Bronchoscopic Lung Cryobiopsy Increases Diagnostic Confidence in the Multidisciplinary Diagnosis of Idiopathic Pulmonary Fibrosis

• Published in: American journal of respiratory and critical care medicine Vol. 193; no. 7; pp. 745 - 752
• Main Authors: Tomassetti, Sara, Wells, Athol U., Costabel, Ulrich, Cavazza, Alberto, Colby, Thomas V., Rossi, Giulio, Sverzellati, Nicola, Carloni, Angelo, Carretta, Elisa, Buccioli, Matteo, Tantalocco, Paola, Ravaglia, Claudia, Gurioli, Christian, Dubini, Alessandra, Piciucchi, Sara, Ryu, Jay H., Poletti, Venerino
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 01.04.2016
• Subjects: Adult; Aged; Biopsy - methods; Bronchoscopy - methods; Cross-Sectional Studies; Diagnosis, Differential; Female; Humans; Idiopathic Pulmonary Fibrosis - diagnosis; Idiopathic Pulmonary Fibrosis - pathology; Italy; Lung - pathology; Male; Middle Aged; Italy; cryobiopsy; idiopathic pulmonary fibrosis; bronchoalveolar lavage; interstitial lung diseases; bronchoscopy
• DOI: 10.1164/rccm.201504-0711OC
• ISSN: 1073-449X

Surgical lung biopsy is often required for a confident multidisciplinary diagnosis of idiopathic pulmonary fibrosis (IPF). Alternative, less-invasive biopsy methods, such as bronchoscopic lung cryobiopsy (BLC), are highly desirable. To address the impact of BLC on diagnostic confidence in the multidisciplinary diagnosis of IPF. In this cross-sectional study we selected 117 patients with fibrotic interstitial lung disease without a typical usual interstitial pneumonia pattern on high-resolution computed tomography. All cases underwent lung biopsies: 58 were BLC, and 59 were surgical lung biopsy (SLB). Two clinicians, two radiologists, and two pathologists sequentially reviewed clinical-radiologic findings and biopsy results, recording at each step in the process their diagnostic impressions and confidence levels. We observed a major increase in diagnostic confidence after the addition of BLC, similar to SLB (from 29 to 63%, P = 0.0003 and from 30 to 65%, P = 0.0016 of high confidence IPF diagnosis, in the BLC group and SLB group, respectively). The overall interobserver agreement in IPF diagnosis was similar for both approaches (BLC overall kappa, 0.96; SLB overall kappa, 0.93). IPF was the most frequent diagnosis (50 and 39% in the BLC and SLB group, respectively; P = 0.23). After the addition of histopathologic information, 17% of cases in the BLC group and 19% of cases in the SLB group, mostly idiopathic nonspecific interstitial pneumonia and hypersensitivity pneumonitis, were reclassified as IPF. BLC is a new biopsy method that has a meaningful impact on diagnostic confidence in the multidisciplinary diagnosis of interstitial lung disease and may prove useful in the diagnosis of IPF. This study provides a robust rationale for future studies investigating the diagnostic accuracy of BLC compared with SLB.