Poor Concordance between Sequential Transbronchial Lung Cryobiopsy and Surgical Lung Biopsy in the Diagnosis of Diffuse Interstitial Lung Diseases

Abstract

Rationale: The diagnostic concordance between transbronchial lung cryobiopsy (TBLC)-versus surgical lung biopsy (SLB) as the current gold standard-in interstitial lung disease (ILD) cases requiring histology remains controversial. Objectives: To assess diagnostic concordance between TBLC and SLB sequentially performed in the same patients, the diagnostic yield of both techniques, and subsequent changes in multidisciplinary assessment (MDA) decisions. Methods: A two-center prospective study included patients with ILD with a nondefinite usual interstitial pneumonia pattern (on highresolution computed tomography scan) confirmed at a first MDA. Patients underwent TBLC immediately followed by video-assisted thoracoscopy for SLB at the same anatomical locations. After open reading of both sample types by local pathologists and final diagnosis at a second MDA (MDA2), anonymized TBLC and SLB slides were blindly assessed by an external expert pathologist (T.V.C.). Kappaconcordance coefficients and percentage agreement were computed for: TBLC versus SLB, MDA2 versus TBLC, MDA2 versus SLB, and blinded pathology versus routine pathology. Measurements and Main Results: Twenty-one patients were included. The median TBLC biopsy size (longest axis) was 7 mm (interquartile range, 5-8 mm). SLB biopsy sizes averaged 46.1 6 13.8 mm. Concordance coefficients and percentage agreement were: TBLC versus SLB: k = 0.22 (95% confidence interval [CI], 0.01-0.44), percentage agreement = 38% (95% CI, 18-62%); MDA2 versus TBLC: k = 0.31 (95% CI, 0.06-0.56), percentage agreement = 48% (95% CI, 26-70)%; MDA2 versus SLB: k = 0.51 (95% CI, 0.27-0.75), percentage agreement = 62% (95% CI, 38-82%); two pneumothoraces (9.5%) were recorded during TBLC. TBLC would have led to a different treatment if SLB was not performed in 11 of 21 (52%) of cases. Conclusions: Pathological results from TBLC and SLB were poorly concordant in the assessment of ILD. SLBs were more frequently concordant with the final diagnosis retained at MDA.

S2K-Leitlinie zur Diagnostik der idiopathischen Lungenfibrose

“…2 prospektive Studien analysierten die Übereinstimmung mittels TBLC und SLB gewonnener Proben; in beiden Studien folgte die SLB unmittelbar einer TBLC in der gleichen Sitzung. Die Studie von Romagnoli fand bei n = 21 eingeschlossenen Patienten in 2 Zentren eine Übereinstimmung der histopathologischen Resultate mit einem: κ = 0,22 (95 % KI, 0,01 -0,44) und schlussfolgerte, dass wenn eine SLB nach TBLC nicht stattgefunden hätte, in 51 % der Fälle eine andere Diagnose und demzufolge Therapie erfolgt wäre [133]. Die multizentrische Studie von Troy et al zeigte hingegen bei n = 65 Patienten eine histopathologische Übereinstimmung zwischen TBLC und SLB von 70,8 %, κ 0,70 (95 % KI, 0,55 -0,86).…”

Enfermedades pulmonares intersticiales. Una perspectiva actual

“…La biopsia transbronquial puede permitir el diagnóstico de otras entidades como la sarcoidosis y la neumonía en organización, pero difícilmente permite diagnosticar FPI. El papel de la criobiopsia es controvertido, con estudios no aleatorizados que muestran rendimientos diagnósticos variables y complicaciones asociadas [27][28][29] . 2) Discordancia mayor entre información clínica, radiológica y patológica, lo que puede ocurrir en las siguientes situaciones: a) terapia previa que altera el patrón radiológico o histológico (ejemplo: DIP luego de terapia con esteroides); b) entidad nueva o variantes raras de enfermedades reconocidas que no han sido adecuadamente caracterizadas; c) patrones diversos en la TAC o en la histología, lo que puede ocurrir en pacientes con NII.…”

Usefulness of Surgical Lung Biopsies after Cryobiopsies when Pathological Results Are Inconclusive or show a Pattern Suggestive of a Nonspecific Interstitial Pneumonia

“…Interestingly, whereas many data support the use of TBLC for the diagnosis of DPLDs, only three studies compared the result of TBLC and SLB performed in a same patient. A rst study was conducted on a limited number of patients (seven) [12] while the other two were conducted on a larger cohort, both providing con icting results concerning the agreement between TBLC and SLB for histological diagnoses [13,14]. Nevertheless, the COLDICE study [14] was the biggest and the unique multicentric study showing a high level of agreement between TBLC and SLB for both histopathological interpretation and MDD diagnoses.…”

“…A rst study was conducted on a limited number of patients (seven) [12] while the other two were conducted on a larger cohort, both providing con icting results concerning the agreement between TBLC and SLB for histological diagnoses [13,14]. Nevertheless, the COLDICE study [14] was the biggest and the unique multicentric study showing a high level of agreement between TBLC and SLB for both histopathological interpretation and MDD diagnoses. In these studies, limited data are available concerning nondiagnostics TBLCs or TBLCs showing a pattern suggestive of a NSIP, two situations in which SLB could particularly provide substantial additional information.…”