CHEST Guidelines-Rebuttal-From-Dr-Ryerson

Rebuttal-From-Dr-Ryerson_chest

Pdf Summary

The debate between transbronchial lung cryobiopsy (TBLC) and surgical lung biopsy (SLB) for diagnosing interstitial lung disease (ILD) centers on their diagnostic accuracy and safety. Dr. Christopher J. Ryerson highlights that while TBLC is suggested as an alternative to SLB due to its less invasive nature, its diagnostic accuracy isn't as robust as claimed, with significant inconsistencies found compared to SLB in several studies, except for findings in the COLDICE trial. He also critiques the perceived high complication rates of SLB, noting they were based on outdated data, and suggests the real-world applicability of both procedures is still uncertain.<br /><br />In contrast, Dr. Sara Tomassetti and colleagues argue TBLC should not be viewed merely as an alternative but as an effective part of a diagnostic protocol alongside SLB. They emphasize TBLC's safety over SLB and dispute the notion that larger tissue samples from surgery inherently offer better diagnostic value. Despite SLB's advantage in obtaining a larger sample, TBLC's comparable diagnostic accuracy and lower risk suggest a paradigmatic shift away from invasive surgical methods. Further, the multidisciplinary diagnostic yield of TBLC often matches SLB, making it a compelling option when used early in the diagnostic process.<br /><br />Both sides acknowledge the shortcomings and strengths of TBLC and SLB, with calls for more contemporary and comprehensive comparative data. Ultimately, the consensus involves using both methods based on specific clinical scenarios, while hoping future advancements might mitigate the need for invasive biopsies entirely.

Keywords

transbronchial lung cryobiopsy

surgical lung biopsy

interstitial lung disease

diagnostic accuracy

safety

COLDICE trial

complication rates

multidisciplinary diagnostic

clinical scenarios

invasive biopsies