The significance of multidisciplinary classifications based on transbronchial pathology in possible idiopathic interstitial pneumonias

Abstract

Background the multidisciplinary diagnosis based on clinic–radiologic–pathologic information had been widely used as the diagnostic gold standard for idiopathic interstitial pneumonias (IIPs). Surgical lung biopsy (SLB) had been recommended as the standard method to sample lung parenchymal lesions for suspected IIPs. Here, we attempted to show the diagnostic confidence of multidisciplinary classifications based on transbronchial pathology including transbronchial lung cryobiopsy (TBLC), bronchoalveolar lavage fluid (BALF) and endobronchial ultrasound-guided transbronchial needle aspiration biopsy (EBUS-TBNA) in IIPs. Methods all new suspected interstitial lung diseases (ILD) were in-patient at the respiratory department of Dalian Municipal Central Hospital from June 2016 to December 2018. The multidisciplinary discussion (MDD) were made to exclude known causes of ILD and typical IPF depending on clinical, radiological information. The cases of atypical IPF, and possible IIPs were included and suggested to transbronchial pathological evaluation. Initial MDD classifications were made depending on clinical, radiological and transbronchial pathological information. The final MDD classifications was confirmed by following therapeutic effect. Results 70 subjects were eligible including 24 males and 46 females. The sampled lung parenchyma from TBLC were enough for confirmation of pathological diagnosis in 68.6% (48/70) cases. If the confirmed pathological evaluations through EBUS-TBNA and BALF were involved, 77.1% (54/70) cases had gotten the defined diagnosis. All cases were following up. Meanwhile, 60% was improved, 11.43% was relapsed when glucocorticoid was reduced to small dose or withdrawal, 14.29% was steady and 8.57% was progressed in which the diagnosis were modified in 4 cases. 94.3% initial MDD classifications based on transbronchial pathology were agreed with the final MDD, the difference of diagnostic yield wasn’t significant between initial and final MDD (Z=-1.414, p=0.157). Conclusion classifications of IIPs based on transbronchial pathology were useful and quite agreed with final MDD.