The future of surgical lung biopsy: moving from the operating room to the bronchoscopy suite

Assessment of patients with suspected interstitial lung disease includes a complete work-up consisting of history and physical examination, laboratory studies, lung function testing, high-resolution CT scan, bronchoscopy with bronchoalveolar lavage, and cardiology workup. Presently, definitive diagnosis of interstitial lung disease is even more important because of newly available therapeutics. The high risk/ benefit ratio perceived in the literature for surgical lung biopsy motivates research for new biopsy techniques that ideally would have the same or better diagnostic yield as surgical lung biopsy with less morbidity, mortality and cost. If endoscopic transbronchial lung cryobiopsy can be shown to be associated with a low morbidity rate and high accuracy, we may be able to obtain a definitive histological diagnosis in a great majority of interstitial lung disease cases and forego complex, inefficient and inaccurate methods of disease diagnosis. Several groups have published prospective and retrospective series on endoscopic transbronchial lung cryobiopsy for interstitial lung disease with promising results and diagnostic yields up to 83% (range, 74–91%). The main complications associated with endoscopic transbronchial lung cryobiopsy are pneumothoraces and bleeding. The optimal techniques and specific settings for endoscopic transbronchial lung cryobiopsy is currently being investigated. In this paper, we present a review of the literature for endoscopic transbronchial lung cryobiopsy and future perspectives.