Bronchoscopic lung cryobiopsy increases diagnostic confidence in the multidisciplinary diagnosis of idiopathic pulmonary fibrosis

Sara Tomassetti, Athol U. Wells, Ulrich Costabel, Alberto Cavazza, Thomas V. Colby, Giulio Rossi, Nicola Sverzellati, Angelo Carloni, Elisa Carretta, Matteo Buccioli, Paola Tantalocco, Claudia Ravaglia, Christian Gurioli, Alessandra Dubini, Sara Piciucchi, Jay H. Ryu, Venerino Poletti

Research output: Contribution to journalArticle

165 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)745-752
Number of pages8
JournalAmerican journal of respiratory and critical care medicine
Volume193
Issue number7
DOIs
StatePublished - Apr 1 2016

Keywords

  • Bronchoalveolar lavage
  • Bronchoscopy
  • Cryobiopsy
  • Idiopathic pulmonary fibrosis
  • Interstitial lung diseases

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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    Tomassetti, S., Wells, A. U., Costabel, U., Cavazza, A., Colby, T. V., Rossi, G., Sverzellati, N., Carloni, A., Carretta, E., Buccioli, M., Tantalocco, P., Ravaglia, C., Gurioli, C., Dubini, A., Piciucchi, S., Ryu, J. H., & Poletti, V. (2016). Bronchoscopic lung cryobiopsy increases diagnostic confidence in the multidisciplinary diagnosis of idiopathic pulmonary fibrosis. American journal of respiratory and critical care medicine, 193(7), 745-752. https://doi.org/10.1164/rccm.201504-0711OC