In interstitial lung disease (ILD) cases needing histology, the diagnostic concordance of transbronchial lung cryobiopsy (TBLC) against surgical lung biopsy (SLB) as the current gold standard remains debatable. To determine the diagnostic concordance of TBLC and SLB done sequentially in the same patients, the diagnostic yield of both procedures, and changes in multidisciplinary assessment (MDA) judgments.
Patients with ILD who had a nondefinite typical interstitial pneumonia pattern (on a high-resolution computed tomography scan) confirmed at a first MDA were enrolled in two-center prospective research. At the same anatomical regions, patients had TBLC followed by video-assisted thoracoscopy for SLB. Anonymized TBLC and SLB slides were blinded examined by an external expert pathologist after open reading of both sample types by local pathologists and final diagnosis at a second MDA. TBLC versus SLB, MDA2 versus TBLC, MDA2 versus SLB, blinded pathology versus chronic pathology, Kappa-concordance coefficients, and percentage agreement were calculated. There were twenty-one patients in total. The longest axis of the median TBLC biopsy was 7 mm (interquartile range, 5–8 mm). The average dimensions of an SLB biopsy were 46.1 x 13.8 mm. TBLC versus SLB: = 0.22 (95% CI, 0.01–0.44), percentage agreement = 38% (95% CI, 18–62%); MDA2 versus TBLC: = 0.31 (95% CI, 0.06–0.56), percentage agreement=48% (95% CI, 26–70) %; MDA2 versus SLB: = 0.51 (95% CI, 0.27–0.75), percentage agreement = 62% (95% If SLB had not been conducted in 11 of the 21 cases (52%), TBLC would have resulted in a different treatment. In the assessment of ILD, the pathological results from TBLC and SLB were inconclusive. The final diagnosis at MDA was more commonly concordant with SLBs.
Reference:www.atsjournals.org/doi/full/10.1164/rccm.201810-1947OC
