Utility of Transbronchial vs Surgical Lung Biopsy in the Diagnosis of Suspected Fibrotic Interstitial Lung Disease

• Published in: Chest Vol. 151; no. 2; p. 389
• Main Authors: Sheth, Jamie S, Belperio, John A, Fishbein, Michael C, Kazerooni, Ella A, Lagstein, Amir, Murray, Susan, Myers, Jeff L, Simon, Richard H, Sisson, Thomas H, Sundaram, Baskaran, White, Eric S, Xia, Meng, Zisman, David, Flaherty, Kevin R
• Format: Journal Article
• Language: English
• Published: United States 01.02.2017
• Subjects: Adult; Aged; Alveolitis, Extrinsic Allergic - diagnostic imaging; Alveolitis, Extrinsic Allergic - pathology; Alveolitis, Extrinsic Allergic - physiopathology; Biopsy - methods; Bronchiolitis - diagnostic imaging; Bronchiolitis - pathology; Bronchiolitis - physiopathology; Bronchoscopy - methods; Cohort Studies; Cryptogenic Organizing Pneumonia - diagnostic imaging; Cryptogenic Organizing Pneumonia - pathology; Cryptogenic Organizing Pneumonia - physiopathology; Female; Forced Expiratory Volume; Humans; Idiopathic Pulmonary Fibrosis - diagnostic imaging; Idiopathic Pulmonary Fibrosis - pathology; Idiopathic Pulmonary Fibrosis - physiopathology; Lung - pathology; Lung - physiopathology; Lung - surgery; Lung Diseases, Interstitial - diagnostic imaging; Lung Diseases, Interstitial - pathology; Lung Diseases, Interstitial - physiopathology; Male; Middle Aged; Pulmonary Diffusing Capacity; Retrospective Studies; Tomography, X-Ray Computed; Vital Capacity; idiopathic pulmonary fibrosis; interstitial lung disease; lung biopsy; idiopathic interstitial pneumonia
• ISSN: 1931-3543
• DOI: 10.1016/j.chest.2016.09.028

Surgical lung biopsy (SLB) is invasive and not possible in all patients with undiagnosed interstitial lung disease (ILD). We hypothesized that transbronchial biopsy (TBB) findings combined with clinical and high-resolution CT (HRCT) data leads to a confident diagnosis congruent to SLB and therefore avoids the need for SLB in some patients. We evaluated 33 patients being investigated for suspected ILD who underwent HRCT, TBB, and SLB. First, clinicians, radiologists, and a pathologist reviewed the clinical information and HRCT and TBB findings. Clinicians were asked to provide a diagnosis and were also asked if SLB was needed for a more confident diagnosis. Subsequently, the clinical, HRCT, and SLB data were reviewed, and the same participants were asked to provide a final diagnosis. Clinician consensus and overall agreement between TBB- and SLB-based diagnoses were calculated. Four patients had definite usual interstitial pneumonia (UIP) on HRCT and would not be considered for biopsy using current guidelines. Of the 29 patients without a definitive HRCT diagnosis, the clinicians felt confident of the diagnosis (ie, would not recommend SLB) in six cases. In these cases, there was 100% agreement between TBB and SLB diagnoses. UIP was the most common diagnosis (n = 3) and was associated with an HRCT diagnosis of possible UIP/nonspecific interstitial pneumonia-like. Agreement was poor (33%) between TBB and SLB diagnoses when confidence in the TBB diagnosis was low. Information from TBB, when combined with clinical and HRCT data, may provide enough information to make a confident and accurate diagnosis in approximately 20% to 30% of patients with ILD.