Observational findings of transbronchial lung biopsy in patients with interstitial lung disease: a retrospective study in Aleppo University Hospital

Abstract

Background: Clinicians face a significant obstacle when attempting to diagnose interstitial lung disease (ILD) patients. However, a thorough clinical examination together with the proper imaging and diagnostic techniques may provide a reliable diagnosis of a particular kind of ILD, and invasive tests such as rigid bronchoscopy or surgical lung biopsy may not be necessary. The aim of this study is to determine the histologic outcomes of an ILD transbronchial lung biopsy (TBLB) carried out at the university hospital in Aleppo. Methods: This retrospective cohort research was done between 1 January 2020 and 18 April 2022 at the pulmonary department of Aleppo University Hospital, Syria, using patient records. In our study, 174 patients were examined. We included patients over the age of 18 who were referred or admitted to our department at Aleppo University Hospital after being diagnosed with diffuse parenchymal lung disease based on high-resolution computed tomography and clinical symptoms, while excluding other respiratory diseases such as tuberculosis and coronavirus disease 2019. Results: Patients in the research were 53±7.1 years old on average. Cough and dyspnea were the most common clinical complaints among the patients, which accounted for 79.12 and 78.16%, respectively. A significant fraction of ground-glass opacity was detected on the high-resolution computed tomography, amounting to 102 (58.62%) and 74 (42.53%) for the reticular lesions, respectively. As a complication there were 40 patients with bleeding, of whom 24 had moderate bleeding, and 11 had major bleeding. We also had three patients with pneumothorax. The diagnostic yield of the TBLB in our ILD patients was 66.66%. Conclusion: An adequate diagnostic accuracy (66.66%) was detected in the TBLB in confirming the diagnosis of ILD; in addition, the bleeding was the most prevalent complication of this procedure. More interventional studies are needed to compare the diagnostic accuracy of this procedure with other invasive and noninvasive diagnostic methodologies of ILD.

Multidisciplinary Approach to the Diagnosis of Idiopathic Interstitial Pneumonias: Focus on the Pathologist’s Key Role

“…All data demonstrate a moderate diagnostic accordance between TBLC and SLB in the setting of the multidisciplinary diagnosis of diffuse lung disease, mainly when performed in experienced centers [242][243][244]. Conversely, the diagnostic values of TBB and bronchoalveolar lavage (BAL) are limited for IIPs, with TBB findings often nondiagnostic [245,246], while the cellular analysis of BAL may help in defined clinical settings, such as suspected HP, eosinophilic pneumonia, sarcoidosis and infections [247][248][249][250]. TBLC is commonly indicated for diffuse parenchymal lung disease when radiological and clinical data do not yield a definitive diagnosis, as it provides enough histopathological information to reach a multidisciplinary diagnosis in patients with diffuse lung disease, with the same diagnostic value but lower risk compared to SLB.…”