To the Editor:We read with interest the article by Romagnoli and colleagues wherein the authors demonstrate poor concordance between surgical lung biopsy (SLB) and transbronchial lung cryobiopsy (TBLC) (1). We congratulate the authors for their excellent study, given that this is the first study to perform SLB and TBLC in the same patient. There are, however, a few limitations of the study that need to be highlighted.The authors clearly state that the study is limited by the small sample size, the use of histopathology findings in isolation to calculate concordance (without integrating clinical and imaging data), and the fact that even SLB had only 62% agreement with the final diagnosis. Despite the major limitations of the study, the authors seem to sound a death knell for TBLC, which is unjustified. If the study had had a larger sample size and a few more concordant patients in the TBLC arm, the results would have been different. The authors also consider subjects with a nondiagnostic TBLC to be discordant. In actual practice, such patients would be counseled to undergo SLB, as TBLC has not been claimed to completely replace SLB. Interestingly, the authors seem to be very hopeful about the utility of SLB even though it had a κ coefficient of only 0.51 (only slightly higher than that obtained for TBLC). It is important to understand that SLB has its own risk of sampling error (2, 3).Also, the authors used a 2.4-mm cryoprobe on the basis that this provides larger tissues. However, the problem with the larger cryoprobe is that it provides more “central” than “peripheral” lung tissue, and this may be one important cause of a lower concordance of TBLC (4, 5).In clinical practice, TBLC is here to stay. In our experience, most patients prefer TBLC to SLB (or indeed any “surgical” procedure) despite the lower diagnostic accuracy of TBLC. In the clinic, and in the proper clinical and radiological context, TBLC is likely to provide far more diagnostic information to the clinician than what is being projected by this study.TBLC may have been projected to be “down” by this study, but certainly it is not out.
Authors: Anna-Luise A Katzenstein; David A Zisman; Leslie A Litzky; Binh T Nguyen; Robert M Kotloff Journal: Am J Surg Pathol Date: 2002-12 Impact factor: 6.394
Authors: Micaela Romagnoli; Thomas V Colby; Jean-Philippe Berthet; Anne Sophie Gamez; Jean-Pierre Mallet; Isabelle Serre; Alessandra Cancellieri; Alberto Cavazza; Laurence Solovei; Andrea Dell'Amore; Giampiero Dolci; Aldo Guerrieri; Paul Reynaud; Sébastien Bommart; Maurizio Zompatori; Giorgia Dalpiaz; Stefano Nava; Rocco Trisolini; Carey M Suehs; Isabelle Vachier; Nicolas Molinari; Arnaud Bourdin Journal: Am J Respir Crit Care Med Date: 2019-05-15 Impact factor: 21.405