• Claudia Ravaglia, Martina Bonifazi, Athol U Wells, Sara Tomassetti, Carlo Gurioli, Sara Piciucchi, Alessandra Dubini, Paola Tantalocco, Stefano Sanna, Eva Negri, Irene Tramacere, Valentina Anna Ventura, Alberto Cavazza, Andrea Rossi, Marco Chilosi, Carlo La Vecchia, Stefano Gasparini, and Venerino Poletti.
• Pulmonology Unit, Department of Thoracic Diseases, G.B. Morgagni - L. Pierantoni Hospital, Forlx00EC;, Italy.
• Respiration. 2016 Jan 1; 91 (3): 215-27.

BackgroundA diagnosis of interstitial lung diseases (ILDs) may include surgical lung biopsy (SLB), which is associated with significant morbidity and mortality and also appreciable costs. Transbronchial lung cryobiopsy (TBLC) is adopting an important role.ObjectivesThe aim of this study was to compare the diagnostic yield (DY) and safety of TBLC and SLB in a large cohort of patients and to perform a systematic review of the literature as well as a meta-analysis.MethodsWe performed a retrospective analysis of 447 cases with ILD undergoing TBLC and/or SLB and a systematic review of the literature (MEDLINE and Embase for all original articles on the DY and safety of TBLC in ILDs up to July 2015).ResultsA total of 150 patients underwent SLB and 297 underwent TBLC. The median time of hospitalization was 6.1 days (SLB) and 2.6 days (TBLC; p < 0.0001). Mortality due to adverse events was observed for 2.7% (SLB) and 0.3% (TBLC) of the patients. Pneumothorax was the most common complication after TBLC (20.2%). No severe bleeding was observed. TBLC was diagnostic for 246 patients (82.8%), SLB for 148 patients (98.7%, p = 0.013). A meta-analysis of 15 investigations including 781 patients revealed an overall DY of 0.81 (0.75-0.87); the overall pooled probability of developing a pneumothorax, as retrieved from 15 studies including 994 patients, was 0.06 (95% CI 0.02-0.11).ConclusionCryobiopsy is safe and has lower complication and mortality rates compared to SLB. TBLC might, therefore, be considered the first diagnostic approach for obtaining tissue in ILDs, reserving the surgical approach for cases in which TBLC is not diagnostic.© 2016 S. Karger AG, Basel.

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