Background: The evaluation of interstitial lung diseases (ILDs) often requires lung biopsy, with transbronchial cryobiopsy (TBCB) emerging as superior to transbronchial forceps biopsy (TBFB), especially for fibrotic ILDs. Nonetheless, studies comparing these modalities in non-fibrotic ILDs and for specific ILD diagnoses are scarce.

Aims and Objectives: To evaluate the diagnostic yield and safety of TBCB and TBFB in a multicenter cohort of patients with fibrotic and non-fibrotic ILDs.

Methods: An observational multicenter study including patients with ILD diagnosis by multidisciplinary discussion that underwent TBCB or TBFB between 2017 and 2021. Chest CT scans were reviewed by a chest radiologist. Biopsy specimens were categorized as diagnostic (with specific histological pattern), non-diagnostic, or without lung parenchyma. Non-diagnostic samples were reassessed by a second lung pathologist. The diagnostic yield of TBCB and TBFB was analyzed by multivariate regression.

Results: 276 patients were included, 116 (42%) underwent TBCB and 160 (58%) TBFB. Fibrotic ILDs were present in 148 patients (54%). TBCB diagnostic yield was 78% and TBFB 48% (adjusted odds ratio 4.2, 95% CI 2.4-7.6, p<0.01). The diagnostic yield of TBCB was higher than TBFB among patients with fibrotic ILD (AOR 3.8, p<0.01), non-fibrotic ILD (AOR 5.8, p<0.01), and across most ILD diagnoses. TBCB was associated with higher risk for significant bleeding (10% vs. 3%, p<0.01), but similar risk for pneumothorax.

Conclusions: The diagnostic yield of TBCB was superior to that of TBFB for both fibrotic and non-fibrotic ILDs, and across most diagnoses.