CHEST Guidelines-COUNTERPOINT--Should-Surgical-Lung-Biopsy-Still-Be

COUNTERPOINT--Should-Surgical-Lung-Biopsy-Still-Be

Pdf Summary

Transbronchial lung cryobiopsy (TBLC) is positioned as a less invasive alternative to surgical lung biopsy (SLB) for diagnosing interstitial lung disease (ILD). With a diagnostic yield of about 80% compared to SLB's 90%, TBLC offers comparable accuracy, evidenced by a strong agreement with SLB results. Despite international preference for SLB owing to historical standards, TBLC's adoption is growing due to its lower risks, reduced costs, and shortened hospital stays. Studies show that mortality related to SLB ranges up to 16%, while TBLC shows lower mortality rates between 0.1% to 0.5%.<br /><br />TBLC generally results in fewer complications than SLB, which includes a significant reduction in common post-procedural issues such as pneumothorax, persistent air leaks, and severe bleeding. Additionally, TBLC can be conducted as an outpatient procedure, reducing pressure on operative rooms and cutting down overall costs.<br /><br />TBLC has proven to enhance diagnostic confidence, especially when integrated into multidisciplinary care approaches. Diagnostic accuracy is supported by studies showing high concordance between TBLC and SLB results. Moreover, TBLC influences critical treatment decisions, allowing for timely initiation of necessary immunomodulatory or antifibrotic therapies.<br /><br />While some contend SLB continues to have a role due to concerns over TBLC’s diagnostic precision and safety, data increasingly supports TBLC's effectiveness. Indeed, the American College of Chest Physicians acknowledges TBLC as a viable alternative, recognizing its potential to revolutionize lung research, particularly with advancements in profiling technologies that were limited by the availability of surgical lung biopsy tissues.<br /><br />In conclusion, TBLC stands out as a safer, cost-effective, and sufficiently accurate approach to ILD diagnosis, warranting its growing preference in clinical practice while supporting progress in lung disease research and precision medicine.

Keywords

Transbronchial lung cryobiopsy

surgical lung biopsy

interstitial lung disease

diagnostic yield

mortality rates

post-procedural complications

outpatient procedure

multidisciplinary care

diagnostic confidence

precision medicine