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Transbronchial Biopsy and Usual Interstitial Pneumonia: A Step Forward in Disease Management FREE TO VIEW

David A. Zisman, MD, FCCP; Anna-Luise A. Katzenstein, MD, FCCP
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Affiliations: David Geffen School of Medicine at UCLA, Los Angeles, CA,  SUNY Upstate Medical University, Syracuse, NY

Correspondence to: David A. Zisman, MD, FCCP, David Geffen School of Medicine at UCLA, Pulmonary & Critical Care Medicine, 10833 Le Conte Ave, 37-131 CHS, Los Angeles, CA 90095; e-mail dzisman@mednet.ucla.edu



Chest. 2006;130(5):1628-1629. doi:10.1378/chest.130.5.1628
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To the Editor:

We believe that Drs. Mukherjee and Spiteri misinterpreted the message of our article (May 2006).1This work was intended to highlight a hypothesis that will require further testing. It was not intended to generate a clinical recommendation to use transbronchial lung biopsies (TBBs) to diagnose usual interstitial pneumonia (UIP). In our article, we clearly stated that TBBs should be tested in a blinded fashion, and in a cohort of patients with diffuse lung diseases, including UIP and non-UIP cases. However, it is undeniable, as we show in several of our figures, and despite the relatively small sizes of the TBB specimens, that in patients with well-characterized UIP from surgical or explanted lung specimens, features specific for UIP such as a patchwork pattern of interstitial fibrosis, fibroblastic foci, and honeycomb change23 are readily recognizable in many TBB specimens.3We agree that in these small specimens one may not identify discordant pathology. However, since the prognosis associated with “discordant” or “concordant” UIP is the same, recognizing the UIP findings will dictate the ultimate prognosis.4We believe that these finding are quite important and should be considered as a step forward, not backward as suggested by Mukherjee and Spiteri. Unfortunately, it has become widely accepted, despite a lack of convincing evidence, that TBBs are not useful in diagnosing idiopathic interstitial pneumonias. However, if in the future TBBs are proven to be useful in diagnosing UIP from a pool of patients with diverse diffuse lung diseases, many unnecessary surgical lung biopsy procedures, with the associated morbidity, mortality, and cost, could be prevented.5 Our study plants the seeds for what could turn out to be a very important step forward in the field.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Berbescu, E, Katzenstein, AL, Snow, J, et al (2006) Transbronchial biopsy in usual interstitial pneumonia.Chest129,1126-1131. [CrossRef]
 
Katzenstein, A-LA, Myers, JL Idiopathic pulmonary fibrosis: clinical relevance of pathologic classification.Am J Respir Crit Care Med1998;157,1301-1315. [CrossRef]
 
Katzenstein, A-LA, Zisman, DA, Litzky, LA, et al Usual interstitial pneumonia: histologic study of biopsy and explant specimens.Am J Surg Pathol2002;26,1567-1577. [CrossRef]
 
Flaherty, KR, Travis, WD, Colby, TV, et al Histopathologic variability in usual and nonspecific interstitial pneumonias.Am J Respir Crit Care Med2001;164,1722-1727. [CrossRef]
 
Utz, JP, Ryu, JH, Douglas, WW, et al High short-term mortality following lung biopsy for usual interstitial pneumonia.Eur Respir J2001;17,175-179. [CrossRef]
 

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References

Berbescu, E, Katzenstein, AL, Snow, J, et al (2006) Transbronchial biopsy in usual interstitial pneumonia.Chest129,1126-1131. [CrossRef]
 
Katzenstein, A-LA, Myers, JL Idiopathic pulmonary fibrosis: clinical relevance of pathologic classification.Am J Respir Crit Care Med1998;157,1301-1315. [CrossRef]
 
Katzenstein, A-LA, Zisman, DA, Litzky, LA, et al Usual interstitial pneumonia: histologic study of biopsy and explant specimens.Am J Surg Pathol2002;26,1567-1577. [CrossRef]
 
Flaherty, KR, Travis, WD, Colby, TV, et al Histopathologic variability in usual and nonspecific interstitial pneumonias.Am J Respir Crit Care Med2001;164,1722-1727. [CrossRef]
 
Utz, JP, Ryu, JH, Douglas, WW, et al High short-term mortality following lung biopsy for usual interstitial pneumonia.Eur Respir J2001;17,175-179. [CrossRef]
 
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