Use of Bronchoscopic Cryobiopsy in Evaluating Interstitial Lung Disease: Radiologic Predictors of Diagnostic Yield and Safety.

Abstract

To identify radiologic computed tomography (CT) predictors of increased diagnostic yield and fewer complications in transbronchial lung cryobiopsy (TBCB). We retrospectively reviewed CT scans of 143 patients (51.7% female; mean age 62.7) who underwent TBCB at Mayo Clinic (January 1, 2017, to July 31, 2020). Multivariable logistic regression evaluated whether imaging, pulmonary function, and procedural parameters predicted diagnostic yield and complications. Procedural complications included clinically significant bleeding (10.5%), pneumothorax (7.0%), and escalation of care (8.4%), with zero procedure-related deaths. Trainee presence did not affect the rate of clinically significant bleeding (10.5% vs 9.4%, p=0.999) or whether the biopsy yielded a specific histopathologic diagnosis (61.9% vs 65.6%, p=0.703). Abnormal histopathologic findings were seen in 87.4% of cases, with 62.2% of biopsies sufficiently identifying a specific diagnosis even when reviewed in isolation. Radiologic honeycombing was associated with an 82% lower yield on histopathology (aOR=0.18, 95% CI 0.05-0.68), despite higher number of passes. Higher DLCO was associated with lower complication rate (aOR=0.95, 95% CI 0.92-0.99), while higher FEV1 was associated with improved histopathologic yield (aOR 1.02, 95% CI 1.01-1.04). CT imaging and pulmonary function parameters influence diagnostic yield and complication rates for TBCB in ILD. Radiologic honeycombing was a negative independent predictor of TBCB histopathologic yield, and clinicians should weigh whether TBCB in such cases provides incremental diagnostic value over integration of clinical and imaging data alone. Better lung function was associated with improved yield and lower complication risk. These findings may help refine patient selection and procedural planning.