Time Is Lung: Inpatient Transbronchial Lung Cryobiopsy Decreases Wait Time to Treatment Initiation for Newly Diagnosed Interstitial Lung Disease

Abstract

Although performing lung biopsies on hospitalized patients with interstitial lung disease (ILD) has risk, initial studies have shown transbronchial lung cryobiopsy (TBLC) may be safely performed in this patient group. Data evaluating the value of this intervention in establishing a diagnosis and impacting management is lacking. We present a comparison of TBLC for inpatients and outpatients and provide data on the impact on medical therapy initiation and wait times from consultation to biopsy and treatment. Demographic data, pulmonary function values, chest imaging patterns, procedural information, diagnosis, and medical therapy changes, defined as medication initiation, adjustment, or cessation guided by TBLC results, were recorded from enrolled patients with newly identified ILD. Changes in medical therapy were the primary outcome. Time from consultation to biopsy and treatment was the secondary outcome. Fifty-four (54) patients (40 outpatient, 14 inpatient) were included. Inpatients underwent biopsy 2.5 ± 4.4 days after consultation compared to 15.5 ± 16.1 days for outpatients (p < 0.001). Medical therapy changes occurred 10.3 ± 7.9 days after biopsy for inpatients compared to 34.6 ± 37.0 days for outpatients (p < 0.001). There were no significant differences in medical therapy changes between the groups (p = 0.45). Our initial study suggests that performing TBLC on inpatients with newly identified ILD decreases wait times to treatment initiation and diagnosis. Efforts to understand the impact of a decreased wait time on ILD prognosis, including the development of progressive disease or fibrosis, symptom evolution, and quality of life, require further evaluation.

Keywords

Diffuse parenchymal lung disease / Interstitial lung disease / Transbronchial lung cryobiopsy / Lung biopsy / Treatment delay

Author Contributions

All authors were responsible for data collection and accuracy of data, analysis of results, finalization of the manuscript, and approval of the submitted article. C.C. and B.S.B. conceived and wrote the manuscript and take responsibility for the integrity of the work as a whole.

Ethics Statement

Approval was obtained from the institutional review board of the Medical College of Wisconsin PRO00036023, Date of Approval: 5 March 2020.

Informed Consent Statement

Patient consent was waived by the institutional review board due to the retrospective nature and minimal risk of this research study.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author.

Funding

This research received no external funding.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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