Transbronchial cryobiopsy in immunocompromised patients with pulmonary infiltrates: a pilot study

Lung. 2013 Dec;191(6):619-24. doi: 10.1007/s00408-013-9507-z. Epub 2013 Sep 26.


Background: In immunocompromised patients with pulmonary infiltrates, transbronchial lung biopsies (TBB) obtained by forceps has been shown to increase the diagnostic yield over simple bronchoalveolar lavage. Cryo-TBB is a novel modality for obtaining lung biopsies. We aimed to evaluate for the first time the efficacy and safety of cryo-TBB in immunocompromised patients.

Methods: Fifteen immunocompromised patients with pulmonary infiltrates underwent cryo-TBB. During the procedure two to three biopsy samples were taken. Procedure characteristics, complications, and the diagnostic yield were retrospectively evaluated.

Results: Most patients (n = 11) were immunocompromised due to hematological malignancies. The remaining four patients were receiving chronic immunosuppressive treatment due to previous solid-organ transplantation (n = 2) or collagen-vascular disease (n = 2). No major complications occurred in the cryo-TBB group. The mean surface area of the specimen taken by cryo-TBB was 9 mm(2). The increase in surface area and quality of biopsy samples translated to a high percentage of alveolated tissue (70 %) that enabled a clear histological detection of the following diagnoses: noncaseating granulomatous inflammation (n = 2), acute interstitial pneumonitis consistent with drug reaction (n = 5), nonspecific interstitial pneumonia fibrotic variant (n = 1), diffuse alveolar damage (n = 3), organizing pneumonia (n = 3), and pulmonary cryptococcal pneumonia (n = 1). Diagnostic information obtained by cryo-TBB led to change in the management of 12 patients (80 %).

Conclusion: Cryo-TBB in immunocompromised patients with pulmonary infiltrates provides clinically important diagnostic data with a low complication rate. These advantages should be further compared with traditional forceps TBB in a prospective randomized trial.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Biopsy / methods*
  • Bronchoscopy*
  • Female
  • Freezing*
  • Humans
  • Immunocompromised Host*
  • Lung / immunology
  • Lung / pathology*
  • Lung Diseases / immunology
  • Lung Diseases / pathology*
  • Lung Diseases / therapy
  • Male
  • Middle Aged
  • Pilot Projects
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies