³, Elena BARGAGLI ⁴, Lorenzo CORBETTA ⁵

¹ Unit of Pneumology, San Martino Policlinic Hospital, Genoa, Italy; ² Unit of Interventional Pneumology, Sant’Orsola-Malpighi Policlinic, Bologna, Italy; ³ Unit of Pneumology, UTIR Azienda Ospedaliera di Perugia, Perugia, Italy; ⁴ Unit of Pneumology, University of Siena, Siena, Italy; ⁵ Unit of Interventional Pulmonology, University of Florence, Florence, Italy

Over the last decade transbronchial lung cryobiopsy (TBLC) has proven to be an “innovative application” of an “old procedure” for the histologic diagnosis of diffuse interstitial lung diseases (DILDs). Thus, the technique of TBL cryobiopsy is now adopted for diagnostic purposes, transbronchially in peripheral airways to sample lung parenchyma, whereas this same technique was traditionally employed in the past for therapeutic purposes, essentially for the management of malignant obstruction of central airways. When patients with interstitial lung diseases (ILDs) need histopathological data in their diagnostic pathway, this bioptic approach could be a valid alternative to surgical lung biopsy, that is still the gold standard at the moment. TBL cryobiopsy has a good safety profile, its sensitivity and specificity appear good overall in idiopathic pulmonary fibrosis. In the last ten years, many papers have been published about this procedure defining modalities by which cryobiopsy should be performed. These studies have shown that TBL cryobiopsy is feasible, it allows to obtain larger lung parenchymal specimens (3 times larger than “classic” transbronchial biopsies), characterized by unaltered and artefact-free morphology, and it represents a safe and poorly invasive diagnostic tool for the histologic diagnosis of ILDs. The technical aspects are really important, and they still need a complete standardization. TBL cryobiopsy should be part of an equipment of the modern interventional pulmonologist, who should know indications and contraindications of this methodic and the technical aspects of the procedure. This is a complex procedure requiring to be performed by endoscopists working in specialized centers with specific knowledge of DILDs, and a multidisciplinary approach, which represent pre-requisites for admission to training in this procedure.

KEY WORDS: Bronchoscopy - Pulmonary medicine - Education