Pulmonology Pulmonology
Pulmonol 2018;24:23-31 - Vol. 24 Num.1 DOI: 10.1016/j.rppnen.2017.09.005
Original article
Learning curve for transbronchial lung cryobiopsy in diffuse lung disease
L.M. Almeidaa,, , B. Limab, P.C. Motaa,c, N. Meloa, A. Magalhãesa, J.M. Pereirad, C.S. Mourac,e, S. Guimarãesc,e, A. Moraisa,c
a Pulmonology Department, Centro Hospitalar de São João, Porto, Portugal
b Oficina de Bioestatística, Porto, Portugal
c Faculdade de Medicina da Universidade do Porto, Porto, Portugal
d Radiology Department, Centro Hospitalar de São João, Porto, Portugal
e Pathology Department, Centro Hospitalar de São João, Porto, Portugal
Received 27 May 2017, Accepted 20 September 2017
Abstract
Introduction

Transbronchial lung cryobiopsy (TBLC) is increasingly used in the diagnosis of diffuse lung disease (DLD), but no data have yet been published on the learning curve associated with this technique.

Aim

To evaluate diagnostic yield, lung tissue sample length and area, and procedure-related complications in a cohort of TBLC procedures to define the learning curve and threshold for proficiency.

Methods

Retrospective analysis of the first 100 TBLCs performed in different segments of the same lobe in patients with suspected DLD. We compared diagnostic yield, sample length and area, and complications between consecutive groups of patients.

Results

The overall diagnostic yield for TBLC was 82%. Median sample length was 5.4mm (IQR, 5–6) and median area was 19.5mm2 (IQR, 13.3–25). Pneumothorax was the most common complication (18%). On comparing the two groups of 50 consecutive patients, a significant difference was found for diagnostic yield (74% vs 90%; p=0.04), sample length (5.0mm [2.5–16] vs 6.0mm [4–12;] p<0.01) and area (17.5mm2 [6–42] vs 21.5mm2 [10–49]; p<0.01). Logarithm regression was applied to median diagnostic yield and sample length and area for groups of 10 consecutive patients to define the learning curve, which plateaued after approximately 70 procedures.

Conclusions

Our findings suggest that proficiency in TBLC is achieved at approximately the 70th procedure; however they need to be validated in more series and cohorts.

Keywords
Tranbronchial lung cryobiopsies, Diffuse lung diseases, Lung histology, Learning curve
Pulmonol 2018;24:23-31 - Vol. 24 Num.1 DOI: 10.1016/j.rppnen.2017.09.005