Feasibility and safety of transbronchial lung cryobiopsy and mediastinal lymph node cryobiopsy: Experience from a resource limited African setting.

BACKGROUND: Transbronchial lung cryobiopsy (TBLC) is a relatively new technique recommended for sampling of lung parenchyma in patients with suspected interstitial lung disease (ILD) and as an alternative to surgical lung biopsy. A more recently introduced technique is endobronchial ultrasound-guided transbronchial mediastinal lymph node lymph node cryobiopsy (EBUS-TMC) to enable tissue biopsy of mediastinal lymph nodes. However, there are no data on the feasibility of implementing these techniques in a resource-limited African setting, where there is a chronic bed shortage and same-day discharges are preferable. OBJECTIVES: To determine the feasibility and diagnostic yield of TBLC and EBUS-TMC in a resource-limited African setting. METHODS: We performed an audit of lung and lymph node cryobiopsy procedures performed at the E16 Respiratory Clinic at Groote Schuur Hospital, Cape Town, South Africa. Indications, diagnostic performance outcomes and lessons learned were documented and analysed. RESULTS: Sixteen patients underwent 19 cryobiopsy procedures that were performed under general anaesthesia (n=11 TBLC, n=8 EBUS TMC, including 3 patients in whom both TBLC and EBUS-TMC were concurrently performed). The main indications were evaluation of ILD and suspected lymph node malignancy. The diagnostic yield was 63.6% for TBLC (n=7/11; 2 nonspecific interstitial pneumonia, 2 sarcoidosis, 1 espiratory bronchiolitis-ILD, 1 organising pneumonia, 1 nonspecific chronic inflammation) and 50.0% for EBUS-TMC (n=4/8; 1 plasmacytoma, 1 lymphoma, 1 cryptococcus infection, 1 patient with both cryptococcus infection and tuberculosis). Of the patients, 2 had moderate bleeding and 3 had mild bleeding, and 14 were discharged on the day of the procedure. CONCLUSION: TBLC and EBUS-TMC, with avoidance of surgical lung biopsy in most patients and same-day discharge in most patients, are feasible in an African setting. These data inform clinical practice and programme implementation in resource-limited settings. STUDY SYNOPSIS: What the study adds. Although transbronchial lung cryobiopsy (TBLC) is widely accessible in resource-rich settings such as Europe and the USA, there are no data from resource-limited African settings. Endobronchial ultrasound-guided transbronchial mediastinal lymph node cryobiopsy (EBUS-TMC) is a newer technique for which there are limited data. We provide feasibility and implementation data from an African setting.Implications of the findings. We provide useful programmatic implementational data for resource-limited African settings and show that implementation of these techniques with same-day discharge is feasible in a setting where there is limited access to overnight beds and anaesthetic support. Important implementational lessons learned that will facilitate initiation of a new TLBC/EBUS-TMC service are outlined.