The role of transbronchial lung cryobiopsy in multidisciplinary discussion for interstitial lung diseases: a dual-center retrospective study

BACKGROUND: Interstitial lung diseases (ILDs) are a heterogeneous group of disorders with complex etiologies and nonspecific clinical manifestations, often requiring histopathological confirmation for accurate diagnosis. Transbronchial lung cryobiopsy (TBLC) has emerged as a less invasive alternative to surgical lung biopsy (SLB) for obtaining lung tissue, yet its role in multidisciplinary discussion (MDD) remains underevaluated. OBJECTIVES: This study aimed to assess the diagnostic yield and safety of TBLC when integrated into MDD for diagnosing ILDs. DESIGN: A retrospective dual-center study was conducted on 208 patients with undiagnosed ILDs who underwent TBLC at Shanghai Chest Hospital and Fuzhou Pulmonary Hospital from May 2021 to December 2024. METHODS: TBLC procedures were performed under general anesthesia, with samples evaluated by pathologists and integrated into MDD involving pulmonologists, radiologists, and rheumatologists. Diagnostic yield, complication rates, and concordance were analyzed. RESULTS: TBLC achieved a histological diagnostic yield of 88.9% (185/208 cases), which improved to 97.6% (203/208 cases) after MDD. The most common diagnosis was hypersensitivity pneumonitis (HP, 18.3%) followed by idiopathic nonspecific interstitial pneumonia (iNSIP, 15.4%). Complications were rare, with pneumothorax occurring in 5.3% of cases and moderate bleeding in 3.4%. No procedure-related mortality was observed. CONCLUSION: TBLC is a safe and effective diagnostic tool for ILDs, with high diagnostic yield when integrated into MDD. TBLC reduces the need for SLB while maintaining low complication rates. These findings support TBLC as a valuable component of the MDD approach for ILDs.