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Am J Respir Crit Care Med. 2019 May 15;199(10):1249-1256. doi: 10.1164/rccm.201810-1947OC.

Poor Concordance between Sequential Transbronchial Lung Cryobiopsy and Surgical Lung Biopsy in the Diagnosis of Diffuse Interstitial Lung Diseases.

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1 Department of Respiratory Diseases.
2 Department of Interventional Pulmonology.
3 Emeritus, Department of Laboratory Medicine Pathology, Mayo Clinic, Scottsdale, Arizona.
4 Department of Thoracic Surgery.
5 Department of Pathology.
6 Department of Pathology, Maggiore and S'Orsola-Malpighi Hospital, Bologna, Italy.
7 Department of Pathology, Azienda USL-IRCCS, Reggio Emilia, Italy; and.
8 Department of Thoracic Surgery.
9 Department of Pulmonology, and.
10 Department of Radiology.
11 PhyMedExp, Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale, and.
12 Department of Radiology, S'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
13 Department of Radiology, Bellaria Hospital, Bologna, Italy.
14 L'Institut Montpelliérain Alexander Grothendieck, CNRS, Centre Hospitalier Universitaire de Montpellier, University of Montpellier, Montpellier, France.


Rationale: The diagnostic concordance between transbronchial lung cryobiopsy (TBLC)-versus surgical lung biopsy (SLB) as the current gold standard-in interstitial lung disease (ILD) cases requiring histology remains controversial. Objectives: To assess diagnostic concordance between TBLC and SLB sequentially performed in the same patients, the diagnostic yield of both techniques, and subsequent changes in multidisciplinary assessment (MDA) decisions. Methods: A two-center prospective study included patients with ILD with a nondefinite usual interstitial pneumonia pattern (on high-resolution computed tomography scan) confirmed at a first MDA. Patients underwent TBLC immediately followed by video-assisted thoracoscopy for SLB at the same anatomical locations. After open reading of both sample types by local pathologists and final diagnosis at a second MDA (MDA2), anonymized TBLC and SLB slides were blindly assessed by an external expert pathologist (T.V.C.). Kappa-concordance coefficients and percentage agreement were computed for: TBLC versus SLB, MDA2 versus TBLC, MDA2 versus SLB, and blinded pathology versus routine pathology. Measurements and Main Results: Twenty-one patients were included. The median TBLC biopsy size (longest axis) was 7 mm (interquartile range, 5-8 mm). SLB biopsy sizes averaged 46.1 ± 13.8 mm. Concordance coefficients and percentage agreement were: TBLC versus SLB: κ = 0.22 (95% confidence interval [CI], 0.01-0.44), percentage agreement = 38% (95% CI, 18-62%); MDA2 versus TBLC: κ = 0.31 (95% CI, 0.06-0.56), percentage agreement = 48% (95% CI, 26-70)%; MDA2 versus SLB: κ = 0.51 (95% CI, 0.27-0.75), percentage agreement = 62% (95% CI, 38-82%); two pneumothoraces (9.5%) were recorded during TBLC. TBLC would have led to a different treatment if SLB was not performed in 11 of 21 (52%) of cases. Conclusions: Pathological results from TBLC and SLB were poorly concordant in the assessment of ILD. SLBs were more frequently concordant with the final diagnosis retained at MDA.


bronchoscopy; deep sedation; idiopathic pulmonary fibrosis; lung histology; multidisciplinary approach

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