Wendy A Cooper1,2,3, Annabelle Mahar1, Jeffrey L Myers4, Christopher Grainge5, Tamera J Corte6,2,7, Jonathan P Williamson8,9, Michael P Vallely2, Simon Lai10, Ellie Mulyadi10, Paul J Torzillo6,2, Martin J Phillips9,11, Edmund M T Lau6,2, Ganesh Raghu12, Lauren K Troy6,2. 1. Tissue Pathology and Diagnostic Oncology, New South Wales Health Pathology. 2. Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia. 3. School of Medicine, Western Sydney University, Sydney, New South Wales, Australia. 4. Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan. 5. Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia. 6. Respiratory and Sleep Medicine, and. 7. Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia. 8. Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia. 9. Macquarie Health, Respiratory and Sleep, Macquarie University Hospital, Sydney, New South Wales, Australia. 10. Department of Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. 11. Respiratory and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and. 12. Division of Pulmonary, Sleep, and Critical Care Medicine, University of Washington, Seattle, Washington.
Abstract
Rationale: Transbronchial lung cryobiopsy (TBLC) is an emerging technique for interstitial lung disease diagnosis. Good histopathologic agreement between TBLC and surgical lung biopsy (SLB) was demonstrated in the COLDICE (Cryobiopsy versus Open Lung Biopsy in the Diagnosis of Interstitial Lung Disease Alliance) study; however, diagnostic confidence was frequently lower for TBLC than SLB. Objectives: To characterize specific features of TBLC predictive of usual interstitial pneumonia (UIP) in corresponding SLB and to identify clinical indices predictive of biopsy concordance. Methods: The COLDICE study was a prospective, multicenter study investigating diagnostic agreement between TBLC and SLB. The participants underwent both procedures with blinded pathologist analysis of specimens, applying international guideline criteria. The TBLC features predictive of UIP in the paired SLB and predictive features of overall concordance were analyzed. Measurements and Main Results: A total of 65 patients (66.1 ± 9.3 yr; FVC, 84.7 ± 14.2%; DlCO, 63.4 ± 13.8%) participated in the COLDICE study. UIP was identified in 33/65 (50.8%) SLB, and 81.5% were concordant with corresponding TBLC (κ, 0.61; 95% confidence interval [CI], 0.38-0.77). The UIP guideline criteria of "predominantly subpleural or paraseptal fibrosis" was infrequently reported in TBLC (8/33, 24.2%), whereas "patchy fibrosis," "fibroblast foci," and the "absence of alternative diagnostic features" were frequently observed in TBLC. The combination of these three features strongly predicted UIP in paired SLB (odds ratio [OR], 23.4; 95% CI, 6.36-86.1; P < 0.0001). Increased numbers of TBLC samples predicted histopathologic concordance with SLB (OR, 1.8; 95% CI, 1.08-3.01; P = 0.03). The predictors of discordance included older age, family history, and radiologic asymmetry. Conclusions: Subpleural and/or paraseptal fibrosis were not essential for diagnosing UIP in TBLC, provided that other guideline criteria features were present. The diagnostic accuracy of TBLC was strengthened when increased numbers of samples were taken. Clinical trial registered with www.anzctr.org.au (ACTRN12615000718549).
Rationale: Transbronchial lung cryobiopsy (TBLC) is an emerging technique for interstitial lung disease diagnosis. Good histopathologic agreement between TBLC and surgical lung biopsy (SLB) was demonstrated in the COLDICE (Cryobiopsy versus Open Lung Biopsy in the Diagnosis of Interstitial Lung Disease Alliance) study; however, diagnostic confidence was frequently lower for TBLC than SLB. Objectives: To characterize specific features of TBLC predictive of usual interstitial pneumonia (UIP) in corresponding SLB and to identify clinical indices predictive of biopsy concordance. Methods: The COLDICE study was a prospective, multicenter study investigating diagnostic agreement between TBLC and SLB. The participants underwent both procedures with blinded pathologist analysis of specimens, applying international guideline criteria. The TBLC features predictive of UIP in the paired SLB and predictive features of overall concordance were analyzed. Measurements and Main Results: A total of 65 patients (66.1 ± 9.3 yr; FVC, 84.7 ± 14.2%; DlCO, 63.4 ± 13.8%) participated in the COLDICE study. UIP was identified in 33/65 (50.8%) SLB, and 81.5% were concordant with corresponding TBLC (κ, 0.61; 95% confidence interval [CI], 0.38-0.77). The UIP guideline criteria of "predominantly subpleural or paraseptal fibrosis" was infrequently reported in TBLC (8/33, 24.2%), whereas "patchy fibrosis," "fibroblast foci," and the "absence of alternative diagnostic features" were frequently observed in TBLC. The combination of these three features strongly predicted UIP in paired SLB (odds ratio [OR], 23.4; 95% CI, 6.36-86.1; P < 0.0001). Increased numbers of TBLC samples predicted histopathologic concordance with SLB (OR, 1.8; 95% CI, 1.08-3.01; P = 0.03). The predictors of discordance included older age, family history, and radiologic asymmetry. Conclusions: Subpleural and/or paraseptal fibrosis were not essential for diagnosing UIP in TBLC, provided that other guideline criteria features were present. The diagnostic accuracy of TBLC was strengthened when increased numbers of samples were taken. Clinical trial registered with www.anzctr.org.au (ACTRN12615000718549).
Authors: Christina Bal; Casper Falster; Andre Carvalho; Nicole Hersch; Judith Brock; Christian B Laursen; Simon Walsh; Jouke Annema; Daniela Gompelmann Journal: ERJ Open Res Date: 2022-05-23
Authors: Manuel L Ribeiro Neto; Andrea Valeria Arrossi; Ruchi Yadav; Daniel A Culver; Sanjay Mukhopadhyay; Joseph G Parambil; Brian D Southern; Leslie Tolle; Aman Pande; Francisco A Almeida; Debasis Sahoo; Jessica Glennie; Usman Ahmad; Atul C Mehta; Thomas R Gildea Journal: BMC Pulm Med Date: 2022-06-02 Impact factor: 3.320