Role of Transbronchial Lung Cryobiopsies in Diffuse Parenchymal Lung Diseases: Interest of a Sequential Approach

Figure 3

Illustration of the additional information obtained from surgical biopsy after cryobiopsies showing an NSIP pattern. A 75-year-old woman with idiopathic interstitial pneumonia had a chest CT scan showing an inconsistent UIP pattern (subpleural and basal reticular opacities, traction bronchiectasis, and ground glass opacities with an extent greater than reticular abnormalities without honeycombing) (a). TBLCs were performed in the left lower lobe and the pathological analysis identified an NSIP pattern (hematoxylin and eosin staining, magnification ×40) (b). The NSIP pattern was characterized by the presence of an interstitial septal thickening preserving the alveolar architecture, black arrow, with chronic inflammatory infiltrate, red arrow. Neither honeycombing nor fibroblastic foci were observed. A surgical lung biopsy was then performed in the same patient, in the same lobe (left lower lobe) showing a UIP pattern (hematoxylin and eosin staining, magnification ×40) (c). The photomicrography shows the presence of fibrotic changes with honeycombing (black arrow), heterogeneous architectural destructions and fibroblastic foci (enlargement and red arrow, magnification ×200). Those features were not observed on the cryobiopsy.

(a)

(b)

(c)