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.
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.
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.
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.