Background
Challenges remain for establishing a specific diagnosis in cases of interstitial lung
disease (ILD). Bronchoscopic lung cryobiopsy (BLC) has impacted the diagnostic impression
and confidence of multidisciplinary discussions (MDDs) in the evaluation of ILD. Reports
indicate that a genomic classifier (GC) can distinguish usual interstitial pneumonia
(UIP) from non-UIP.
Research Question
What is the impact of sequentially presented data from BLC and GC on the diagnostic
confidence of MDDs in diagnosing ILD?
Study Design and Methods
Two MDD teams met to discuss 24 patients with ILD without a definitive UIP pattern.
MDD1 sequentially reviewed clinical-radiologic findings, BLC, and GC. MDD2 sequentially
reviewed GC before BLC. At each step in the process the MDD diagnosis and confidence
level were recorded.
Results
MDD1 had a significant increase in diagnostic confidence, from 43% to 93% (
P = .023), in patients with probable UIP after the addition of GC to BLC. MDD2 had
an increase in diagnostic confidence, from 27% to 73% (
P = .074), after the addition of BLC to GC. The concordance coefficients and percentage
agreement of categorical idiopathic pulmonary fibrosis (IPF) and non-IPF diagnoses
were as follows: GC vs MDD1: 0.92, 96%; GC vs MDD2: 0.83, 92%; BLC1 vs MDD1: 0.67,
83%; BLC2 vs MDD2: 0.66, 83%.
Interpretation
GC increased diagnostic confidence when added to BLC for patients with a probable
UIP pattern, and in appropriate clinical settings can be used without BLC. In contrast,
BLC had the greatest impact regarding a specific diagnosis when the likelihood of
UIP was considered low following clinical-radiographic review.
Key Words
Abbreviations:
BLC ( bronchoscopic lung cryobiopsy), CHP ( chronic hypersensitivity pneumonitis), Dlco ( diffusing capacity of the lungs for carbon monoxide), GC ( genomic classifier), HRCT ( high-resolution CT), ILD ( interstitial lung disease), IPF ( idiopathic pulmonary fibrosis), MDD ( multidisciplinary discussion), OP ( organizing pneumonia), SLB ( surgical lung biopsy), UIP ( usual interstitial pneumonia)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: May 25, 2020
Footnotes
Drs Kheir and Alkhatib contributed equally to this manuscript.
FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.
Identification
Copyright
© 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
