Risk Factors for Complications After Transbronchial Lung Cryobiopsy Identified

Clinicians should consider age, the extent of traction bronchiectasis, and cough history in patients undergoing transbronchial lung cryobiopsy for interstitial lung disease.

The risk for clinically significant complications following transbronchial lung cryobiopsy for suspected interstitial lung disease (ILD) was found to be associated with younger age and the extent of traction bronchiectasis observed during high-resolution computed tomography (CT). These findings, from a prospective, multicenter study, were published in Respiratory Medicine.

Researchers evaluated risk factors for clinically significant complications following transbronchial lung cryobiospy among patients (N=100) with suspected ILD. Included patients were enrolled at Kuopio University Hospital and Tampere University Hospital in Finland between 2015 and 2019. The patients were evaluated by the Leicester Cough Questionnaire (LCQ), and clinically significant complications were defined as moderate to severe bleeding, moderate to severe pneumothorax, or death within 90 days. Results were evaluated using a backward stepwise logistic regression model.

Among patients included in the analysis, 60% were women, the mean [SD] age was 66.1 [9.07] years, the mean BMI was 28.5 [4.51] kg/m2, and the mean LCQ total score was 15.7 [3.82]. In addition, the mean [SD] predicted forced vital capacity percentage among the patients was 81.0% [14.6%], and 15% of patients were receiving oral corticosteroids.

Within 90 days, 22% of patients had mild bleeding, 19% had moderate bleeding, 5% had mild pneumothorax, 11% had moderate pneumothorax, and 2% had severe pneumothorax. In addition, 3% of patients had infection, 1% had subcutaneous emphysema, 2% were admitted to the intensive care unit, and 2% died. Clinically significant complications were observed among a total of 32 patients.

In the multivariable model, the risk for clinically significant complications was associated with an age of 59.5 years or younger (odds ratio [OR], 7.96; 95% CI, 2.32-27.3; P =.001) and traction bronchiectasis score (OR, 1.30; 95% CI, 1.03-1.65; P =.027). The risk for moderate or severe bleeding was associated with biopsy specimens obtained from the lower lobe (OR, 0.106; 95% CI, 0.017-0.678; P =.018), and the risk for moderate to severe pneumothorax was associated with an age of 59.5 years or younger (OR, 7.56; 95% CI, 2.00-27.8; P =.002) and an LCQ total score of 14.6 or lower (OR, 4.18; 95% CI, 1.10-16.0; P =.036).

The histopathologic patterns observed among patients had a diagnostic yield of 87%.

During radiologic reassessment, definite, probable, or indeterminate usual interstitial pneumonia was indicated in 5%, 29%, and 37% of patients, respectively; 29% of patients had an alternative diagnosis. Based on histopathologic patterns, usual interstitial pneumonia was indicated among 16% of patients, with probable, possible, and nonspecific cases indicated in 6%, 36%, and 12% of patients, respectively.

It might be wise to investigate severe cough before the TBLC is considered.

Histopathologic patterns also indicated hypersensitivity pneumonia among 10% of patients; 13% of patients were not diagnostic, and 7% were categorized as other. Following multidisciplinary discussions, the most common diagnoses among the patients were idiopathic pulmonary fibrosis (62%), idiopathic nonspecific interstitial pneumonia (15%), and hypersensitivity pneumonia (10%).

The major limitation of this study was the small sample size.

Based on these findings, the researchers concluded, “It might be wise to investigate severe cough before the TBLC [transbronchial lung cryobiospy] is considered.”

Disclosure: Multiple authors declared affiliations with industry. Please see the original reference for a full list of disclosures.


Mononen M, Saari E, Hasala H, et al. Risk factors of clinically significant complications in transbronchial lung cryobiopsy: a prospective multi-center study. Respir Med. 2022;200:106922. doi:10.1016/j.rmed.2022.106922