Competence in transbronchial cryobiopsy.

Transbronchial (TBL) cryobiopsy has been shown in the last decade to potentially represent an "innovative application" of an "old procedure" for the histologic diagnosis of diffuse interstitial lung diseases (DILDs). Thus, the technique of TBL cryobiopsy is now adopted for diagnostic purposes, transbronchially in peripheral airways to sample lung parenchyma, whereas this same technique was traditionally employed for therapeutic purposes, essentially for the management of malignant obstruction of central airways. When patients with Interstitial Lung Diseases (ILDs) need hystopathological data in their diagnostic pathway, this bioptic approach could be a valide alternative to surgical lung biopsy, that is still the gold standard at the moment. The Tranbronchial cryobiopsy has a good safety profile, its sensitivity and specifity appear good overall in idiopathic pulmonary fibrosis. In the last ten years, many papers were published about this procedure defining modalities by which cryobiopsy should performed. This studies have shown that TBL cryobiopsy is feasable, it allows to obtain large lung parenchymal specimens (3 times larger than "classic" transbronchial biopsies), characterized by unaltered and artefact- free morphology, and it represents a safe and poorly invasive diagnostic tool for the histologic diagnosis of ILDs. The technical aspects are really important, and they still need a complete standardization. Tranbronchial cryobiopsy should be part of an equipement of the modern interventional pulmonologist, who should know indications and controindications of this methodic and the technical aspects of the procedure. This is a complex procedure requiring to be performed by endoscopists working in specialized centers with specific knowledge of DILDs, and a multidisciplinary approach, which represent pre-requisites for admission to training in this procedure.