Bronchoscopic Lung Cryobiopsy Increases Diagnostic Confidence in the Multidisciplinary Diagnosis of Idiopathic Pulmonary Fibrosis

Tomassetti, Sara; Wells, Athol U.; Costabel, Ulrich; Cavazza, Alberto; Colby, Thomas V.; Rossi, Giulio; Sverzellati, Nicola; Carloni, Angelo; Carretta, Elisa; Buccioli, Matteo; Tantalocco, Paola; Ravaglia, Claudia; Gurioli, Carlo; Dubini, Alessandra; Piciucchi, Sara; Ryu, Jay H.; Poletti, Venerino

doi:10.1164/rccm.201504-0711oc

Cited by 312 publications

(246 citation statements)

References 32 publications

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“…However, direct patient contact in a study of this size would have been impracticable. Our methodology of web-based case reviews is instead similar to that of previously published studies of diagnostic agreement and accuracy between MDT meetings [15,20,26]. Second, physicians who completed the study were more likely to be fellowship trained, work at university institutions, attend MDT meetings and diagnose more cases of IPF per month.…”

Section: Discussionmentioning

confidence: 93%

Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: an international case–cohort study

et al. 2017

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We conducted an international study of idiopathic pulmonary fibrosis (IPF) diagnosis among a large group of physicians and compared their diagnostic performance to a panel of IPF experts.A total of 1141 respiratory physicians and 34 IPF experts participated. Participants evaluated 60 cases of interstitial lung disease (ILD) without interdisciplinary consultation. Diagnostic agreement was measured using the weighted kappa coefficient (κw). Prognostic discrimination between IPF and other ILDs was used to validate diagnostic accuracy for first-choice diagnoses of IPF and were compared using the C-index.A total of 404 physicians completed the study. Agreement for IPF diagnosis was higher among expert physicians (κw=0.65, IQR 0.53–0.72, p<0.0001) than academic physicians (κw=0.56, IQR 0.45–0.65, p<0.0001) or physicians with access to multidisciplinary team (MDT) meetings (κw=0.54, IQR 0.45–0.64, p<0.0001). The prognostic accuracy of academic physicians with >20 years of experience (C-index=0.72, IQR 0.0–0.73, p=0.229) and non-university hospital physicians with more than 20 years of experience, attending weekly MDT meetings (C-index=0.72, IQR 0.70–0.72, p=0.052), did not differ significantly (p=0.229 and p=0.052 respectively) from the expert panel (C-index=0.74 IQR 0.72–0.75).Experienced respiratory physicians at university-based institutions diagnose IPF with similar prognostic accuracy to IPF experts. Regular MDT meeting attendance improves the prognostic accuracy of experienced non-university practitioners to levels achieved by IPF experts.

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Section: Discussionmentioning

confidence: 93%

Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: an international case–cohort study

et al. 2017

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“…The diagnostic yield and complication rates of TBLC for ILD have been reported in 10 publications from 8 distinct cohorts, [64][65][66][67][68][69][70][71][72][73][74] although there was significant heterogeneity among studies (eg, patient population, method of sedation, flexible vs. rigid bronchoscope, method of determining the diagnosis). The reported diagnostic yield ranges from 51%-98% when TBLC is guided by HRCT and real-time fluoroscopy, varying by whether the diagnostic yield is reported based on pathological findings assessed in isolation or whether biopsies were reviewed in a MDD.…”

Section: Key Messages: Surgical Lung Biopsymentioning

confidence: 99%

“…Conversely, IPF was the most frequent MDD diagnosis after TBLC in a recent retrospective study of TBLC and SLBx in fibrotic ILD. 70 There is significant heterogeneity in the reported complications following TBLC with pneumothorax rates ranging from 0%-33% 64,67,70,73 and moderate to severe bleeding ranging from 0%-78%. 66,67,69,71 It is unclear whether this heterogeneity reflects differences in study populations, reporting standards, procedural techniques and/or operator expertise.…”

Section: Key Messages: Surgical Lung Biopsymentioning

confidence: 99%

Evaluation of patients with fibrotic interstitial lung disease: A Canadian Thoracic Society position statement

Johannson

Kolb

Fell

et al. 2017

Canadian Journal of Respiratory, Critical Care, and Sleep Medic

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“…For practical reasons and concerns about patient safety, trials performing consecutive TBCx and SLB in the same patient have not yet been completed and, given the high diagnostic yield and low complication rate of TBCx compared to SLB, seem unlikely to be proposed to patients in the future. Our group recently published a study [34] comparing TBCx and SLB in a consecutive series of 117 patients (58 TBCx and 59 SLB) with fibrotic ILDs (all without definite UIP on HRCT). We applied the methodology of FLAHERTY et al [24] to estimate the diagnostic impact of TBCx for the diagnosis of IPF in the multidisciplinary discussion process.…”

Section: Multidisciplinary Diagnosis Of Dplds: All That Glitters Is Nmentioning

confidence: 99%

Diffuse parenchymal lung disease

Tomassetti¹,

Ravaglia²,

Poletti

2017

Eur Respir Rev

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Between September 2015 and August 2016 there were >1500 publications in the field of diffuse parenchymal lung diseases (DPLDs). For the Clinical Year in Review session at the European Respiratory Society Congress that was held in London, UK, in September 2016, we selected only five articles. This selection, made from the enormous number of published papers, does not include all the relevant studies that will significantly impact our knowledge in the field of DPLDs in the near future. This review article provides our personal view on the following topics: early diagnosis of idiopathic pulmonary fibrosis, current knowledge on the multidisciplinary team diagnosis of DPLDs and the diagnostic role of transbronchial cryobiopsy in this diagnostic setting, insights on the new entity of interstitial pneumonia with autoimmune features, and new therapeutic approaches for scleroderma-related interstitial lung disease.

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Bronchoscopic Lung Cryobiopsy Increases Diagnostic Confidence in the Multidisciplinary Diagnosis of Idiopathic Pulmonary Fibrosis

Cited by 312 publications

References 32 publications

Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: an international case–cohort study

Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: an international case–cohort study

Evaluation of patients with fibrotic interstitial lung disease: A Canadian Thoracic Society position statement

Diffuse parenchymal lung disease

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