Utilization of transbronchial cryobiopsy in bronchoscopic procedures: a clinical practice review of procedural considerations

Abstract

The use of transbronchial lung cryobiopsy (TBLC) in bronchoscopic procedures represents an area of considerable interest. Initially, cryobiopsy was limited to treatment of visible central airway obstructions. However, since its initial introduction for the evaluation of parenchymal abnormalities concerning for interstitial lung disease (ILD), numerous studies have shown the promise of this technique in the evaluation of ILD as well as other non-ILD lung diseases. Meta-analyses have shown that TBLC represents a reasonable alternative to surgical lung biopsy for the evaluation of ILD with a comparable diagnostic accuracy when results are presented in a multidisciplinary discussion with an improved safety profile. International society guidelines now recommend considering this approach for patients with ILD of unclear etiology, showing the value and utility of this biopsy technique. Consensus recommendations for performing TBLC with best clinical practices also exist to ensure the procedure is done safely and effectively. Evidence has also emerged for the role of TBLC in the evaluation of non-ILD parenchymal processes, including malignancy and other inflammatory or infectious processes, to both facilitate a diagnosis and establish a treatment plan. This review will highlight the available literature related to the use of TBLC for the evaluation of lung parenchymal abnormalities and discuss considerations for performing the procedure.