Abstract

Challenges remain for establishing a specific diagnosis in cases of ILD. Bronchoscopic lung cryobiopsy (BLC) has impacted the diagnostic impression and confidence of multidisciplinary discussions (MDD) in the evaluation of ILD. Recent reports indicate that a genomic classifier (GC) can distinguish UIP from non-UIP.This study aimed to address the impact of sequentially presented data from BLC and GC on the diagnostic confidence of the MDD in ILD.and Methods: Two MDDs 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 prior to BLC. At each step in the process the MDD diagnosis and confidence level were recorded.MDD1 had a significant increase in diagnostic confidence from 43 to 93% (P = 0.023) in patients with probable UIP after the addition of GC to BLC. MDD2 had an increase in diagnostic confidence from 27 to 73% (P = 0.074) after the addition of BLC to GC. The concordance coefficients and percentage agreement of categorical IPF and non-IPF diagnoses were GC versus MDD1: 0.92, 96%; GC versus MDD2: 0.83, 92%; BLC1 versus MDD1: 0.67, 83%; BLC2 versus MDD2: 0.66, 83%.GC increased the diagnostic confidence when added to BLC in 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 in cases wherein the likelihood of UIP was considered low following clinical-radiographic review.

View details for DOI 10.1016/j.chest.2020.05.532

View details for PubMedID 32464189