Safety And Diagnostic Yield Of Transbronchial Lung Cryobiopsy In The Diagnosis Of Interstitial Lung Disease

SESSION TITLE: Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Transbronchial lung cryobiopsy (TBLC) has recently emerged as a promising less invasive alternative to SLB for the diagnosis of interstitial lung diseases. There have been many recent studies showing high complication rates and low diagnostic yield of cryobiopsy. These results have led to some debate in terms of the safety, efficacy and utility of TBLC. Herein we describe our experience with TBLC with regards to safety utilizing a standardized protocol. METHODS: This is a retrospective case series of TBLC performed between 2017-2020. TBLC were performed under general anesthesia with rigid bronchoscopy. The airway was transitioned to an ETT if the patient was unable to tolerate rigid bronchoscopy. An endobronchial blocker, radial EBUS and fluoroscopy were utilized for every case. A 2.4 cryoprobe was utilized to obtain biopsies. Patients were followed for minimum of 6 months for diagnostic accuracy. RESULTS: 143 patients were identified over a 3-year period. Demographics are shown in table 1. 95% of patients were non-smokers or ex-smokers. 89.5% were performed with rigid bronchoscopy. Average DLCO was 58.2 ± 20.4%. Complications are listed in Table 2. The rate of pneumothorax was 5.5% with 5/8 requiring a chest tube. There were no cases of prolonged air leak. Of note the average DLCO in patient with pneumothorax was 25% compared to 59% (p < 0.001). There was 1 case of severe hemoptysis which required overnight hospitalization. There was 1 high risk case where anticipated outcome was for ICU admission overnight. Overall 30-day mortality was 0. The patient was successfully liberated from the ventilator POD1 and discharged. The average biopsy size was 1.02 ± 0.2 cm. 40% had one lobe sampled, 59% of patients had two lobes sampled, and 1% had 3 lobes sampled. Organizing pneumonia was the most common diagnosis (21%), followed by UIP/IPF (18%), sarcoidosis (14%), hypersensitivity pneumonitis (13%), CTD-ILD (9%), drug induced pneumonitis (9%), and others (16%). The most common lobes sampled was the RLL followed by the RUL. A diagnosis was achieved in 96%. CONCLUSIONS: Our experience suggests that TBLC can be performed safely with an acceptable diagnostic yield of > 90% when performed with a standardized protocol by experienced interventional pulmonologists on an outpatient basis. Our protocol includes the use of general anesthesia, rigid bronchoscopy transitioning to an ETT when needed, an endobronchial blocker, radial EBUS, a 2.4 cryoprobe and fluoroscopy. Our pneumothorax rate was 5.5% with 3.5% requiring a chest tube and no prolonged air leaks. Of note a lower DLCO was strongly associated with risk for pneumothorax. There was 1 case of severe hemoptysis. In conclusion, our data suggests TBLC remains a promising and safe alternative to SLB. CLINICAL IMPLICATIONS: We show that transbronchial cryobiopsy can be performed safely, and provide a high diagnostic yield for the diagnosis of ILD. DISCLOSURES: no disclosure on file for Mathew Carroll; My spouse/partner as a Consultant relationship with Actelion Please note: $20001 - $100000 Added 04/20/2020 by Colleen Channick, source=Web Response, value=Consulting fee My spouse/partner as a Consultant relationship with Bayer Please note: $5001 - $20000 Added 04/20/2020 by Colleen Channick, source=Web Response, value=Consulting fee No relevant relationships by Tao He, source=Web Response No relevant relationships by Catherine Oberg, source=Web Response No relevant relationships by Scott Oh, source=Web Response No relevant relationships by Reza Ronaghi, source=Web Response No relevant relationships by Irawan Susanto, source=Web Response