Does transbronchial lung cryobiopsy give useful information in asthmatic patients?

Multidisciplinary Respiratory Medicine ORIGINAL RESEARCH ARTICLE

Sara Colella, Claudia Ravaglia, Chiara Massaccesi, Vittorio D’Emilio, Gianluca Panella, Federica Fioretti, Emanuele Giovanni Conte, Guido Collina, Riccardo Pela and Venerino Poletti

Multidisciplinary Respiratory Medicine 2019, 14:12

Abstract Introduction Lung biopsy in asthmatic patients is justified in case of atypical presentations of asthma, when other differential diagnoses, such as hypersensitivity pneumonitis or eosinophilic granulomatosis with polyangiitis, could be possible or for research purposes. Aim We aim to describe the utility and the safety of TBLC (transbronchial lung cryobiopsy) in asthmatic patients, providing data on the pathological changes occurring in the airways and in the lung parenchyma. Methods We reviewed asthmatic patients that underwent TBLC, that eventually had only a final diagnosis of asthma. Results Three patients were detected. TBLC described pathological abnormalities in peribronchiolar and alveolar spaces already well identified with SLB (surgical lung biopsy); the pathological information provided could be useful to better understand the pathobiology of the disease. Finally, we had no complications, confirming a satisfactory safety profile of TBLC. Pathological and radiological findings in a severe asthmatic patient. a A small bronchiole (arrow) presents goblet cell metaplasia and the lumen completely occupied by mucus, epithelial cells and eosinophils. In the peribronchial region lymphoid nodules are evident (arrowhead). b In the peribronchiolar alveolated tissue lymphoid infiltrates are evident (arrows) (H&E, low power). c High-Resolution CT scan at the lung base showing thickening of the wall and dilatation of the lumens of the bronchi and some centrilobular micronodules Conclusion We suggest the potential role of TBLC in asthmatic patients: its safety and its acceptable diagnostic accuracy lead to consider this procedure instead of SLB when histological changes in lung parenchyma are needed for the differential diagnosis. Furthermore, TLBC could be useful for research in the pathobiology of asthma and severe asthma. Full Text | PDF