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Original Research |

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

Jamie S. Sheth, MD; John A. Belperio, MD; Michael C. Fishbein, MD; Ella A. Kazerooni, MD MS; Amir Lagstein, MD; Susan Murray, ScD; Jeff L. Myers, MD; Richard H. Simon, MD; Thomas H. Sisson, MD; Baskaran Sundaram, MD; Eric S. White, MD; Meng Xia, MS; David Zisman, MD; Kevin R. Flaherty, MD
Author and Funding Information

Author Disclosures:

J.S.S. Dr. Sheth has nothing to disclose.

J.A.B. Dr. Belperio has nothing to disclose.

M.C.F. Dr. Fishbein has nothing to disclose.

E.A.K. Dr. Kazerooni has nothing to disclose.

A.L. Dr. Lagstein has nothing to disclose.

S.M. Dr. Murray has nothing to disclose.

J.L.M Dr. Myers has nothing to disclose.

R.H.S. Dr. Simon has nothing to disclose.

T.H.S. Dr. Sisson has nothing to disclose.

B.S. Dr. Sundaram has nothing to disclose.

E.S.W. Dr. White has nothing to disclose.

M.X. Ms. Xia has nothing to disclose.

D.Z. Dr. Zisman is a member of the speaker bureau and advisory boards for Genentech and Boehringer Ingelheim.

K.R.F. Dr. Flaherty has nothing to disclose.

Funding Information: National Institutes of Health NHLBI grants R01 HL91743, T32 HL00749 and K24 HL111316 (Kevin R. Flaherty)

1Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan

2Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, California

3Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA

4Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan

5Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan

6Division of Cardiothoracic Imaging, Department of Radiology, Thomas Jefferson University, Philadelphia, PA

7Pulmonary and Critical Care Consultants, Sansum Clinic, Santa Barbara, CA and Adjunct Clinical Associate Professor of Medicine at University of Southern California

8Department of Biostatistics, University of Michigan, Ann Arbor, Michigan

Corresponding Author: Jamie S. Sheth, MD, 1500 E. Medical Center Drive 3916 Taubman Center, Ann Arbor, MI 48109-5360.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.09.028
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Published online

Abstract

Background  Surgical lung biopsy (SLB) is invasive and not possible in all patients with undiagnosed interstitial lung diseases (ILD). We hypothesized that transbronchial biopsy (TBB) findings combined with clinical and high resolution computed tomography (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 evaluated for suspected ILD who underwent HRCT, TBB and SLB. First, clinicians, radiologists and a pathologist reviewed the clinical information, HRCT and TBB. Clinicians were asked to provide a diagnosis, and if SLB was needed for 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 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 (i.e. would not recommend SLB) in 6 cases. In these cases there was 100% agreement between TBB and SLB diagnoses. Usual interstitial pneumonia was the most common diagnosis (n=3) and was associated with an HRCT diagnosis of possible UIP/NSIP-like. Agreement was poor (33%) between TBB and SLB diagnosis when confidence in 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 20-30% of patients with ILD.


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