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Am J Respir Crit Care Med. 2016 Apr 1;193(7):745-52. doi: 10.1164/rccm.201504-0711OC.

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

Author information

1
1 Department of Diseases of the Thorax.
2
2 Interstitial Lung Disease Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom.
3
3 Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, Essen, Germany.
4
4 Department of Pathology, Arcispedale S. Maria Nuova, Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
5
5 Department of Pathology, Mayo Clinic, Scottsdale, Arizona.
6
6 Pathologic Anatomy, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy.
7
7 Radiology Unit, Parma University, Parma, Italy.
8
8 U.O. Radiologia Diagnostica ed Interventistica Az. Osp. Santa Maria, Terni, Italy.
9
9 Bioscience Department, Bologna University, Bologna, Italy.
10
10 Pathology Unit, and.
11
11 Radiology Unit, GB Morgagni Hospital, Forlì, Italy.
12
12 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota; and.
13
13 Department Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark.

Abstract

RATIONALE:

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.

OBJECTIVES:

To address the impact of BLC on diagnostic confidence in the multidisciplinary diagnosis of IPF.

METHODS:

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.

MEASUREMENTS AND MAIN RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

bronchoalveolar lavage; bronchoscopy; cryobiopsy; idiopathic pulmonary fibrosis; interstitial lung diseases

PMID:
26562389
DOI:
10.1164/rccm.201504-0711OC
[Indexed for MEDLINE]

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