Summary

Objective
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare condition for which the diagnostic role of transbronchial lung cryobiopsy (TBLC) remains incompletely investigated. This study compared histological samples obtained by transbronchial lung cryobiopsy (TBLC) with those obtained by surgical lung biopsy (SLB).

Methods
This is an observational retrospective study enrolling adult patients with final diagnosis of DIPNECH histologically proved by TBLC and/or SLB, from 2011 to 2025. Clinical data, pulmonary function tests, BAL findings, CT features, and histology were compared between groups.

Results
Fourteen women with a final biopsy-proven diagnosis of DIPNECH were included: 8 diagnosed by TBLC and 6 by SLB. Median age was 64 years (IQR 59-67). Pulmonary function tests showed airflow obstruction and air trapping, with median FEV1 71.4% predicted (IQR 49.8-90.0), FEV1/FVC 0.67 (IQR 0.57-0.75), and RV/TLC 47.3% (IQR 42.4-53.5). Clinical and radiological features were similar across groups. BAL showed lymphocytosis in 6/9 patients (67%). Histology showed a nonsignificant trend toward more frequent detection of constrictive bronchiolitis in SLB specimens than in TBLC specimens (66% vs 13%; p = 0.09), whereas no significant differences were observed for the other histological features. In the TBLC group, pneumothorax occurred in two cases, neither requiring drainage.

Conclusion
The study suggests that TBLC can represent a valid diagnostic alternative to SLB for DIPNECH, capturing key histological features, though apparently less sensitive for constrictive bronchiolitis. Moreover, a lymphocytic BAL pattern may be observed in DIPNECH and, if confirmed in larger cohorts, could support the diagnostic workup.

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Authors

Matteo Morviducci - Department of Medical Specialties, Pulmonology Unit, GB Morgagni - L. Pierantoni Hospital, Forlì, Italy; Department of Public Health and Infectious Disease, Respiratory and Critical Care Division, Sapienza University of Rome, Italy https://orcid.org/0009-0006-3719-8913

Sara Piciucchi - Department of Medical and Surgical Sciences (DIMEC), University of Bologna/Forlì Campus, Forlì, Italy; Department of Radiology, GB Morgagni - L. Pierantoni Hospital, Forlì, Italy

Stefano Oldani - Department of Medical Specialties, Pulmonology Unit, GB Morgagni - L. Pierantoni Hospital, Forlì, Italy

Simone Petrarulo - Department of Medical Specialties, Pulmonology Unit, GB Morgagni - L. Pierantoni Hospital, Forlì, Italy

Alessandra Dubini - Department of Pathology, GB Morgagni - L. Pierantoni Hospital, Forlì, Italy

Matteo Costantini - Department of Pathology, GB Morgagni - L. Pierantoni Hospital, Forlì, Italy

Paolo Palange - Department of Public Health and Infectious Disease, Respiratory and Critical Care Division, Sapienza University of Rome, Italy

Claudia Ravaglia - Department of Medical Specialties, Pulmonology Unit, GB Morgagni - L. Pierantoni Hospital, Forlì, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna/Forlì Campus, Forlì, Italy

Venerino Poletti - Department of Medical Specialties, Pulmonology Unit, GB Morgagni - L. Pierantoni Hospital, Forlì, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna/Forlì Campus, Forlì, Italy; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark

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Copyright

Copyright (c) 2026 Società Italiana di Anatomia Patologica e Citopatologia Diagnostica, Divisione Italiana della International Academy of Pathology

How to Cite
Morviducci, M., Piciucchi, S., Oldani, S., Petrarulo, S., Dubini, A., Costantini, M., Palange, P., Ravaglia, C., & Poletti, V. (2026). The role of transbronchial cryobiopsy in DIPNECH diagnosis. Pathologica - Journal of the Italian Society of Anatomic Pathology and Diagnostic Cytopathology, 118(3). Retrieved from https://www.pathologica.it/article/view/2543
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