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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The differential diagnosis of diffuse interstitial lung diseases &#40;ILD&#41; is a complex process&#44; often requiring a multidisciplinary team and lung parenchyma sample collection using various diagnostic techniques&#46; Idiopathic pulmonary fibrosis &#40;IPF&#41; is the most common disease within this group&#44; and has the poorest prognosis<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">1&#8211;3</span></a>&#59; whereas differential diagnosis with other ILDs presents a major challenge&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">International consensus guidelines for the diagnosis and treatment of ILD<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">1&#44;2</span></a> indicate that in approximately 50&#37; of cases&#44; chest high-resolution computed tomography &#40;HRCT&#41; is sufficient to diagnose IPF in the correct clinical context&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">4&#44;5</span></a> In the remaining patients&#44; radiological criteria are inconclusive&#44; and surgical lung biopsy &#40;SLB&#41; is recommended in order to distinguish usual interstitial pneumonia &#40;UIP&#41; from other ILDs&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">6&#44;7</span></a> Transbronchial biopsy &#40;TBB&#41; via fiberoptic bronchoscopy &#40;FBS&#41; can provide diagnosis in some cases of ILD&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">8&#8211;11</span></a> This technique&#44; however&#44; has been dismissed in clinical guidelines<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">1&#8211;3</span></a> because the frequently patchy nature of ILDs&#44; small size of specimens obtained and poor preservation means that the diagnostic yield of TBB is at times less than 30&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Recent studies have shown that&#44; unlike conventional TBB&#44; TBB using a cryoprobe &#40;also known as cryobiopsy&#41; is a viable technique for obtaining lung parenchyma samples with a higher diagnostic yield and relatively few complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">14&#44;15</span></a> It differs from conventional TBB in that samples for histological analysis are larger and better preserved&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">16&#8211;19</span></a> Furthermore&#44; unlike SLB&#44; it does not require an operating theater and can be performed on an outpatient basis&#46; The role of cryobiopsy in the diagnostic algorithm of IPF and differential diagnosis with other ILDs is unclear&#44; and its potential benefits have not been specifically determined in a cost&#8211;benefit analysis&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The main aim of this study was to analyze the diagnostic yield of cryobiopsy in the differential diagnosis of ILDs&#46; As a secondary objective&#44; we analyzed the complications and economic costs derived from the systematic application of cryobiopsy in ILDs&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a retrospective observational study that analyzed the results of lung cryobiopsies performed in the Respiratory Endoscopy Unit of a tertiary hospital between January 2011 and January 2014&#46; Patients had been previously assessed by an ILD multidisciplinary committee&#44; where all cases referred from the different hospital departments&#44; outpatients&#44; and district primary care clinics were evaluated&#46; Clinical decisions were taken by consensus among the members of the multidisciplinary team&#44; which was composed of pulmonologists&#44; thoracic surgeons&#44; radiologists&#44; and specialists in systemic and pathological autoimmune diseases&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients with an ILD pattern on HRCT defined as &#8220;possible UIP&#8221; or &#8220;inconsistent with UIP&#8221;&#44; in whom histological confirmation would be required &#40;in accordance with ATS&#47;ERS guidelines<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a>&#41; were included&#46; The specific lobe where the cryobiopsy was performed was determined following the radiologists&#8217; recommendations&#44; based on ATS&#47;ERS<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a> criteria for surgical lung biopsy&#46; In summary&#44; lung biopsy should cover a wide spectrum of lung disease&#44; including honeycomb foci&#44; as this finding is a criterion for UIP&#46; However&#44; if there are signs of very severe fibrosis with gross honeycombing&#44; the biopsy should be taken from less affected honeycomb areas&#44; as non-specific changes are usually found in the most affected areas&#46; If the lung does not show any signs of fibrosis or honeycombing&#44; the sample should be taken from radiologically abnormal areas&#46; Following this protocol&#44; biopsies were taken in all cases from different sub-segments of the target lobe and&#44; when possible&#44; from various lobes&#46; All patients had a complete blood count with coagulation study&#44; echocardiography and lung function study that included forced spirometry&#44; determination of lung volumes and carbon monoxide diffusing capacity&#46; SLB was proposed in patients in whom the cryobiopsies were not diagnostic&#46; All patients signed a specific informed consent for cryobiopsies&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedure</span><p id="par0035" class="elsevierStylePara elsevierViewall">The cryobiopsies were performed in an examination room equipped with hemodynamic monitoring equipment&#44; a ventilator and mechanical radioscopy arm&#46; The procedure was carried out under general anesthetic with propofol &#40;3&#8211;6<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;h&#41; and remifentanil &#40;0&#46;05&#8211;0&#46;1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;h&#41; infusion&#46; Patients were intubated with a flexible&#44; cuffed tube &#40;7&#46;5<span class="elsevierStyleHsp" style=""></span>mm Bronchoflex&#44; R&#252;sch&#44; Teleflex Medical&#44; Durham&#44; NC&#44; US&#41;&#46; This tube has a side channel that allows the introduction of a Fogarty&#8482; occlusion balloon catheter &#40;4F&#47;5F&#47;6F&#59; Edwards Lifesciences Corporation&#8482;&#44; Irvine&#44; CA&#44; US&#41;&#44; which was placed at the entry of the lobe to be biopsied and inflated immediately after performing the cryobiopsy to stem any possible bleeding from the target airway&#46; An EB-1970K video bronchoscope &#40;outer diameter&#58; 6&#46;2<span class="elsevierStyleHsp" style=""></span>mm&#44; diameter of working channel&#58; 2&#46;8<span class="elsevierStyleHsp" style=""></span>mm&#59; Pentax Medical&#44; US&#41; was used&#46; After examining the bronchial tree&#44; bronchoalveolar lavage was carried out in the area selected by HRCT imaging in patients in whom it had not previously been performed&#46; TBB was then performed on the selected segments using a 1&#46;9<span class="elsevierStyleHsp" style=""></span>mm cryoprobe &#40;Erbokryo CA&#44; Erbe&#44; Germany&#41; under fluoroscopic guidance&#46; The cryoprobe was introduced through the working channel of the bronchoscope and&#44; once the correct position had been confirmed by fluoroscopy&#44; the cryoprobe pedal was activated for 3&#8211;4<span class="elsevierStyleHsp" style=""></span>s&#46; The probe was then withdrawn&#44; together with the bronchoscope&#44; with the specimen adhered to the tip of the cryoprobe&#46; At least 3 samples were taken&#44; although the total number of biopsies depended on their size&#44; the patient&#39;s tolerance and possible complications&#46; After the procedure had been completed and the patient ex-tubated&#44; a post-procedure chest X-ray was performed&#46; Any complications observed were recorded&#44; particularly bleeding and pneumothorax&#46; Pulmonary bleeding was classified according to its severity as&#58; grade I&#58; mild bleeding which does not require endoscopic intervention&#59; grade II&#58; moderate bleeding which stops within 3<span class="elsevierStyleHsp" style=""></span>min after endoscopic intervention &#40;bronchial occlusion and&#47;or instillation of cold serum&#41;&#44; and grade III&#58; severe bleeding that cannot be controlled endoscopically&#44; causing hemodynamic or respiratory instability&#44; and making it necessary to halt the procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Histological Evaluation</span><p id="par0040" class="elsevierStylePara elsevierViewall">The specimens were fixed in 4&#37; formaldehyde and sent to the histopathology laboratory&#44; where they were measured before being embedded in paraffin&#46; Each sample was embedded in a separate block and stained with hematoxylin&#8211;eosin and Masson&#39;s trichrome stain&#46; The specimens were evaluated by a pathologist from the multidisciplinary team with experience in respiratory disease pathology&#46; The sample was not considered diagnostic when the findings did not allow a specific diagnosis to be made&#46; Samples with insufficient alveoli for analysis were considered invalid&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Evaluation in the Multidisciplinary Committee</span><p id="par0045" class="elsevierStylePara elsevierViewall">The clinical&#44; radiological&#44; and histopathological parameters were reviewed by specialists who regularly participated in our hospital&#39;s ILD multidisciplinary committee&#46; A sample was considered to be diagnostic when the histopathological findings enabled the specific diagnosis of the particular disease&#46; Once the histopathological report had been obtained&#44; the members of the multidisciplinary committee established the definitive diagnosis of the patient&#39;s interstitial disease based on the report and the patient&#39;s clinical and radiological characteristics&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Economic Analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">For the economic analysis&#44; the cost of the different diagnostic processes was calculated in euros&#46; We used data based on the Catalonian Government taxes and public prices Act approved by Legislative Decree 33&#47;2008 of 25 June and Act 26&#47;2010 of 3 August&#44; and data reported by other authors in the same setting&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">21&#44;22</span></a> The final cost per process was calculated by totaling the cost of the different procedures required to reach the definitive diagnosis&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical Analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">The results of the quantitative variables were expressed as mean&#177;standard deviation&#46; Percentages and absolute frequencies were used for the qualitative variables&#46; Statistical data analysis was performed using the SPSS statistics package version 17&#46;0 for Windows<span class="elsevierStyleSup">&#174;</span> &#40;SPSS&#44; Chicago&#44; IL&#44; US&#41;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Diagnostic Yield and Safety of the Procedure</span><p id="par0060" class="elsevierStylePara elsevierViewall">During the study period&#44; 33 patients underwent lung cryobiopsy for confirmation of ILD&#46; Their general characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The location of the biopsies&#44; number of samples obtained&#44; and complications observed are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The bronchoalveolar lavages were performed in the middle lobe or lingula to avoid technical difficulties in performing the cryobiopsy&#46; More than one lung lobe was biopsied in 2 patients&#46; In the remaining 31 patients&#44; the biopsies were carried out in various segments of the lower lobes&#46; A mean of 2&#46;7 biopsies were obtained per patient&#44; with a mean size of 0&#46;4<span class="elsevierStyleHsp" style=""></span>cm &#40;SD&#177;0&#46;17&#41;&#46; Biopsy specimens considered to be diagnostic were obtained in 26 patients &#40;79&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#59; the samples were considered non-diagnostic in 5 patients &#40;15&#37;&#41; and invalid in only 2 patients &#40;6&#37;&#41;&#46; There were no significant differences in the size of the diagnostic and non-diagnostic specimens &#40;0&#46;5&#177;0&#46;19<span class="elsevierStyleHsp" style=""></span>cm and 0&#46;34&#177;0&#46;15<span class="elsevierStyleHsp" style=""></span>cm&#44; respectively&#41;&#46; In general&#44; no artifacts due to compression of the alveoli were found in the samples analyzed&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> summarizes the diagnostic orientation based on the HRCT images&#46; The definitive diagnoses were obtained from the histopathology of the cryobiopsy samples and the opinion of the multidisciplinary team&#46; Of the 5 patients with non-diagnostic specimens&#44; a diagnostic SLB &#40;peribronchiolar metaplasia&#41; was performed in only 1 case &#40;3&#37;&#41;&#46; Of the remaining 4 patients&#44; 2 cases were diagnosed with idiopathic NSIP&#44; mainly based on radiological criteria&#46; Given that these patients had severe comorbidities that contraindicated the intervention&#44; SLB was dismissed by the multidisciplinary team&#46; The other 2 cases had radiological images&#44; symptoms&#44; and histopathological findings suggestive of ILD&#44; but a more accurate diagnosis could not be reached&#44; so they were diagnosed with ILD of unknown origin&#46; Of the 2 patients with invalid samples&#44; one had radiological images suggestive of organized pneumonia&#46; Since SLB was also contraindicated due to severe comorbidities&#44; the patient was treated with oral corticosteroids&#44; with a good clinical and radiological response&#46; In the other case&#44; the radiological image and symptoms suggestive of ILD were mainly taken into account for the final diagnosis&#44; suggesting ILD of unknown origin&#46; In 1 patient&#44; despite images characteristic of UIP on the HRCT&#44; a cryobiopsy was performed due to clinical suspicion of hypersensitivity pneumonitis&#46; Cryobiopsies were performed in patients with ILD associated with a systemic autoimmune disease &#40;SAD&#41; due to the lack of criteria for a firm diagnosis of SAD&#46; These patients had lung disease at the outset and later presented extra-pulmonary symptoms&#44; thus fulfilling sufficient criteria for a diagnosis of systemic sclerosis&#46; As regards the safety of the technique&#44; 4 cases of pneumothorax &#40;12&#37;&#41; were identified&#59; 3 resolved spontaneously while 1 required a chest drain for 2 days&#44; after which the patient was discharged&#46; In total&#44; 9&#37; of patients had grade I bleeding&#44; and 21&#37; had grade II bleeding&#46; No cases of severe bleeding requiring suspension of the procedure were detected&#44; and no additional medical or surgical measures were needed to control bleeding&#46; Although 2 patients had mild pulmonary hypertension as comorbidity&#44; neither of them had complications&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Cost Analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">Following the method used by Leiro Fernandez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">22</span></a> and establishing the cost of FBS at &#8364;250&#46;45&#44; cryoprobe at &#8364;54 per case&#44; and histopathology analysis at &#8364;253&#46;69&#44; the total cost of the cryobiopsies performed was &#91;&#40;&#8364;250&#46;45&#43;&#8364;54&#43;&#8364;253&#46;69&#41;&#215;33&#93;&#61;&#8364;18&#44;426&#46;54&#44; giving a total cost of &#8364;304&#46;69 per patient&#46; In 26 of the 33 patients evaluated&#44; the cryobiopsy provided the definitive diagnosis of the disease and SLB was not needed&#46; The costs of this surgical technique in both the hospital and outpatient setting are summarized in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; In the case of the 3 patients who presented pneumothorax with spontaneous resolution&#44; the added cost was &#8364;1458&#46;30 &#40;&#8364;486&#46;10 per patient&#41;&#46; In the case of the patient who required a drainage tube to resolve the pneumothorax&#44; the added cost was &#8364;2229&#46;98&#46; Therefore&#44; the systematic use of lung cryobiopsy in the assessment of patients with suspected ILD reduced costs by &#8364;41&#44;506&#46;74&#8722;&#40;&#8364;10&#44;054&#46;77&#43;&#8364;3688&#46;28&#41;&#61;&#8364;27&#44;763&#46;69 in the case of SLB without admission&#59; &#8364;57&#44;548&#46;04&#8722;&#40;&#8364;10&#44;054&#46;77&#43;&#8364;3688&#46;28&#41;&#61;&#8364;43&#44;804&#46;99 in the case of 24-h hospital stay&#44; and &#8364;73&#44;589&#46;34&#8722;&#40;&#8364;10&#44;054&#46;77&#43;&#8364;3688&#46;28&#41;&#61;&#8364;59&#44;846&#46;29 if hospital stay was extended to 48<span class="elsevierStyleHsp" style=""></span>h&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">This study shows that specimens obtained with cryobiopsy are of sufficient quality for specific diagnosis in most cases of suspected ILD when histological findings are combined with clinical&#44; radiological&#44; and laboratory data&#46; Furthermore&#44; this technique was shown to be safe and much less costly than SLB&#44; and could be an alternative to consider in the diagnostic management of these patients&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">It has been estimated that approximately one third of patients with ILD will require lung biopsy&#44; although this will be performed in only 7&#46;5&#37;&#8211;12&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">3&#44;4&#44;15</span></a> highlighting the reticence of some patients and physicians to perform this procedure&#46; Moreover&#44; although suitable samples for histopathological study can be obtained with SLB&#44;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">23&#44;24</span></a> it is not without significant drawbacks&#44; such as the need for an operating theater and hospitalization in most cases&#44; limited availability&#44; and moderate morbidity and mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">25&#8211;29</span></a> The recent introduction of the flexible cryoprobe&#44; which thanks to the Joule&#8211;Thomson effect generates very low temperatures at its distal tip &#40;around &#8722;85<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#44; enables larger&#44; better preserved TBB samples to be obtained than those taken with forceps&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">14&#44;30&#8211;33</span></a> In 2009&#44; Babiak et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">16</span></a> published the first report on the potential usefulness of cryobiopsy in diffuse lung diseases&#46; Although this study included a very heterogeneous group of patients&#44; and the primary objective was not to determine diagnostic yield&#44; the information provided by the cryobiopsy contributed substantially to the definitive diagnosis in a significant number of cases&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Casoni et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">19</span></a> evaluated 69 patients with undefined diffuse interstitial pneumonia&#44; and obtained a specific diagnosis in 76&#37; of cases&#46; Very recently&#44; Pajares et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> in a randomized study of 77 patients also showed that cryobiopsy obtained specific diagnoses in 74&#37; of patients with interstitial disease&#44; a significantly higher yield than the 34&#37; obtained using traditional TBB&#46; In our study&#44; diagnostic yield was 79&#37;&#44; very similar to that of Casoni et al&#46; and Pajares et al&#46;&#44; confirming the usefulness of cryobiopsy in this patient group&#46; Interestingly&#44; the diameter of the probe used in our study &#40;1&#46;9<span class="elsevierStyleHsp" style=""></span>mm&#41; was smaller than that reported by Casoni et al&#46; and Pajares et al&#46; &#40;2&#46;4<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Although there is experimental evidence that the size of the specimen depends&#44; among other variables&#44; on the diameter of the probe&#44; the fact remains that the number of specific diagnoses does not appear to differ greatly according to the size of probe&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">30</span></a> Furthermore&#44; the number of complications in our series was acceptable&#44; the most notable being pneumothorax in 12&#37; of cases&#44; with moderate bleeding in 20&#37;&#44; and a 48-h chest drain in only 1 patient&#46; The hemostatic effect of freezing the cryoprobe probably contributed to the low incidence of bleeding&#44; which in no case required specific intervention or interruption of the procedure&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Although there are no studies comparing the yield of cryobiopsy and SLB&#44; the former certainly appears to have advantages that make it worth considering in ILD diagnostic protocols &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; This study also highlights an additional advantage of cryobiopsies over SLB&#58; cost&#46; Systematic cryobiopsies could save between &#8364;31&#44;451&#46;97 &#40;&#8364;953&#46;09&#47;patient&#41;&#44; in the case of outpatient SLB&#44; and &#8364;59&#44;846&#46;29 &#40;&#8364;1925&#46;29&#47;patient&#41; in the case of SLB with 48-h admission&#44; which is often the case in our region&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">A series of limitations must be considered in order to correctly interpret the results&#46; Firstly&#44; this is a retrospective observational study with a relatively small number of patients from a single center&#46; Secondly&#44; the patients were probably at an early stage of the disease&#44; as evidenced by the respiratory function values&#46; The cryobiopsy yield in patients in more advanced stages of the disease may differ&#46; Thirdly&#44; specimen evaluation by pathologists with experience in lung pathology is probably essential for this diagnostic yield&#46; Finally&#44; the &#8220;patchy&#8221; nature of most ILDs could mean that more extensive sample analysis could change the diagnosis in some cases&#46; Furthermore&#44; technical difficulties in reaching the upper lobes could also interfere in the diagnosis&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In conclusion&#44; the use of cryobiopsy in the ILD diagnostic algorithm is a viable and safe alternative for obtaining specimens that enable a histopathological diagnosis to be made in many patients&#46; In experienced hands&#44; this technique would rule out SLB with its associated therapeutic implications in a great many cases&#44; and also significantly reduce costs&#46; Although there are still numerous aspects that must be standardized&#44; such as the size of the probe&#44; freezing time&#44; number of biopsies or their location&#44; the results obtained suggest that cryobiopsy should be considered in the diagnostic management of ILDs&#46; Prospective&#44; comparative&#44; randomized&#44; multicenter studies need to be carried out with a large series of well characterized patients and a common&#44; duly standardized protocol and methodology&#46; This would help define the role of this novel modality in the diagnosis of ILDs&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Funding</span><p id="par0100" class="elsevierStylePara elsevierViewall">This study has not received any type of funding&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Authors&#8217; Contributions</span><p id="par0105" class="elsevierStylePara elsevierViewall">Design and performance of the study&#58; FHG&#44; CL&#44; MS&#44; JR&#44; MJJ&#44; AX&#44; JS&#44; CA&#46; Data analysis&#58; FHG&#44; CL&#44; JS&#44; CA&#46; Contributions to the manuscript&#58; FHG&#44; CL&#44; MS&#44; JR&#44; MJJ&#44; AX&#44; JS&#44; CA&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of Interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests&#46;</p></span></span>"
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          "titulo" => "Conflict of Interest"
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        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-06-30"
    "fechaAceptado" => "2014-09-22"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec537542"
          "palabras" => array:3 [
            0 => "Transbronchial lung biopsy"
            1 => "Cryobiopsy"
            2 => "Interstitial lung disease"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec537543"
          "palabras" => array:3 [
            0 => "Biopsia pulmonar transbronquial"
            1 => "Criobiopsia"
            2 => "Enfermedad pulmonar intersticial difusa"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Assessment of patients with suspected interstitial lung disease &#40;ILD&#41; includes surgical lung biopsy &#40;SLB&#41; when clinical and radiological data are inconclusive&#46; However&#44; cryobiopsy is acquiring an important role in the ILD diagnostic process&#46; The objective of this study was to evaluate the diagnostic yield&#44; safety&#44; and economic costs of the systematic use of cryobiopsy in the assessment of patients with suspected ILD&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a retrospective observational study of patients who had undergone transbronchial cryobiopsy for the evaluation of ILD from January 2011 to January 2014&#46; The procedures were performed with a video bronchoscope using a cryoprobe for the collection of lung parenchyma specimens&#44; which were analyzed by pathologists&#46; Diagnostic yield&#44; complications&#44; and economic costs of this technique were analyzed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Criobiopsy specimens from a total of 33 patients were included&#46; A specific diagnosis was obtained in 26&#44; producing a diagnostic yield of 79&#37;&#46; In 5 patients&#44; SLB was required for a histopathological confirmation of disease&#44; but the procedure could not be performed in 4&#44; due to severe comorbidities&#46; The most frequent complications were pneumothorax &#40;12&#37;&#41; and grade <span class="elsevierStyleSmallCaps">I</span> &#40;9&#37;&#41; or grade <span class="elsevierStyleSmallCaps">II</span> &#40;21&#37;&#41; bleeding&#46; There were no life-threatening complications&#46; The systematic use of cryobiopsy saved up to &#8364;59&#46;846&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cryobiopsy is a safe and potentially useful technique in the diagnostic assessment of patients with ILD&#46; Furthermore&#44; the systematic use of cryobiopsy has an important economic impact&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En los pacientes con enfermedad pulmonar intersticial difusa &#40;EPID&#41; que presentan datos cl&#237;nicos y radiol&#243;gicos inconsistentes es recomendable la realizaci&#243;n de una biopsia pulmonar quir&#250;rgica &#40;BPQ&#41;&#46; La criobiopsia es una t&#233;cnica endosc&#243;pica reciente menos invasiva que la BPQ que podr&#237;a jugar un papel relevante en el diagn&#243;stico de las EPID&#46; El objetivo del presente estudio es analizar la rentabilidad diagn&#243;stica&#44; las complicaciones y los costes econ&#243;micos derivados del uso de la criobiopsia en el diagn&#243;stico de las EPID&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo en el que se incluyeron pacientes afectados de EPID tributarios de biopsia pulmonar&#44; a los que se les practicaron criobiopsias desde enero de 2011 a enero de 2014&#46; El procedimiento se realiz&#243; mediante videobroncoscopio&#44; bajo anestesia general y ventilaci&#243;n mec&#225;nica&#46; Se analiz&#243; la rentabilidad diagn&#243;stica&#44; las complicaciones producidas y los costes econ&#243;micos derivados de esta t&#233;cnica&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se analizaron las muestras de criobiopsia de un total de 33 pacientes&#46; Se obtuvo un diagn&#243;stico espec&#237;fico en 26&#44; lo que representa una rentabilidad diagn&#243;stica del 79&#37;&#46; Cinco pacientes hubieran requerido BPQ para confirmaci&#243;n histol&#243;gica&#44; aunque en 4 de ellos no pudo realizarse por presentar comorbilidades graves&#46; Las complicaciones m&#225;s frecuentes fueron el neumot&#243;rax &#40;12&#37;&#41; y el sangrado moderado &#40;21&#37;&#41;&#46; No hubo complicaciones graves&#46; Considerando que a los pacientes con diagn&#243;stico espec&#237;fico se les evit&#243; una BPQ&#44; la criobiopsia represent&#243; un ahorro econ&#243;mico estimado de hasta 59&#46;846<span class="elsevierStyleHsp" style=""></span>&#8364;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La criobiopsia es una t&#233;cnica segura y potencialmente &#250;til en el diagn&#243;stico de las EPID que permite&#44; adem&#225;s&#44; un ahorro econ&#243;mico considerable&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Hern&#225;ndez-Gonz&#225;lez F&#44; Lucena CM&#44; Ram&#237;rez J&#44; S&#225;nchez M&#44; Jimenez MJ&#44; Xaubet A&#44; et al&#46; Utilidad de la criobiopsia en el diagn&#243;stico de la enfermedad pulmonar intersticial difusa&#58; an&#225;lisis de rentabilidad y coste&#46; Arch Bronconeumol&#46; 2015&#59;51&#58;261-267&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Optical microscopy image of a lung biopsy histological section&#44; showing&#58; &#40;A&#41; good conservation of the alveolar structures of the specimen&#44; as well as the presence of predominantly lymphocytic inflammatory infiltrate located in the interstitium &#40;hematoxylin-eosin&#44; 40&#215;&#41;&#46; &#40;B&#41; The immunohistochemical study shows the presence of T lymphocytes &#40;CD3 labeling&#59; 100&#215;&#41; and &#40;C&#41; B lymphocytes &#40;CD20 labeling&#44; 100&#215;&#41;&#46; The patient was diagnosed with lymphocytic interstitial pneumonia&#44; with no evidence of lymphoma&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Final diagnoses made by the multidisciplinary committee based on the radiological images&#44; classified according to ATS&#47;ERS guidelines for idiopathic pulmonary fibrosis into usual interstitial pneumonia &#40;UIP&#41;&#44; possible UIP and inconsistent with UIP&#44; and histopathological results of the cryobiopsy specimens&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Hist&#44; histopathology&#59; MCD&#44; multidisciplinary committee diagnosis&#59; SAD&#44; systemic autoimmune disease&#59; ILD&#44; interstitial lung disease&#59; IPF&#44; idiopathic pulmonary fibrosis&#59; LAM&#44; lymphangioleiomyomatosis&#59; HP&#44; hypersensitivity pneumonitis&#59; LIP&#44; lymphocytic interstitial pneumonia&#59; NSIP&#44; nonspecific interstitial pneumonia&#59; UIP&#44; usual interstitial pneumonia&#59; OP&#44; organized pneumonia&#59; HRCT&#44; high-resolution computed tomography&#46; &#42;Based on radiological images&#44; the suspected diagnosis was OP&#46; &#42;&#42;The final diagnosis of peribronchiolar metaplasia was made by SLB&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Idiopathic pulmonary fibrosis diagnostic algorithm proposed after systematic use of cryobiopsy before performing surgical lung biopsy&#46;</p>"
        ]
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      3 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">DLCO&#44; carbon monoxide diffusing capacity&#59; FEV<span class="elsevierStyleInf">1</span>&#44; forced expiratory volume in the first second&#59; FVC&#44; forced vital capacity&#59; PH&#44; pulmonary hypertension&#59; BMI&#44; body mass index&#59; LFT&#44; lung function tests&#59; TLC&#44; total lung capacity&#59; AV&#44; alveolar volume&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; &#40;&#37;&#41; or mean &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64 &#40;30&#8211;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Smoking habits</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Never&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Former smoker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Active smoker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">BMI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;22&#8211;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">LFT pre-intervention &#40;&#37; reference&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FVC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69 &#40;43&#8211;103&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73 &#40;49&#8211;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#47;FVC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;66&#8211;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>TLC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73 &#40;49&#8211;102&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>DLCO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;23&#8211;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>DLCO&#47;AV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72 &#40;41&#8211;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Home oxygen therapy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Pre-intervention PH</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Characteristics of Patients Undergoing Lung Cryobiopsy&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">RLL&#44; right lower lobe&#59; LLL&#44; left lower lobe&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Location of the biopsy</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>RLL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LLL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LLL and RLL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LLL and lingula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Number of samples &#40;median&#44; range&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;7 &#40;0&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Complications</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild bleeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate bleeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
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            0 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An official ATS&#47;ERS&#47;JRS&#47;ALAT statement&#58; idiopathic pulmonary fibrosis&#58; evidence-based guidelines for diagnosis and management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Raghu"
                            1 => "H&#46;R&#46; Collard"
                            2 => "J&#46;J&#46; Egan"
                            3 => "F&#46;J&#46; Martinez"
                            4 => "J&#46; Behr"
                            5 => "K&#46;K&#46; Brown"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1164/rccm.2009-040GL"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2011"
                        "volumen" => "183"
                        "paginaInicial" => "788"
                        "paginaFinal" => "824"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21471066"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the diagnosis and treatment of idiopathic pulmonary fibrosis&#46; Sociedad Espanola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica &#40;SEPAR&#41; Research Group on Diffuse Pulmonary Diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Xaubet"
                            1 => "J&#46; Ancochea"
                            2 => "E&#46; Bollo"
                            3 => "E&#46; Fernandez-Fabrellas"
                            4 => "T&#46; Franquet"
                            5 => "M&#46; Molina-Molina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2013.03.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2013"
                        "volumen" => "49"
                        "paginaInicial" => "343"
                        "paginaFinal" => "353"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23742884"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An official American Thoracic Society&#47;European Respiratory Society statement&#58; update of the international multidisciplinary classification of the idiopathic interstitial pneumonias"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46;D&#46; Travis"
                            1 => "U&#46; Costabel"
                            2 => "D&#46;M&#46; Hansell"
                            3 => "T&#46;E&#46; King Jr&#46;"
                            4 => "D&#46;A&#46; Lynch"
                            5 => "A&#46;G&#46; Nicholson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201308-1483ST"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2013"
                        "volumen" => "188"
                        "paginaInicial" => "733"
                        "paginaFinal" => "748"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24032382"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis of idiopathic pulmonary fibrosis with high-resolution CT"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;A&#46; Johannson"
                            1 => "K&#46; de Boer"
                            2 => "P&#46;J&#46; Wolters"
                            3 => "J&#46;A&#46; Golden"
                            4 => "J&#46;S&#46; Lee"
                            5 => "H&#46;R&#46; Collard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2213-2600(14)70075-X"
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet Respir Med"
                        "fecha" => "2014"
                        "volumen" => "2"
                        "paginaInicial" => "e5"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24815808"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Future directions in idiopathic pulmonary fibrosis research an NHLBI workshop report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46;S&#46; Blackwell"
                            1 => "A&#46;M&#46; Tager"
                            2 => "Z&#46; Borok"
                            3 => "B&#46;B&#46; Moore"
                            4 => "D&#46;A&#46; Schwartz"
                            5 => "K&#46;J&#46; Anstrom"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201306-1141WS"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2014"
                        "volumen" => "189"
                        "paginaInicial" => "214"
                        "paginaFinal" => "222"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24160862"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic pulmonary fibrosis&#58; clinical relevance of pathologic classification"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;L&#46; Katzenstein"
                            1 => "J&#46;L&#46; Myers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.157.4.9707039"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1998"
                        "volumen" => "157"
                        "paginaInicial" => "1301"
                        "paginaFinal" => "1315"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9563754"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fibrosing interstitial lung disease&#46; A practical high-resolution computed tomography-based approach to diagnosis and management and a review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;A&#46; Hodnett"
                            1 => "D&#46;P&#46; Naidich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201208-1544CI"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med&#46;"
                        "fecha" => "2013"
                        "volumen" => "188"
                        "paginaInicial" => "141"
                        "paginaFinal" => "149"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23672718"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role for transbronchial biopsy in the diagnosis of usual interstitial pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;F&#46; Shorr"
                            1 => "C&#46;J&#46; Lettieri"
                            2 => "D&#46;L&#46; Helman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.06-1266"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2007"
                        "volumen" => "131"
                        "paginaInicial" => "329"
                        "paginaFinal" => "330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17218598"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial biopsy and usual interstitial pneumonia&#58; a step backward in disease management&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Mukherjee"
                            1 => "M&#46; Spiteri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2006"
                        "volumen" => "130"
                        "paginaInicial" => "1628"
                        "paginaFinal" => "1629"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17099054"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial biopsy and usual interstitial pneumonia&#58; a new paradigm&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Churg"
                            1 => "M&#46; Schwarz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.129.5.1117"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2006"
                        "volumen" => "129"
                        "paginaInicial" => "1117"
                        "paginaFinal" => "1118"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16684996"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Histopathologic findings of transbronchial biopsy in usual interstitial pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46;S&#46; Shim"
                            1 => "M&#46;S&#46; Park"
                            2 => "I&#46;K&#46; Park"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1440-1827.2010.02528.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pathol Int"
                        "fecha" => "2010"
                        "volumen" => "60"
                        "paginaInicial" => "373"
                        "paginaFinal" => "377"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20518887"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial lung biopsy and bronchoalveolar lavage in diagnosis of diffuse infiltrative lung diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "V&#46; Poletti"
                            1 => "M&#46; Patelli"
                            2 => "S&#46; Poggi"
                            3 => "T&#46; Bertanti"
                            4 => "L&#46; Spiga"
                            5 => "R&#46; Ferracini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Respiration"
                        "fecha" => "1988"
                        "volumen" => "54"
                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "66"
                        "paginaFinal" => "72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3231906"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0230"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The value of transbronchial lung biopsy using jumbo forceps via rigid bronchoscope in diffuse lung disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;L&#46; Casoni"
                            1 => "C&#46; Gurioli"
                            2 => "P&#46;N&#46; Chhajed"
                            3 => "M&#46; Chilosi"
                            4 => "M&#46; Zompatori"
                            5 => "D&#46; Olivieri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4081/monaldi.2008.397"
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                        "tituloSerie" => "Monaldi Arch Chest Dis"
                        "fecha" => "2008"
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                        "paginaInicial" => "59"
                        "paginaFinal" => "64"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18837418"
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                    0 => array:2 [
                      "titulo" => "Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease&#46; A randomized trial"
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                          "etal" => true
                          "autores" => array:6 [
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                            4 => "M&#46;A&#46; Montero"
                            5 => "D&#46; Ramos-Barbon"
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                    0 => array:2 [
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                      "titulo" => "Transbronchial cryobiopsy in the diagnosis of interstitial lung disease&#58; a cool new approach"
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                          "etal" => false
                          "autores" => array:2 [
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                        "paginaFinal" => "624"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24862354"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial cryobiopsy&#58; a new tool for lung biopsies"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Babiak"
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                            2 => "G&#46; Krishna"
                            3 => "P&#46; Fritz"
                            4 => "P&#46; Moeller"
                            5 => "T&#46; Balli"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1159/000203987"
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                        "tituloSerie" => "Respiration"
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                        "volumen" => "78"
                        "paginaInicial" => "203"
                        "paginaFinal" => "208"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19246874"
                            "web" => "Medline"
                          ]
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                      ]
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                ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Cryobiopsy&#58; should this be used in place of endobronchial forceps biopsies&#63;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            1 => "S&#46;R&#46; Ie"
                            2 => "R&#46;E&#46; Whatley"
                            3 => "M&#46;B&#46; Boyd"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Biomed Res Int"
                        "fecha" => "2013"
                        "volumen" => "2013"
                        "paginaInicial" => "730574"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24066296"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0255"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bronchoscopic cryobiopsy for the diagnosis of diffuse parenchymal lung disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Kropski"
                            1 => "J&#46;M&#46; Pritchett"
                            2 => "W&#46;R&#46; Mason"
                            3 => "L&#46; Sivarajan"
                            4 => "L&#46;A&#46; Gleaves"
                            5 => "J&#46;E&#46; Johnson"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0078674"
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                        "tituloSerie" => "PLOS ONE"
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                        "volumen" => "8"
                        "paginaInicial" => "e78674"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24265706"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0260"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;L&#46; Casoni"
                            1 => "S&#46; Tomassetti"
                            2 => "A&#46; Cavazza"
                            3 => "T&#46;V&#46; Colby"
                            4 => "A&#46; Dubini"
                            5 => "J&#46;H&#46; Ryu"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0086716"
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                        "tituloSerie" => "PLOS ONE"
                        "fecha" => "2014"
                        "volumen" => "9"
                        "paginaInicial" => "e86716"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24586252"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial lung biopsy using cryoprobes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "V&#46; Pajares"
                            1 => "A&#46; Torrego"
                            2 => "C&#46; Puzo"
                            3 => "E&#46; Lerma"
                            4 => "M&#46;A&#46; Gil de Bernabe"
                            5 => "T&#46; Franquet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2009.09.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2010"
                        "volumen" => "46"
                        "paginaInicial" => "111"
                        "paginaFinal" => "115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19939546"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0270"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Outpatient thoracic surgical programme in 300 patients&#58; clinical results and economic impact"
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                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Molins"
                            1 => "J&#46;J&#46; Fibla"
                            2 => "J&#46; Perez"
                            3 => "A&#46; Sierra"
                            4 => "G&#46; Vidal"
                            5 => "C&#46; Simon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejcts.2005.12.003"
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                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2006"
                        "volumen" => "29"
                        "paginaInicial" => "271"
                        "paginaFinal" => "275"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16427300"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost-effectiveness analysis of transbronchial needle aspiration of pulmonary lesions without endobronchial affectation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "V&#46; Leiro Fernandez"
                            1 => "M&#46; Botana Rial"
                            2 => "C&#46; Represas Represas"
                            3 => "A&#46; Gonzalez Pineiro"
                            4 => "V&#46; Del Campo Perez"
                            5 => "A&#46; Fernandez-Villar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2012.07.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2012"
                        "volumen" => "48"
                        "paginaInicial" => "448"
                        "paginaFinal" => "452"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22974766"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0280"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inter-observer variation between pathologists in diffuse parenchymal lung disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;G&#46; Nicholson"
                            1 => "B&#46;J&#46; Addis"
                            2 => "H&#46; Bharucha"
                            3 => "C&#46;A&#46; Clelland"
                            4 => "B&#46; Corrin"
                            5 => "A&#46;R&#46; Gibbs"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2004"
                        "volumen" => "59"
                        "paginaInicial" => "500"
                        "paginaFinal" => "505"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15170033"
                            "web" => "Medline"
                          ]
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                      ]
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                ]
              ]
            ]
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              "etiqueta" => "24"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nonspecific interstitial pneumonia and the other idiopathic interstitial pneumonias&#58; classification and diagnostic criteria"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
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                            1 => "J&#46;L&#46; Myers"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Surg Pathol"
                        "fecha" => "2000"
                        "volumen" => "24"
                        "paginaInicial" => "1"
                        "paginaFinal" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10632482"
                            "web" => "Medline"
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0290"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "VATS lung biopsy in suspected&#44; diffuse interstitial lung disease provides diagnosis&#44; and alters management strategies"
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                          "etal" => false
                          "autores" => array:4 [
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                            2 => "J&#46; Ferguson"
                            3 => "A&#46;J&#46; Ritchie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.hlc.2005.01.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Heart Lung Circ"
                        "fecha" => "2005"
                        "volumen" => "14"
                        "paginaInicial" => "90"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16352261"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Video-assisted thoracoscopic lobectomy is less costly and morbid than open lobectomy&#58; a retrospective multiinstitutional database analysis"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "B&#46;F&#46; Meyers"
                            2 => "C&#46;L&#46; Gunnarsson"
                            3 => "M&#46; Moore"
                            4 => "J&#46;A&#46; Howington"
                            5 => "M&#46;A&#46; Maddaus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2011.06.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2012"
                        "volumen" => "93"
                        "paginaInicial" => "1027"
                        "paginaFinal" => "1032"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22130269"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0300"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of thoracoscopy in the diagnosis of interstitial lung disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;J&#46; Krasna"
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                            2 => "S&#46;C&#46; Aisner"
                            3 => "P&#46;A&#46; Templeton"
                            4 => "J&#46;S&#46; McLaughlin"
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                        ]
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                    0 => array:1 [
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                        "tituloSerie" => "Ann&#46; Thorac&#46; Surg&#46;"
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                        "volumen" => "59"
                        "paginaInicial" => "348"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7847948"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "28"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "A randomized&#44; controlled trial comparing thoracoscopy and limited thoracotomy for lung biopsy in interstitial lung disease"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;D&#46; Miller"
                            1 => "J&#46;D&#46; Urschel"
                            2 => "G&#46; Cox"
                            3 => "J&#46; Olak"
                            4 => "J&#46;E&#46; Young"
                            5 => "J&#46;M&#46; Kay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann&#46; Thorac&#46; Surg&#46;"
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                        "volumen" => "70"
                        "paginaInicial" => "1647"
                        "paginaFinal" => "1650"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11093503"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0310"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of video thoracoscopic lung biopsy to open lung biopsy in the diagnosis of interstitial lung disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            2 => "B&#46;J&#46; Waring"
                            3 => "J&#46;S&#46; Simon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1993"
                        "volumen" => "103"
                        "paginaInicial" => "765"
                        "paginaFinal" => "770"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8449066"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0315"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Experimental study on biopsy sampling using new flexible cryoprobes&#58; Influence of activation time&#44; probe size&#44; tissue consistency&#44; and contact pressure of the probe on the size of the biopsy specimen"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;J&#46; Franke"
                            1 => "M&#46; Szyrach"
                            2 => "G&#46; Nilius"
                            3 => "J&#46; Hetzel"
                            4 => "M&#46; Hetzel"
                            5 => "K&#46;H&#46; Ruehle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00408-009-9156-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lung"
                        "fecha" => "2009"
                        "volumen" => "187"
                        "paginaInicial" => "253"
                        "paginaFinal" => "259"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19548030"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial biopsy in usual interstitial pneumonia"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46;A&#46; Berbescu"
                            1 => "A&#46;L&#46; Katzenstein"
                            2 => "J&#46;L&#46; Snow"
                            3 => "D&#46;A&#46; Zisman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.129.5.1126"
                      "Revista" => array:6 [
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Original Article
Cryobiopsy in the Diagnosis of Diffuse Interstitial Lung Disease: Yield and Cost-Effectiveness Analysis
Utilidad de la criobiopsia en el diagnóstico de la enfermedad pulmonar intersticial difusa: análisis de rentabilidad y coste
Fernanda Hernández-Gonzáleza, Carmen M. Lucenaa, José Ramírezb, Marcelo Sánchezc, María José Jimenezd, Antoni Xaubeta, Jacobo Sellaresa,
Corresponding author
sellares@clinic.ub.es

Corresponding author.
, Carlos Agustía
a Servicio de Neumología y Alergia Respiratoria, Institut del Tòrax, Hospital Clínic, Barcelona, Spain
b Servicio de Anatomía Patológica, Hospital Clínic, Barcelona, Spain
c Servicio de Radiodiagnóstico, Hospital Clínic, Barcelona, Spain
d Servicio de Anestesia y Reanimación, Hospital Clínic, Barcelona, Spain
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        "titulo" => "Utilidad de la criobiopsia en el diagn&#243;stico de la enfermedad pulmonar intersticial difusa&#58; an&#225;lisis de rentabilidad y coste"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Optical microscopy image of a lung biopsy histological section&#44; showing&#58; &#40;A&#41; good conservation of the alveolar structures of the specimen&#44; as well as the presence of predominantly lymphocytic inflammatory infiltrate located in the interstitium &#40;hematoxylin-eosin&#44; 40&#215;&#41;&#46; &#40;B&#41; The immunohistochemical study shows the presence of T lymphocytes &#40;CD3 labeling&#59; 100&#215;&#41; and &#40;C&#41; B lymphocytes &#40;CD20 labeling&#44; 100&#215;&#41;&#46; The patient was diagnosed with lymphocytic interstitial pneumonia&#44; with no evidence of lymphoma&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The differential diagnosis of diffuse interstitial lung diseases &#40;ILD&#41; is a complex process&#44; often requiring a multidisciplinary team and lung parenchyma sample collection using various diagnostic techniques&#46; Idiopathic pulmonary fibrosis &#40;IPF&#41; is the most common disease within this group&#44; and has the poorest prognosis<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">1&#8211;3</span></a>&#59; whereas differential diagnosis with other ILDs presents a major challenge&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">International consensus guidelines for the diagnosis and treatment of ILD<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">1&#44;2</span></a> indicate that in approximately 50&#37; of cases&#44; chest high-resolution computed tomography &#40;HRCT&#41; is sufficient to diagnose IPF in the correct clinical context&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">4&#44;5</span></a> In the remaining patients&#44; radiological criteria are inconclusive&#44; and surgical lung biopsy &#40;SLB&#41; is recommended in order to distinguish usual interstitial pneumonia &#40;UIP&#41; from other ILDs&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">6&#44;7</span></a> Transbronchial biopsy &#40;TBB&#41; via fiberoptic bronchoscopy &#40;FBS&#41; can provide diagnosis in some cases of ILD&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">8&#8211;11</span></a> This technique&#44; however&#44; has been dismissed in clinical guidelines<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">1&#8211;3</span></a> because the frequently patchy nature of ILDs&#44; small size of specimens obtained and poor preservation means that the diagnostic yield of TBB is at times less than 30&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Recent studies have shown that&#44; unlike conventional TBB&#44; TBB using a cryoprobe &#40;also known as cryobiopsy&#41; is a viable technique for obtaining lung parenchyma samples with a higher diagnostic yield and relatively few complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">14&#44;15</span></a> It differs from conventional TBB in that samples for histological analysis are larger and better preserved&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">16&#8211;19</span></a> Furthermore&#44; unlike SLB&#44; it does not require an operating theater and can be performed on an outpatient basis&#46; The role of cryobiopsy in the diagnostic algorithm of IPF and differential diagnosis with other ILDs is unclear&#44; and its potential benefits have not been specifically determined in a cost&#8211;benefit analysis&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The main aim of this study was to analyze the diagnostic yield of cryobiopsy in the differential diagnosis of ILDs&#46; As a secondary objective&#44; we analyzed the complications and economic costs derived from the systematic application of cryobiopsy in ILDs&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a retrospective observational study that analyzed the results of lung cryobiopsies performed in the Respiratory Endoscopy Unit of a tertiary hospital between January 2011 and January 2014&#46; Patients had been previously assessed by an ILD multidisciplinary committee&#44; where all cases referred from the different hospital departments&#44; outpatients&#44; and district primary care clinics were evaluated&#46; Clinical decisions were taken by consensus among the members of the multidisciplinary team&#44; which was composed of pulmonologists&#44; thoracic surgeons&#44; radiologists&#44; and specialists in systemic and pathological autoimmune diseases&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients with an ILD pattern on HRCT defined as &#8220;possible UIP&#8221; or &#8220;inconsistent with UIP&#8221;&#44; in whom histological confirmation would be required &#40;in accordance with ATS&#47;ERS guidelines<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a>&#41; were included&#46; The specific lobe where the cryobiopsy was performed was determined following the radiologists&#8217; recommendations&#44; based on ATS&#47;ERS<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a> criteria for surgical lung biopsy&#46; In summary&#44; lung biopsy should cover a wide spectrum of lung disease&#44; including honeycomb foci&#44; as this finding is a criterion for UIP&#46; However&#44; if there are signs of very severe fibrosis with gross honeycombing&#44; the biopsy should be taken from less affected honeycomb areas&#44; as non-specific changes are usually found in the most affected areas&#46; If the lung does not show any signs of fibrosis or honeycombing&#44; the sample should be taken from radiologically abnormal areas&#46; Following this protocol&#44; biopsies were taken in all cases from different sub-segments of the target lobe and&#44; when possible&#44; from various lobes&#46; All patients had a complete blood count with coagulation study&#44; echocardiography and lung function study that included forced spirometry&#44; determination of lung volumes and carbon monoxide diffusing capacity&#46; SLB was proposed in patients in whom the cryobiopsies were not diagnostic&#46; All patients signed a specific informed consent for cryobiopsies&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedure</span><p id="par0035" class="elsevierStylePara elsevierViewall">The cryobiopsies were performed in an examination room equipped with hemodynamic monitoring equipment&#44; a ventilator and mechanical radioscopy arm&#46; The procedure was carried out under general anesthetic with propofol &#40;3&#8211;6<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;h&#41; and remifentanil &#40;0&#46;05&#8211;0&#46;1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;h&#41; infusion&#46; Patients were intubated with a flexible&#44; cuffed tube &#40;7&#46;5<span class="elsevierStyleHsp" style=""></span>mm Bronchoflex&#44; R&#252;sch&#44; Teleflex Medical&#44; Durham&#44; NC&#44; US&#41;&#46; This tube has a side channel that allows the introduction of a Fogarty&#8482; occlusion balloon catheter &#40;4F&#47;5F&#47;6F&#59; Edwards Lifesciences Corporation&#8482;&#44; Irvine&#44; CA&#44; US&#41;&#44; which was placed at the entry of the lobe to be biopsied and inflated immediately after performing the cryobiopsy to stem any possible bleeding from the target airway&#46; An EB-1970K video bronchoscope &#40;outer diameter&#58; 6&#46;2<span class="elsevierStyleHsp" style=""></span>mm&#44; diameter of working channel&#58; 2&#46;8<span class="elsevierStyleHsp" style=""></span>mm&#59; Pentax Medical&#44; US&#41; was used&#46; After examining the bronchial tree&#44; bronchoalveolar lavage was carried out in the area selected by HRCT imaging in patients in whom it had not previously been performed&#46; TBB was then performed on the selected segments using a 1&#46;9<span class="elsevierStyleHsp" style=""></span>mm cryoprobe &#40;Erbokryo CA&#44; Erbe&#44; Germany&#41; under fluoroscopic guidance&#46; The cryoprobe was introduced through the working channel of the bronchoscope and&#44; once the correct position had been confirmed by fluoroscopy&#44; the cryoprobe pedal was activated for 3&#8211;4<span class="elsevierStyleHsp" style=""></span>s&#46; The probe was then withdrawn&#44; together with the bronchoscope&#44; with the specimen adhered to the tip of the cryoprobe&#46; At least 3 samples were taken&#44; although the total number of biopsies depended on their size&#44; the patient&#39;s tolerance and possible complications&#46; After the procedure had been completed and the patient ex-tubated&#44; a post-procedure chest X-ray was performed&#46; Any complications observed were recorded&#44; particularly bleeding and pneumothorax&#46; Pulmonary bleeding was classified according to its severity as&#58; grade I&#58; mild bleeding which does not require endoscopic intervention&#59; grade II&#58; moderate bleeding which stops within 3<span class="elsevierStyleHsp" style=""></span>min after endoscopic intervention &#40;bronchial occlusion and&#47;or instillation of cold serum&#41;&#44; and grade III&#58; severe bleeding that cannot be controlled endoscopically&#44; causing hemodynamic or respiratory instability&#44; and making it necessary to halt the procedure&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Histological Evaluation</span><p id="par0040" class="elsevierStylePara elsevierViewall">The specimens were fixed in 4&#37; formaldehyde and sent to the histopathology laboratory&#44; where they were measured before being embedded in paraffin&#46; Each sample was embedded in a separate block and stained with hematoxylin&#8211;eosin and Masson&#39;s trichrome stain&#46; The specimens were evaluated by a pathologist from the multidisciplinary team with experience in respiratory disease pathology&#46; The sample was not considered diagnostic when the findings did not allow a specific diagnosis to be made&#46; Samples with insufficient alveoli for analysis were considered invalid&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Evaluation in the Multidisciplinary Committee</span><p id="par0045" class="elsevierStylePara elsevierViewall">The clinical&#44; radiological&#44; and histopathological parameters were reviewed by specialists who regularly participated in our hospital&#39;s ILD multidisciplinary committee&#46; A sample was considered to be diagnostic when the histopathological findings enabled the specific diagnosis of the particular disease&#46; Once the histopathological report had been obtained&#44; the members of the multidisciplinary committee established the definitive diagnosis of the patient&#39;s interstitial disease based on the report and the patient&#39;s clinical and radiological characteristics&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Economic Analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">For the economic analysis&#44; the cost of the different diagnostic processes was calculated in euros&#46; We used data based on the Catalonian Government taxes and public prices Act approved by Legislative Decree 33&#47;2008 of 25 June and Act 26&#47;2010 of 3 August&#44; and data reported by other authors in the same setting&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">21&#44;22</span></a> The final cost per process was calculated by totaling the cost of the different procedures required to reach the definitive diagnosis&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical Analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">The results of the quantitative variables were expressed as mean&#177;standard deviation&#46; Percentages and absolute frequencies were used for the qualitative variables&#46; Statistical data analysis was performed using the SPSS statistics package version 17&#46;0 for Windows<span class="elsevierStyleSup">&#174;</span> &#40;SPSS&#44; Chicago&#44; IL&#44; US&#41;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Diagnostic Yield and Safety of the Procedure</span><p id="par0060" class="elsevierStylePara elsevierViewall">During the study period&#44; 33 patients underwent lung cryobiopsy for confirmation of ILD&#46; Their general characteristics are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The location of the biopsies&#44; number of samples obtained&#44; and complications observed are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The bronchoalveolar lavages were performed in the middle lobe or lingula to avoid technical difficulties in performing the cryobiopsy&#46; More than one lung lobe was biopsied in 2 patients&#46; In the remaining 31 patients&#44; the biopsies were carried out in various segments of the lower lobes&#46; A mean of 2&#46;7 biopsies were obtained per patient&#44; with a mean size of 0&#46;4<span class="elsevierStyleHsp" style=""></span>cm &#40;SD&#177;0&#46;17&#41;&#46; Biopsy specimens considered to be diagnostic were obtained in 26 patients &#40;79&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#59; the samples were considered non-diagnostic in 5 patients &#40;15&#37;&#41; and invalid in only 2 patients &#40;6&#37;&#41;&#46; There were no significant differences in the size of the diagnostic and non-diagnostic specimens &#40;0&#46;5&#177;0&#46;19<span class="elsevierStyleHsp" style=""></span>cm and 0&#46;34&#177;0&#46;15<span class="elsevierStyleHsp" style=""></span>cm&#44; respectively&#41;&#46; In general&#44; no artifacts due to compression of the alveoli were found in the samples analyzed&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> summarizes the diagnostic orientation based on the HRCT images&#46; The definitive diagnoses were obtained from the histopathology of the cryobiopsy samples and the opinion of the multidisciplinary team&#46; Of the 5 patients with non-diagnostic specimens&#44; a diagnostic SLB &#40;peribronchiolar metaplasia&#41; was performed in only 1 case &#40;3&#37;&#41;&#46; Of the remaining 4 patients&#44; 2 cases were diagnosed with idiopathic NSIP&#44; mainly based on radiological criteria&#46; Given that these patients had severe comorbidities that contraindicated the intervention&#44; SLB was dismissed by the multidisciplinary team&#46; The other 2 cases had radiological images&#44; symptoms&#44; and histopathological findings suggestive of ILD&#44; but a more accurate diagnosis could not be reached&#44; so they were diagnosed with ILD of unknown origin&#46; Of the 2 patients with invalid samples&#44; one had radiological images suggestive of organized pneumonia&#46; Since SLB was also contraindicated due to severe comorbidities&#44; the patient was treated with oral corticosteroids&#44; with a good clinical and radiological response&#46; In the other case&#44; the radiological image and symptoms suggestive of ILD were mainly taken into account for the final diagnosis&#44; suggesting ILD of unknown origin&#46; In 1 patient&#44; despite images characteristic of UIP on the HRCT&#44; a cryobiopsy was performed due to clinical suspicion of hypersensitivity pneumonitis&#46; Cryobiopsies were performed in patients with ILD associated with a systemic autoimmune disease &#40;SAD&#41; due to the lack of criteria for a firm diagnosis of SAD&#46; These patients had lung disease at the outset and later presented extra-pulmonary symptoms&#44; thus fulfilling sufficient criteria for a diagnosis of systemic sclerosis&#46; As regards the safety of the technique&#44; 4 cases of pneumothorax &#40;12&#37;&#41; were identified&#59; 3 resolved spontaneously while 1 required a chest drain for 2 days&#44; after which the patient was discharged&#46; In total&#44; 9&#37; of patients had grade I bleeding&#44; and 21&#37; had grade II bleeding&#46; No cases of severe bleeding requiring suspension of the procedure were detected&#44; and no additional medical or surgical measures were needed to control bleeding&#46; Although 2 patients had mild pulmonary hypertension as comorbidity&#44; neither of them had complications&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Cost Analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">Following the method used by Leiro Fernandez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">22</span></a> and establishing the cost of FBS at &#8364;250&#46;45&#44; cryoprobe at &#8364;54 per case&#44; and histopathology analysis at &#8364;253&#46;69&#44; the total cost of the cryobiopsies performed was &#91;&#40;&#8364;250&#46;45&#43;&#8364;54&#43;&#8364;253&#46;69&#41;&#215;33&#93;&#61;&#8364;18&#44;426&#46;54&#44; giving a total cost of &#8364;304&#46;69 per patient&#46; In 26 of the 33 patients evaluated&#44; the cryobiopsy provided the definitive diagnosis of the disease and SLB was not needed&#46; The costs of this surgical technique in both the hospital and outpatient setting are summarized in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; In the case of the 3 patients who presented pneumothorax with spontaneous resolution&#44; the added cost was &#8364;1458&#46;30 &#40;&#8364;486&#46;10 per patient&#41;&#46; In the case of the patient who required a drainage tube to resolve the pneumothorax&#44; the added cost was &#8364;2229&#46;98&#46; Therefore&#44; the systematic use of lung cryobiopsy in the assessment of patients with suspected ILD reduced costs by &#8364;41&#44;506&#46;74&#8722;&#40;&#8364;10&#44;054&#46;77&#43;&#8364;3688&#46;28&#41;&#61;&#8364;27&#44;763&#46;69 in the case of SLB without admission&#59; &#8364;57&#44;548&#46;04&#8722;&#40;&#8364;10&#44;054&#46;77&#43;&#8364;3688&#46;28&#41;&#61;&#8364;43&#44;804&#46;99 in the case of 24-h hospital stay&#44; and &#8364;73&#44;589&#46;34&#8722;&#40;&#8364;10&#44;054&#46;77&#43;&#8364;3688&#46;28&#41;&#61;&#8364;59&#44;846&#46;29 if hospital stay was extended to 48<span class="elsevierStyleHsp" style=""></span>h&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">This study shows that specimens obtained with cryobiopsy are of sufficient quality for specific diagnosis in most cases of suspected ILD when histological findings are combined with clinical&#44; radiological&#44; and laboratory data&#46; Furthermore&#44; this technique was shown to be safe and much less costly than SLB&#44; and could be an alternative to consider in the diagnostic management of these patients&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">It has been estimated that approximately one third of patients with ILD will require lung biopsy&#44; although this will be performed in only 7&#46;5&#37;&#8211;12&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">3&#44;4&#44;15</span></a> highlighting the reticence of some patients and physicians to perform this procedure&#46; Moreover&#44; although suitable samples for histopathological study can be obtained with SLB&#44;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">23&#44;24</span></a> it is not without significant drawbacks&#44; such as the need for an operating theater and hospitalization in most cases&#44; limited availability&#44; and moderate morbidity and mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">25&#8211;29</span></a> The recent introduction of the flexible cryoprobe&#44; which thanks to the Joule&#8211;Thomson effect generates very low temperatures at its distal tip &#40;around &#8722;85<span class="elsevierStyleHsp" style=""></span>&#176;C&#41;&#44; enables larger&#44; better preserved TBB samples to be obtained than those taken with forceps&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">14&#44;30&#8211;33</span></a> In 2009&#44; Babiak et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">16</span></a> published the first report on the potential usefulness of cryobiopsy in diffuse lung diseases&#46; Although this study included a very heterogeneous group of patients&#44; and the primary objective was not to determine diagnostic yield&#44; the information provided by the cryobiopsy contributed substantially to the definitive diagnosis in a significant number of cases&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Casoni et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">19</span></a> evaluated 69 patients with undefined diffuse interstitial pneumonia&#44; and obtained a specific diagnosis in 76&#37; of cases&#46; Very recently&#44; Pajares et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> in a randomized study of 77 patients also showed that cryobiopsy obtained specific diagnoses in 74&#37; of patients with interstitial disease&#44; a significantly higher yield than the 34&#37; obtained using traditional TBB&#46; In our study&#44; diagnostic yield was 79&#37;&#44; very similar to that of Casoni et al&#46; and Pajares et al&#46;&#44; confirming the usefulness of cryobiopsy in this patient group&#46; Interestingly&#44; the diameter of the probe used in our study &#40;1&#46;9<span class="elsevierStyleHsp" style=""></span>mm&#41; was smaller than that reported by Casoni et al&#46; and Pajares et al&#46; &#40;2&#46;4<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Although there is experimental evidence that the size of the specimen depends&#44; among other variables&#44; on the diameter of the probe&#44; the fact remains that the number of specific diagnoses does not appear to differ greatly according to the size of probe&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">30</span></a> Furthermore&#44; the number of complications in our series was acceptable&#44; the most notable being pneumothorax in 12&#37; of cases&#44; with moderate bleeding in 20&#37;&#44; and a 48-h chest drain in only 1 patient&#46; The hemostatic effect of freezing the cryoprobe probably contributed to the low incidence of bleeding&#44; which in no case required specific intervention or interruption of the procedure&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Although there are no studies comparing the yield of cryobiopsy and SLB&#44; the former certainly appears to have advantages that make it worth considering in ILD diagnostic protocols &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; This study also highlights an additional advantage of cryobiopsies over SLB&#58; cost&#46; Systematic cryobiopsies could save between &#8364;31&#44;451&#46;97 &#40;&#8364;953&#46;09&#47;patient&#41;&#44; in the case of outpatient SLB&#44; and &#8364;59&#44;846&#46;29 &#40;&#8364;1925&#46;29&#47;patient&#41; in the case of SLB with 48-h admission&#44; which is often the case in our region&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">A series of limitations must be considered in order to correctly interpret the results&#46; Firstly&#44; this is a retrospective observational study with a relatively small number of patients from a single center&#46; Secondly&#44; the patients were probably at an early stage of the disease&#44; as evidenced by the respiratory function values&#46; The cryobiopsy yield in patients in more advanced stages of the disease may differ&#46; Thirdly&#44; specimen evaluation by pathologists with experience in lung pathology is probably essential for this diagnostic yield&#46; Finally&#44; the &#8220;patchy&#8221; nature of most ILDs could mean that more extensive sample analysis could change the diagnosis in some cases&#46; Furthermore&#44; technical difficulties in reaching the upper lobes could also interfere in the diagnosis&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In conclusion&#44; the use of cryobiopsy in the ILD diagnostic algorithm is a viable and safe alternative for obtaining specimens that enable a histopathological diagnosis to be made in many patients&#46; In experienced hands&#44; this technique would rule out SLB with its associated therapeutic implications in a great many cases&#44; and also significantly reduce costs&#46; Although there are still numerous aspects that must be standardized&#44; such as the size of the probe&#44; freezing time&#44; number of biopsies or their location&#44; the results obtained suggest that cryobiopsy should be considered in the diagnostic management of ILDs&#46; Prospective&#44; comparative&#44; randomized&#44; multicenter studies need to be carried out with a large series of well characterized patients and a common&#44; duly standardized protocol and methodology&#46; This would help define the role of this novel modality in the diagnosis of ILDs&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Funding</span><p id="par0100" class="elsevierStylePara elsevierViewall">This study has not received any type of funding&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Authors&#8217; Contributions</span><p id="par0105" class="elsevierStylePara elsevierViewall">Design and performance of the study&#58; FHG&#44; CL&#44; MS&#44; JR&#44; MJJ&#44; AX&#44; JS&#44; CA&#46; Data analysis&#58; FHG&#44; CL&#44; JS&#44; CA&#46; Contributions to the manuscript&#58; FHG&#44; CL&#44; MS&#44; JR&#44; MJJ&#44; AX&#44; JS&#44; CA&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of Interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests&#46;</p></span></span>"
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          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Background"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
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            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
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            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
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        1 => array:2 [
          "identificador" => "xpalclavsec537542"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres516624"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec537543"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Patients"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Procedure"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Histological Evaluation"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Evaluation in the Multidisciplinary Committee"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Economic Analysis"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Statistical Analysis"
            ]
          ]
        ]
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          "identificador" => "sec0045"
          "titulo" => "Results"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Diagnostic Yield and Safety of the Procedure"
            ]
            1 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Cost Analysis"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Funding"
        ]
        9 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Authors&#8217; Contributions"
        ]
        10 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Conflict of Interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-06-30"
    "fechaAceptado" => "2014-09-22"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec537542"
          "palabras" => array:3 [
            0 => "Transbronchial lung biopsy"
            1 => "Cryobiopsy"
            2 => "Interstitial lung disease"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec537543"
          "palabras" => array:3 [
            0 => "Biopsia pulmonar transbronquial"
            1 => "Criobiopsia"
            2 => "Enfermedad pulmonar intersticial difusa"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Assessment of patients with suspected interstitial lung disease &#40;ILD&#41; includes surgical lung biopsy &#40;SLB&#41; when clinical and radiological data are inconclusive&#46; However&#44; cryobiopsy is acquiring an important role in the ILD diagnostic process&#46; The objective of this study was to evaluate the diagnostic yield&#44; safety&#44; and economic costs of the systematic use of cryobiopsy in the assessment of patients with suspected ILD&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a retrospective observational study of patients who had undergone transbronchial cryobiopsy for the evaluation of ILD from January 2011 to January 2014&#46; The procedures were performed with a video bronchoscope using a cryoprobe for the collection of lung parenchyma specimens&#44; which were analyzed by pathologists&#46; Diagnostic yield&#44; complications&#44; and economic costs of this technique were analyzed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Criobiopsy specimens from a total of 33 patients were included&#46; A specific diagnosis was obtained in 26&#44; producing a diagnostic yield of 79&#37;&#46; In 5 patients&#44; SLB was required for a histopathological confirmation of disease&#44; but the procedure could not be performed in 4&#44; due to severe comorbidities&#46; The most frequent complications were pneumothorax &#40;12&#37;&#41; and grade <span class="elsevierStyleSmallCaps">I</span> &#40;9&#37;&#41; or grade <span class="elsevierStyleSmallCaps">II</span> &#40;21&#37;&#41; bleeding&#46; There were no life-threatening complications&#46; The systematic use of cryobiopsy saved up to &#8364;59&#46;846&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cryobiopsy is a safe and potentially useful technique in the diagnostic assessment of patients with ILD&#46; Furthermore&#44; the systematic use of cryobiopsy has an important economic impact&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En los pacientes con enfermedad pulmonar intersticial difusa &#40;EPID&#41; que presentan datos cl&#237;nicos y radiol&#243;gicos inconsistentes es recomendable la realizaci&#243;n de una biopsia pulmonar quir&#250;rgica &#40;BPQ&#41;&#46; La criobiopsia es una t&#233;cnica endosc&#243;pica reciente menos invasiva que la BPQ que podr&#237;a jugar un papel relevante en el diagn&#243;stico de las EPID&#46; El objetivo del presente estudio es analizar la rentabilidad diagn&#243;stica&#44; las complicaciones y los costes econ&#243;micos derivados del uso de la criobiopsia en el diagn&#243;stico de las EPID&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo en el que se incluyeron pacientes afectados de EPID tributarios de biopsia pulmonar&#44; a los que se les practicaron criobiopsias desde enero de 2011 a enero de 2014&#46; El procedimiento se realiz&#243; mediante videobroncoscopio&#44; bajo anestesia general y ventilaci&#243;n mec&#225;nica&#46; Se analiz&#243; la rentabilidad diagn&#243;stica&#44; las complicaciones producidas y los costes econ&#243;micos derivados de esta t&#233;cnica&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se analizaron las muestras de criobiopsia de un total de 33 pacientes&#46; Se obtuvo un diagn&#243;stico espec&#237;fico en 26&#44; lo que representa una rentabilidad diagn&#243;stica del 79&#37;&#46; Cinco pacientes hubieran requerido BPQ para confirmaci&#243;n histol&#243;gica&#44; aunque en 4 de ellos no pudo realizarse por presentar comorbilidades graves&#46; Las complicaciones m&#225;s frecuentes fueron el neumot&#243;rax &#40;12&#37;&#41; y el sangrado moderado &#40;21&#37;&#41;&#46; No hubo complicaciones graves&#46; Considerando que a los pacientes con diagn&#243;stico espec&#237;fico se les evit&#243; una BPQ&#44; la criobiopsia represent&#243; un ahorro econ&#243;mico estimado de hasta 59&#46;846<span class="elsevierStyleHsp" style=""></span>&#8364;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La criobiopsia es una t&#233;cnica segura y potencialmente &#250;til en el diagn&#243;stico de las EPID que permite&#44; adem&#225;s&#44; un ahorro econ&#243;mico considerable&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
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          1 => array:2 [
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            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Hern&#225;ndez-Gonz&#225;lez F&#44; Lucena CM&#44; Ram&#237;rez J&#44; S&#225;nchez M&#44; Jimenez MJ&#44; Xaubet A&#44; et al&#46; Utilidad de la criobiopsia en el diagn&#243;stico de la enfermedad pulmonar intersticial difusa&#58; an&#225;lisis de rentabilidad y coste&#46; Arch Bronconeumol&#46; 2015&#59;51&#58;261-267&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Optical microscopy image of a lung biopsy histological section&#44; showing&#58; &#40;A&#41; good conservation of the alveolar structures of the specimen&#44; as well as the presence of predominantly lymphocytic inflammatory infiltrate located in the interstitium &#40;hematoxylin-eosin&#44; 40&#215;&#41;&#46; &#40;B&#41; The immunohistochemical study shows the presence of T lymphocytes &#40;CD3 labeling&#59; 100&#215;&#41; and &#40;C&#41; B lymphocytes &#40;CD20 labeling&#44; 100&#215;&#41;&#46; The patient was diagnosed with lymphocytic interstitial pneumonia&#44; with no evidence of lymphoma&#46;</p>"
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      1 => array:7 [
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        "etiqueta" => "Fig&#46; 2"
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Final diagnoses made by the multidisciplinary committee based on the radiological images&#44; classified according to ATS&#47;ERS guidelines for idiopathic pulmonary fibrosis into usual interstitial pneumonia &#40;UIP&#41;&#44; possible UIP and inconsistent with UIP&#44; and histopathological results of the cryobiopsy specimens&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Hist&#44; histopathology&#59; MCD&#44; multidisciplinary committee diagnosis&#59; SAD&#44; systemic autoimmune disease&#59; ILD&#44; interstitial lung disease&#59; IPF&#44; idiopathic pulmonary fibrosis&#59; LAM&#44; lymphangioleiomyomatosis&#59; HP&#44; hypersensitivity pneumonitis&#59; LIP&#44; lymphocytic interstitial pneumonia&#59; NSIP&#44; nonspecific interstitial pneumonia&#59; UIP&#44; usual interstitial pneumonia&#59; OP&#44; organized pneumonia&#59; HRCT&#44; high-resolution computed tomography&#46; &#42;Based on radiological images&#44; the suspected diagnosis was OP&#46; &#42;&#42;The final diagnosis of peribronchiolar metaplasia was made by SLB&#46;</p>"
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        "etiqueta" => "Fig&#46; 3"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Idiopathic pulmonary fibrosis diagnostic algorithm proposed after systematic use of cryobiopsy before performing surgical lung biopsy&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">DLCO&#44; carbon monoxide diffusing capacity&#59; FEV<span class="elsevierStyleInf">1</span>&#44; forced expiratory volume in the first second&#59; FVC&#44; forced vital capacity&#59; PH&#44; pulmonary hypertension&#59; BMI&#44; body mass index&#59; LFT&#44; lung function tests&#59; TLC&#44; total lung capacity&#59; AV&#44; alveolar volume&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; &#40;&#37;&#41; or mean &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64 &#40;30&#8211;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Smoking habits</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Never&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Former smoker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Active smoker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">BMI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;22&#8211;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">LFT pre-intervention &#40;&#37; reference&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FVC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69 &#40;43&#8211;103&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73 &#40;49&#8211;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FEV<span class="elsevierStyleInf">1</span>&#47;FVC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;66&#8211;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>TLC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73 &#40;49&#8211;102&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>DLCO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;23&#8211;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>DLCO&#47;AV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72 &#40;41&#8211;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Home oxygen therapy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Pre-intervention PH</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Characteristics of Patients Undergoing Lung Cryobiopsy&#46;</p>"
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">RLL&#44; right lower lobe&#59; LLL&#44; left lower lobe&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Location of the biopsy</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>RLL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LLL and RLL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Total cost &#40;&#8364;&#41;&nbsp;\t\t\t\t\t\t\n
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            0 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An official ATS&#47;ERS&#47;JRS&#47;ALAT statement&#58; idiopathic pulmonary fibrosis&#58; evidence-based guidelines for diagnosis and management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Raghu"
                            1 => "H&#46;R&#46; Collard"
                            2 => "J&#46;J&#46; Egan"
                            3 => "F&#46;J&#46; Martinez"
                            4 => "J&#46; Behr"
                            5 => "K&#46;K&#46; Brown"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.2009-040GL"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2011"
                        "volumen" => "183"
                        "paginaInicial" => "788"
                        "paginaFinal" => "824"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21471066"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the diagnosis and treatment of idiopathic pulmonary fibrosis&#46; Sociedad Espanola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica &#40;SEPAR&#41; Research Group on Diffuse Pulmonary Diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Xaubet"
                            1 => "J&#46; Ancochea"
                            2 => "E&#46; Bollo"
                            3 => "E&#46; Fernandez-Fabrellas"
                            4 => "T&#46; Franquet"
                            5 => "M&#46; Molina-Molina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2013.03.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2013"
                        "volumen" => "49"
                        "paginaInicial" => "343"
                        "paginaFinal" => "353"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23742884"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An official American Thoracic Society&#47;European Respiratory Society statement&#58; update of the international multidisciplinary classification of the idiopathic interstitial pneumonias"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46;D&#46; Travis"
                            1 => "U&#46; Costabel"
                            2 => "D&#46;M&#46; Hansell"
                            3 => "T&#46;E&#46; King Jr&#46;"
                            4 => "D&#46;A&#46; Lynch"
                            5 => "A&#46;G&#46; Nicholson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201308-1483ST"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2013"
                        "volumen" => "188"
                        "paginaInicial" => "733"
                        "paginaFinal" => "748"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24032382"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis of idiopathic pulmonary fibrosis with high-resolution CT"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "K&#46;A&#46; Johannson"
                            1 => "K&#46; de Boer"
                            2 => "P&#46;J&#46; Wolters"
                            3 => "J&#46;A&#46; Golden"
                            4 => "J&#46;S&#46; Lee"
                            5 => "H&#46;R&#46; Collard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2213-2600(14)70075-X"
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet Respir Med"
                        "fecha" => "2014"
                        "volumen" => "2"
                        "paginaInicial" => "e5"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24815808"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Future directions in idiopathic pulmonary fibrosis research an NHLBI workshop report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46;S&#46; Blackwell"
                            1 => "A&#46;M&#46; Tager"
                            2 => "Z&#46; Borok"
                            3 => "B&#46;B&#46; Moore"
                            4 => "D&#46;A&#46; Schwartz"
                            5 => "K&#46;J&#46; Anstrom"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201306-1141WS"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2014"
                        "volumen" => "189"
                        "paginaInicial" => "214"
                        "paginaFinal" => "222"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24160862"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic pulmonary fibrosis&#58; clinical relevance of pathologic classification"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;L&#46; Katzenstein"
                            1 => "J&#46;L&#46; Myers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.157.4.9707039"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "1998"
                        "volumen" => "157"
                        "paginaInicial" => "1301"
                        "paginaFinal" => "1315"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9563754"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fibrosing interstitial lung disease&#46; A practical high-resolution computed tomography-based approach to diagnosis and management and a review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;A&#46; Hodnett"
                            1 => "D&#46;P&#46; Naidich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201208-1544CI"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med&#46;"
                        "fecha" => "2013"
                        "volumen" => "188"
                        "paginaInicial" => "141"
                        "paginaFinal" => "149"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23672718"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role for transbronchial biopsy in the diagnosis of usual interstitial pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;F&#46; Shorr"
                            1 => "C&#46;J&#46; Lettieri"
                            2 => "D&#46;L&#46; Helman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.06-1266"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2007"
                        "volumen" => "131"
                        "paginaInicial" => "329"
                        "paginaFinal" => "330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17218598"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial biopsy and usual interstitial pneumonia&#58; a step backward in disease management&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Mukherjee"
                            1 => "M&#46; Spiteri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2006"
                        "volumen" => "130"
                        "paginaInicial" => "1628"
                        "paginaFinal" => "1629"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17099054"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial biopsy and usual interstitial pneumonia&#58; a new paradigm&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Churg"
                            1 => "M&#46; Schwarz"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.129.5.1117"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
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                        "paginaInicial" => "1117"
                        "paginaFinal" => "1118"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16684996"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Histopathologic findings of transbronchial biopsy in usual interstitial pneumonia"
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46;S&#46; Shim"
                            1 => "M&#46;S&#46; Park"
                            2 => "I&#46;K&#46; Park"
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                    0 => array:2 [
                      "doi" => "10.1111/j.1440-1827.2010.02528.x"
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                        "tituloSerie" => "Pathol Int"
                        "fecha" => "2010"
                        "volumen" => "60"
                        "paginaInicial" => "373"
                        "paginaFinal" => "377"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20518887"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial lung biopsy and bronchoalveolar lavage in diagnosis of diffuse infiltrative lung diseases"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "V&#46; Poletti"
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                            2 => "S&#46; Poggi"
                            3 => "T&#46; Bertanti"
                            4 => "L&#46; Spiga"
                            5 => "R&#46; Ferracini"
                          ]
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                  "host" => array:1 [
                    0 => array:1 [
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                        "tituloSerie" => "Respiration"
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                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "66"
                        "paginaFinal" => "72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3231906"
                            "web" => "Medline"
                          ]
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                ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The value of transbronchial lung biopsy using jumbo forceps via rigid bronchoscope in diffuse lung disease"
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                          "etal" => true
                          "autores" => array:6 [
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                            2 => "P&#46;N&#46; Chhajed"
                            3 => "M&#46; Chilosi"
                            4 => "M&#46; Zompatori"
                            5 => "D&#46; Olivieri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4081/monaldi.2008.397"
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                        "tituloSerie" => "Monaldi Arch Chest Dis"
                        "fecha" => "2008"
                        "volumen" => "69"
                        "paginaInicial" => "59"
                        "paginaFinal" => "64"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18837418"
                            "web" => "Medline"
                          ]
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                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease&#46; A randomized trial"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "D&#46; Castillo"
                            3 => "E&#46; Lerma"
                            4 => "M&#46;A&#46; Montero"
                            5 => "D&#46; Ramos-Barbon"
                          ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/resp.12322"
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                        "tituloSerie" => "Respirology"
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                        "volumen" => "19"
                        "paginaInicial" => "900"
                        "paginaFinal" => "906"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24890124"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial cryobiopsy in the diagnosis of interstitial lung disease&#58; a cool new approach"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46;A&#46; Mikolasch"
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1111/resp.12320"
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                        "tituloSerie" => "Respirology"
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                        "paginaFinal" => "624"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24862354"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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              "identificador" => "bib0245"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial cryobiopsy&#58; a new tool for lung biopsies"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Babiak"
                            1 => "J&#46; Hetzel"
                            2 => "G&#46; Krishna"
                            3 => "P&#46; Fritz"
                            4 => "P&#46; Moeller"
                            5 => "T&#46; Balli"
                          ]
                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000203987"
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                        "tituloSerie" => "Respiration"
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                        "volumen" => "78"
                        "paginaInicial" => "203"
                        "paginaFinal" => "208"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19246874"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0250"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cryobiopsy&#58; should this be used in place of endobronchial forceps biopsies&#63;"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46;R&#46; Rubio"
                            1 => "S&#46;R&#46; Ie"
                            2 => "R&#46;E&#46; Whatley"
                            3 => "M&#46;B&#46; Boyd"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1155/2013/730574"
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                        "tituloSerie" => "Biomed Res Int"
                        "fecha" => "2013"
                        "volumen" => "2013"
                        "paginaInicial" => "730574"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24066296"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0255"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bronchoscopic cryobiopsy for the diagnosis of diffuse parenchymal lung disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Kropski"
                            1 => "J&#46;M&#46; Pritchett"
                            2 => "W&#46;R&#46; Mason"
                            3 => "L&#46; Sivarajan"
                            4 => "L&#46;A&#46; Gleaves"
                            5 => "J&#46;E&#46; Johnson"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0078674"
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                        "tituloSerie" => "PLOS ONE"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "e78674"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24265706"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;L&#46; Casoni"
                            1 => "S&#46; Tomassetti"
                            2 => "A&#46; Cavazza"
                            3 => "T&#46;V&#46; Colby"
                            4 => "A&#46; Dubini"
                            5 => "J&#46;H&#46; Ryu"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0086716"
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                        "tituloSerie" => "PLOS ONE"
                        "fecha" => "2014"
                        "volumen" => "9"
                        "paginaInicial" => "e86716"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24586252"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0265"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial lung biopsy using cryoprobes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "V&#46; Pajares"
                            1 => "A&#46; Torrego"
                            2 => "C&#46; Puzo"
                            3 => "E&#46; Lerma"
                            4 => "M&#46;A&#46; Gil de Bernabe"
                            5 => "T&#46; Franquet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2009.09.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2010"
                        "volumen" => "46"
                        "paginaInicial" => "111"
                        "paginaFinal" => "115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19939546"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0270"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outpatient thoracic surgical programme in 300 patients&#58; clinical results and economic impact"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Molins"
                            1 => "J&#46;J&#46; Fibla"
                            2 => "J&#46; Perez"
                            3 => "A&#46; Sierra"
                            4 => "G&#46; Vidal"
                            5 => "C&#46; Simon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejcts.2005.12.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2006"
                        "volumen" => "29"
                        "paginaInicial" => "271"
                        "paginaFinal" => "275"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16427300"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost-effectiveness analysis of transbronchial needle aspiration of pulmonary lesions without endobronchial affectation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "V&#46; Leiro Fernandez"
                            1 => "M&#46; Botana Rial"
                            2 => "C&#46; Represas Represas"
                            3 => "A&#46; Gonzalez Pineiro"
                            4 => "V&#46; Del Campo Perez"
                            5 => "A&#46; Fernandez-Villar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2012.07.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2012"
                        "volumen" => "48"
                        "paginaInicial" => "448"
                        "paginaFinal" => "452"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22974766"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0280"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inter-observer variation between pathologists in diffuse parenchymal lung disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;G&#46; Nicholson"
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                            2 => "H&#46; Bharucha"
                            3 => "C&#46;A&#46; Clelland"
                            4 => "B&#46; Corrin"
                            5 => "A&#46;R&#46; Gibbs"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2004"
                        "volumen" => "59"
                        "paginaInicial" => "500"
                        "paginaFinal" => "505"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15170033"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nonspecific interstitial pneumonia and the other idiopathic interstitial pneumonias&#58; classification and diagnostic criteria"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;L&#46; Katzenstein"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Surg Pathol"
                        "fecha" => "2000"
                        "volumen" => "24"
                        "paginaInicial" => "1"
                        "paginaFinal" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10632482"
                            "web" => "Medline"
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                    ]
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                ]
              ]
            ]
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              "identificador" => "bib0290"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "VATS lung biopsy in suspected&#44; diffuse interstitial lung disease provides diagnosis&#44; and alters management strategies"
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                          "etal" => false
                          "autores" => array:4 [
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                            2 => "J&#46; Ferguson"
                            3 => "A&#46;J&#46; Ritchie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Heart Lung Circ"
                        "fecha" => "2005"
                        "volumen" => "14"
                        "paginaInicial" => "90"
                        "paginaFinal" => "92"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16352261"
                            "web" => "Medline"
                          ]
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                      ]
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                ]
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              "etiqueta" => "26"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Video-assisted thoracoscopic lobectomy is less costly and morbid than open lobectomy&#58; a retrospective multiinstitutional database analysis"
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                          "etal" => true
                          "autores" => array:6 [
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                            1 => "B&#46;F&#46; Meyers"
                            2 => "C&#46;L&#46; Gunnarsson"
                            3 => "M&#46; Moore"
                            4 => "J&#46;A&#46; Howington"
                            5 => "M&#46;A&#46; Maddaus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Ann Thorac Surg"
                        "fecha" => "2012"
                        "volumen" => "93"
                        "paginaInicial" => "1027"
                        "paginaFinal" => "1032"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22130269"
                            "web" => "Medline"
                          ]
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                ]
              ]
            ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of thoracoscopy in the diagnosis of interstitial lung disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                            4 => "J&#46;S&#46; McLaughlin"
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                        ]
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                    0 => array:1 [
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                        "tituloSerie" => "Ann&#46; Thorac&#46; Surg&#46;"
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                        "paginaInicial" => "348"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7847948"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "A randomized&#44; controlled trial comparing thoracoscopy and limited thoracotomy for lung biopsy in interstitial lung disease"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;D&#46; Miller"
                            1 => "J&#46;D&#46; Urschel"
                            2 => "G&#46; Cox"
                            3 => "J&#46; Olak"
                            4 => "J&#46;E&#46; Young"
                            5 => "J&#46;M&#46; Kay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann&#46; Thorac&#46; Surg&#46;"
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                        "paginaInicial" => "1647"
                        "paginaFinal" => "1650"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11093503"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0310"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of video thoracoscopic lung biopsy to open lung biopsy in the diagnosis of interstitial lung disease"
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                        "volumen" => "187"
                        "paginaInicial" => "253"
                        "paginaFinal" => "259"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19548030"
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                ]
              ]
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              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial biopsy in usual interstitial pneumonia"
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                          "autores" => array:4 [
                            0 => "E&#46;A&#46; Berbescu"
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                            2 => "J&#46;L&#46; Snow"
                            3 => "D&#46;A&#46; Zisman"
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                        ]
                      ]
                    ]
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                        "volumen" => "129"
                        "paginaInicial" => "1126"
                        "paginaFinal" => "1131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16685001"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "32"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transbronchial biopsy is useful in predicting UIP pattern"
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                            5 => "E&#46; Scarpi"
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                        "volumen" => "13"
                        "paginaInicial" => "96"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23107232"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Old meets modern&#58; the use of traditional cryoprobes in the age of molecular biology"
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Article information
ISSN: 15792129
Original language: English
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