Employing Bronchoscopic Lung Cryobiopsy and a Genomic Classifier in the Multidisciplinary Diagnosis of Diffuse Interstitial Lung Diseases. Chest Kheir, F. n., Alkhatib, A. n., Berry, G. J., Daroca, P. n., Diethelm, L. n., Rampolla, R. n., Saito, S. n., Smith, D. L., Weill, D. n., Bateman, M. n., Abdelghani, R. n., Lasky, J. A. 2020


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