Safety and utility of transbronchial lung cryobiopsy re-assessment in progressive interstitial lung disease

<bold>Background & Aims:</bold> The ATS/ERS/JRS/ALAT guideline for Idiopathic Pulmonary Fibrosis has conditionally recommended transbronchial lung cryobiopsy (TBLC) as an alternative to surgical lung biopsy. However, the diagnostic competence of TBLC is lower than that of surgical biopsy. It is sometimes necessary to conduct second time TBLC and to re-assess initial treatment strategy. The aim of this retrospective study is to investigate the safety and utility of multiple time TBLC for re-assessment. <bold>Methods:</bold> We reviewed the medical records of 36 patients with interstitial lung disease (ILD) who underwent TBLC multiple times for diagnosis and evaluation of the disease, and investigated the safety and utility of second time TBLC. <bold>Results:</bold> After the second TBLC, three (8.3%) developed a pneumothorax, 11 (30.6%) developed bleeding, and one (2.8%) had an acute exacerbation. There was no significant difference in safety between the first and second TBLC. We successfully modified treatment in 27 (75.0%) of the 36 patients on the basis of the second time biopsy. Anti-inflammatory agents were added to 18 (50%) patients and anti-fibrotic agents to 13 (36.1%) patients. In 25 patients with progressive pulmonary fibrosis, anti-inflammatory agents were added to 11 (44.0%) patients and antifibrotic agents to 10 (40.0%) patients according to the second biopsy results. <bold>Conclusions:</bold> Re-assessment by TBLC for patients with progressive ILD is as safe as first time TBLC and allows pathology-based treatment modification in many cases.