Concordance between sequential transbronchial lung cryobiopsy and surgical lung biopsy in patients with diffuse interstitial lung disease

Abstract

BackgroundIncreasing evidence indicates the utility of transbronchial lung cryobiopsy (TBLC) for the diagnosis of interstitial lung disease (ILD). However, only one study has compared TBLC and surgical lung biopsy (SLB) performed on the same patients.MethodsWe identified seven patients with ILD with TBLC and SLB. We evaluated the clinical characteristics and made a pathological diagnosis based on the official ATS/ERS/JRS/ALAT clinical practice guideline of idiopathic pulmonary fibrosis with both TBLC and SLB.ResultsSix cases were diagnosed as Usual interstitial pneumonia (UIP) in both TBLC and SLB. One case was diagnosed as indeterminate for UIP with TBLC and probable UIP with SLB. Etiological diagnosis with TBLC and SLB were concordant in 2 cases of idiopathic pulmonary fibrosis (IPF) but discordant for other diagnoses. Major histological findings of UIP including dense fibrosis, peripheral distribution, and fibroblastic foci showed high concordance between TBLC and SLB, which implies that TBLC can reliably detect these features. In contrast, loose fibrosis, cellular infiltration, and airway disease showed poor concordance between the two methods.ConclusionOur study showed that TBLC is useful for UIP diagnosis but not for other ILD. With a multidisciplinary approach, diagnosis of IPF may be determined by TBLC, whereas ILD other than IPF may require SLB.

Usefulness of surgical lung biopsies after cryobiopsies when pathological results are inconclusive or show a pattern suggestive of a nonspecific interstitial pneumonia

“…Beside the growing evidence supporting the use of TBLCs for the diagnosis of DPLDs, only three studies directly compared TBLC and SLB performed in a same patient [ 12 – 14 ]. Romagnoli and colleagues included 21 patients and found a poor agreement for TBLC and SLB histological diagnoses [ 14 ].…”

“…Interestingly, whereas many data support the use of TBLC for the diagnosis of DPLDs, only three studies compared the result of TBLC and SLB performed in a same patient. A first study was conducted on a limited number of patients (seven) [12] while the other two were conducted on a larger cohort, both providing conflicting results concerning the agreement between TBLC and SLB for histological diagnoses [13,14]. Nevertheless, the COLDICE study [14] was the biggest and the unique multicentric study showing a high level of agreement between TBLC and SLB for both histopathological interpretation and MDD diagnoses.…”

Usefulness of Surgical Lung Biopsies after Cryobiopsies when Pathological Results Are Inconclusive or show a Pattern Suggestive of a Nonspecific Interstitial Pneumonia

“…Beside the growing evidence supporting the use of TBLCs for the diagnosis of DPLDs, only three studies directly compared TBLC and SLB performed in a same patient [14][15][16]. Romagnoli and colleagues included 21 patients and found a poor agreement for TBLC and SLB histological diagnoses [16].…”

Daugiadisciplinio konsiliumo vertė diagnozuojant ir gydant intersticines plaučių ligas. Kauno klinikų patirtis

“…IPL yra retos ligos, tačiau dėl reikšmingų gydymo ir prognozės skirtumų specifinių IPL diagnozių nustatymas ir diferencijavimas yra labai svarbus [3]. Šiam tikslui pasitelkiami klinikiniai duomenys [4], radiologiniai tyrimai [5,6], invazinių procedūrų ir biopsijos rezultatai [7,8]. IPL diagnostikai ypač reikšminga didelės skiriamosios gebos kompiuterinė tomografija (DSGKT).…”