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Original Research: Diffuse Lung Disease |

Utility of Transbronchial vs 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; 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

FUNDING/SUPPORT: This work was supported by National Institutes of Health NHLBI [grants R01 HL91743, T32 HL00749, and K24 HL111316 (K. R. F.)].

aDivision of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, MI

bDivision of Cardiothoracic Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, MI

cDepartment of Pathology, University of Michigan Health System, Ann Arbor, MI

dDepartment of Biostatistics, University of Michigan Health System, Ann Arbor, MI

eDivision of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, Los Angeles, Los Angeles, CA

fDepartment of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA

gDivision of Cardiothoracic Imaging, Department of Radiology, Thomas Jefferson University, Philadelphia, PA

hPulmonary and Critical Care Consultants, Sansum Clinic, Santa Barbara, CA and Department of Medicine, University of Southern California, Los Angeles, CA

CORRESPONDENCE TO: Jamie S. Sheth, MD, 1500 E Medical Center Dr, 3916 Taubman Center, Ann Arbor, MI 48109-5360


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(2):389-399. doi:10.1016/j.chest.2016.09.028
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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.

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