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. 2017 Feb;151(2):389-399.
doi: 10.1016/j.chest.2016.09.028. Epub 2016 Oct 8.

Utility of Transbronchial vs Surgical Lung Biopsy in the Diagnosis of Suspected Fibrotic Interstitial Lung Disease

Jamie S Sheth  1 , John A Belperio  2 , Michael C Fishbein  3 , Ella A Kazerooni  4 , Amir Lagstein  5 , Susan Murray  6 , Jeff L Myers  5 , Richard H Simon  7 , Thomas H Sisson  7 , Baskaran Sundaram  8 , Eric S White  7 , Meng Xia  6 , David Zisman  9 , Kevin R Flaherty  7
Affiliations

Utility of Transbronchial vs Surgical Lung Biopsy in the Diagnosis of Suspected Fibrotic Interstitial Lung Disease

Jamie S Sheth et al. Chest. 2017 Feb.

Abstract

Background: Surgical lung biopsy (SLB) is invasive and not possible in all patients with undiagnosed interstitial lung disease (ILD). We hypothesized that transbronchial biopsy (TBB) findings combined with clinical and high-resolution CT (HRCT) data leads to a confident diagnosis congruent to SLB and therefore avoids the need for SLB in some patients.

Methods: We evaluated 33 patients being investigated for suspected ILD who underwent HRCT, TBB, and SLB. First, clinicians, radiologists, and a pathologist reviewed the clinical information and HRCT and TBB findings. Clinicians were asked to provide a diagnosis and were also asked if SLB was needed for a more confident diagnosis. Subsequently, the clinical, HRCT, and SLB data were reviewed, and the same participants were asked to provide a final diagnosis. Clinician consensus and overall agreement between TBB- and SLB-based diagnoses were calculated.

Results: Four patients had definite usual interstitial pneumonia (UIP) on HRCT and would not be considered for biopsy using current guidelines. Of the 29 patients without a definitive HRCT diagnosis, the clinicians felt confident of the diagnosis (ie, would not recommend SLB) in six cases. In these cases, there was 100% agreement between TBB and SLB diagnoses. UIP was the most common diagnosis (n = 3) and was associated with an HRCT diagnosis of possible UIP/nonspecific interstitial pneumonia-like. Agreement was poor (33%) between TBB and SLB diagnoses when confidence in the TBB diagnosis was low.

Conclusions: Information from TBB, when combined with clinical and HRCT data, may provide enough information to make a confident and accurate diagnosis in approximately 20% to 30% of patients with ILD.

Keywords: idiopathic interstitial pneumonia; idiopathic pulmonary fibrosis; interstitial lung disease; lung biopsy.

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Figures

Figure 1
Figure 1
Adequacy of TBB specimens. TBB = transbronchial biopsy; UIP = usual interstitial pneumonia.
Figure 2
Figure 2
Transbronchial biopsy with honeycomb changes.
Figure 3
Figure 3
Usual interstitial pneumonia on transbronchial biopsy with fibrosis, honeycomb changes, and fibroblast foci. The asterisk indicates a fibroblast focus.
Figure 4
Figure 4
Flow diagram of agreement between TBB and SLB final diagnoses. HRCT = high-resolution CT; SLB = surgical lung biopsy. See Figure 1 legend for expansion of other abbreviations.
Figure 5
Figure 5
TBB results in patients with possible UIP/NSIP-like on HRCT. UIP/NSIP = usual interstitial pneumonia/nonspecific interstitial pneumonia. See Figure 1 and 4 legends for expansion of other abbreviations.
See this image and copyright information in PMC

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