Transbronchial lung cryobiopsy: a safe and effective technique in the diagnosis of interstitial lung disease in the older people

BACKGROUND AND OBJECTIVE: Patients presenting with interstitial lung disease (ILD) are getting older. In the older people, although idiopathic pulmonary fibrosis (IPF) is the most common ILD, the rate of unclassifiable ILD remains high after multidisciplinary discussion (MDD). One explicative factor could be the less frequent use of surgical lung biopsy (SLB) in this population because of its associated risks. Transbronchial lung cryobiopsy (TBLC) is a particularly interesting alternative to SLB in the diagnostic approach of ILD in older people subjects. Our objective was to assess the safety and diagnostic yield of TBLC in older people, as compared to younger patients. METHODS: We conducted a retrospective observational study in patients with ILD who underwent TBLC from 2015 to 2023. Individuals were defined as "older people" if they were older than or equal to 75 years. RESULTS: Out of 110 patients, 26 were classified as older people, with a median age of 78 years (IQR 76-79). In the whole cohort, the most represented HRCT pattern was "indeterminate" (27%). The rate of severe TBLC complications was 8% in the older people and 12% in the non-older people (p = 0.73). The diagnostic yield of TLBC was 85% in the older people and 79% in the non-older people (p = 0.50). In the older people group, the most common diagnoses after MDD were fibrotic hypersensitivity pneumonitis (31%) and IPF (31%). CONCLUSION: In ILD workup, the benefit/risk ratio of TBLC seems to be favorable in the older people, encouraging it to be proposed first in selected patients when clinical features are not appropriate for IPF.