Transbronchial lung biopsy in patients with diffuse parenchymal lung disease without 'idiopathic pulmonary fibrosis pattern' on HRCT scan - Experience from a tertiary care center of North India

Abstract

Background:Diffuse parenchymal lung diseases (DPLD) are a group of disorders characterized by chest radiological findings of bilateral diffuse shadowing. Lung biopsy is generally required to make an etiological diagnosis of DPLD's. Transbronchial lung biopsy (TBLB) is a minimally invasive method to achieve a lung sample which has been found to be a useful diagnostic tool in patients with DPLD. As per American Thoracic Society guidelines for management of idiopathic interstitial pneumonias, TBLB is not required in patients who have findings consistent with idiopathic pulmonary fibrosis (IPF) on HRCT scan thorax. Some Indian researchers have evaluated, on a small number of subjects, the role of TBLB in patients with DPLD, but they had not excluded patients with ‘IPF pattern’. This study was planned to assess TBLB in patients with DPLD after excluding patients with ‘IPF pattern’.Materials and Methods:A prospective non-randomized study on 49 patients with DPLD without a characteristic ‘IPF pattern’ were subjected to TBLB.Results:The overall diagnostic yield of TBLB was 85.7%. Non-specific interstitial pneumonitis, tuberculosis and sarcoidosis were the most common histology patterns found (22.4, 18.4 and 16.3%, respectively). Procedure-related mortality was nil. Iatrogenic pneumothorax occurred in five patients (10.2%). Minor complications included hemorrhage and transient hypoxia.Conclusion:TBLB is a safe and effective tool in the diagnosis of DPLD.

Pneumothorax After Transbronchial Biopsy in Pulmonary Fibrosis: Lessons from the Multicenter COMET Trial

“…Among all spontaneously breathing patients undergoing bronchoscopy with TBB, the reported risk of pneumothorax ranges from 1–6% (Table 2) [3,10–33]. In a study by Sindhwani and others transbronchial biopsies were performed only in patients with diffuse parenchymal lung disease (without a definite UIP pattern) on CT scan [37]. This study reported a 10% incidence of iatrogenic PTX following TBB, which is higher than previously reported rates for all spontaneously breathing subjects undergoing the procedure.…”

Management of interstitial lung diseases: A consensus statement of the Indian Chest Society (ICS) and National College of Chest Physicians (NCCP)

“…The diagnostic yield of a TBLB specimen is high in ILD with a peribronchovascular or centrilobular pattern of distribution such as sarcoidosis, HP, PAP, lymphangitis carcinomatosis, and alveolar microlithiasis. [ 19 ] Recent reports suggest the utility of TBLB for molecular diagnosis of UIP. [ 20 21 ]…”

“…[ 22 ] Bleeding (1%–4%), pneumothorax (1%–6%), and mortality (<0.05%) constitute the main complications. [ 16 19 23 ]…”

Transbronchial lung biopsy in diffuse parenchymal lung disease - Question still remains whether to go for surgical lung biopsy or not?

“…We read with interest the original article titled, “Transbronchial lung biopsy (TBLB) in patients with diffuse parenchymal lung disease (DPLD) without ‘idiopathic pulmonary fibrosis (IPF) pattern’ on high resolution computed tomography scan–Experience from a tertiary care centre of North India” by Sindhwani et al . [ 1 ] First, we would like to congratulate the authors for their excellent diagnostic yield of TBLB (85.6%). According to the earlier published literature, in DPLD, histological support for a specific diagnosis can be obtained using TBLB in 29–79% of cases only.…”