Jürgen Hetzel1,2, Athol U Wells3, Ulrich Costabel4, Thomas V Colby5, Simon L F Walsh6, Johny Verschakelen7, Alberto Cavazza8, Sara Tomassetti9, Claudia Ravaglia9, Michael Böckeler10, Werner Spengler10, Michael Kreuter11,12, Ralf Eberhardt12,13, Kaid Darwiche14, Alfons Torrego15, Virginia Pajares15, Rainer Muche16, Regina Musterle10, Marius Horger17, Falko Fend18, Arne Warth19,20, Claus Peter Heußel12,21, Sara Piciucchi22, Alessandra Dubini23, Dirk Theegarten24, Tomas Franquet25, Enrique Lerma26, Venerino Poletti9,27, Maik Häntschel10,2. 1. Dept of Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany juergen.hetzel@med.uni-tuebingen.de. 2. Division of Internal Medicine, Dept of Pneumology, Kantonsspital Winterthur, Winterthur, Switzerland. 3. Interstitial Lung Disease Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, UK. 4. Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, University of Duisburg-Essen, Essen, Germany. 5. Dept of Pathology and Laboratory Medicine (retired), Mayo Clinic, Scottsdale, AZ, USA. 6. Dept of Radiology, National Heart and Lung Institute, Imperial College, London, UK. 7. Dept of Radiology, University Hospitals Leuven, Leuven, Belgium. 8. Dept of Pathology, Azienda USL/IRCCS di Reggio Emilia, Reggio Emilia, Italy. 9. Dept of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy. 10. Dept of Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany. 11. Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, Heidelberg, Germany. 12. Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research (DZL), Heidelberg, Germany. 13. Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany. 14. Dept of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Essen, Germany. 15. Respiratory Dept, Hospital de la Santa Creu I Sant Pau (HSCSP), Barcelona, Spain. 16. Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany. 17. Dept for Diagnostic and Interventional Radiology, Eberhard-Karls University, Tübingen, Germany. 18. Institute of Pathology and Neuropathology, Reference Center for Hematopathology University Hospital, Tuebingen Eberhard-Karls-University, Tübingen, Germany. 19. Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany. 20. Institute for Pathology, Wetzlar, Germany. 21. Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany. 22. Dept of Radiology, Ospedale GB Morgagni, Forlì, Italy. 23. Dept of Pathology, Ospedale GB Morgagni, Forlì, Italy. 24. Dept of Pathology, University Medicine Essen - Ruhrlandklinik, University Duisburg-Essen, Essen, Germany. 25. Radiology Dept, Hospital de la Santa Creu I Sant Pau (HSCSP), Barcelona, Spain. 26. Pathology Dept, Hospital de la Santa Creu I Sant Pau (HSCSP), Barcelona, Spain. 27. Dept of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
Abstract
INTRODUCTION: The accurate diagnosis of individual interstitial lung diseases (ILD) is often challenging, but is a critical determinant of appropriate management. If a diagnosis cannot be made after multidisciplinary team discussion (MDTD), surgical lung biopsy is the current recommended tissue sampling technique according to the most recent guidelines. Transbronchial lung cryobiopsy (TBLC) has been proposed as an alternative to surgical lung biopsy. METHODS: This prospective, multicentre, international study analysed the impact of TBLC on the diagnostic assessment of 128 patients with suspected idiopathic interstitial pneumonia by a central MDTD board (two clinicians, two radiologists, two pathologists). The level of confidence for the first-choice diagnoses were evaluated in four steps, as follows: 1) clinicoradiological data alone; 2) addition of bronchoalveolar lavage (BAL) findings; 3) addition of TBLC interpretation; and 4) surgical lung biopsy findings (if available). We evaluated the contribution of TBLC to the formulation of a confident first-choice MDTD diagnosis. RESULTS: TBLC led to a significant increase in the percentage of cases with confident diagnoses or provisional diagnoses with high confidence (likelihood ≥70%) from 60.2% to 81.2%. In 32 out of 52 patients nondiagnostic after BAL, TBLC provided a diagnosis with a likelihood ≥70%. The percentage of confident diagnoses (likelihood ≥90%) increased from 22.7% after BAL to 53.9% after TBLC. Pneumothoraces occurred in 16.4% of patients, and moderate or severe bleeding in 15.7% of patients. No deaths were observed within 30 days. INTERPRETATION: TBLC increases diagnostic confidence in the majority of ILD patients with an uncertain noninvasive diagnosis, with manageable side-effects. These data support the integration of TBLC into the diagnostic algorithm for ILD.
INTRODUCTION: The accurate diagnosis of individual interstitial lung diseases (ILD) is often challenging, but is a critical determinant of appropriate management. If a diagnosis cannot be made after multidisciplinary team discussion (MDTD), surgical lung biopsy is the current recommended tissue sampling technique according to the most recent guidelines. Transbronchial lung cryobiopsy (TBLC) has been proposed as an alternative to surgical lung biopsy. METHODS: This prospective, multicentre, international study analysed the impact of TBLC on the diagnostic assessment of 128 patients with suspected idiopathic interstitial pneumonia by a central MDTD board (two clinicians, two radiologists, two pathologists). The level of confidence for the first-choice diagnoses were evaluated in four steps, as follows: 1) clinicoradiological data alone; 2) addition of bronchoalveolar lavage (BAL) findings; 3) addition of TBLC interpretation; and 4) surgical lung biopsy findings (if available). We evaluated the contribution of TBLC to the formulation of a confident first-choice MDTD diagnosis. RESULTS:TBLC led to a significant increase in the percentage of cases with confident diagnoses or provisional diagnoses with high confidence (likelihood ≥70%) from 60.2% to 81.2%. In 32 out of 52 patients nondiagnostic after BAL, TBLC provided a diagnosis with a likelihood ≥70%. The percentage of confident diagnoses (likelihood ≥90%) increased from 22.7% after BAL to 53.9% after TBLC. Pneumothoraces occurred in 16.4% of patients, and moderate or severe bleeding in 15.7% of patients. No deaths were observed within 30 days. INTERPRETATION:TBLC increases diagnostic confidence in the majority of ILDpatients with an uncertain noninvasive diagnosis, with manageable side-effects. These data support the integration of TBLC into the diagnostic algorithm for ILD.
Authors: Katrin E Hostettler; Michael Tamm; Lukas Bubendorf; Peter Grendelmeier; Kathleen Jahn; Daiana Stolz; Jens Bremerich; Spasenija Savic Prince Journal: Respir Res Date: 2021-08-14
Authors: Maik Häntschel; Ralf Eberhardt; Christoph Petermann; Wolfgang Gesierich; Kaid Darwiche; Lars Hagmeyer; Thomas V Colby; Falko Fend; Dirk Theegarten; Hanns-Olof Wintzer; Michael Kreuter; Werner Spengler; Annika Felicitas Behrens-Zemek; Richard A Lewis; Henry C Evrard; Ahmed Ehab; Michael Böckeler; Jürgen Hetzel Journal: J Clin Med Date: 2021-12-02 Impact factor: 4.241
Authors: Sara Tomassetti; Thomas V Colby; Athol U Wells; Venerino Poletti; Ulrich Costabel; Marco Matucci-Cerinic Journal: Ther Adv Musculoskelet Dis Date: 2021-12-08 Impact factor: 5.346