title: Evaluation of the use of transbronchial biopsy in patients with clinical suspicion of interstitial lung disease.
abstract: OBJECTIVE
  To study the clinical, radiological, and histopathological patterns of transbronchial biopsy (TBB) used in order to confirm the diagnosis in patients with clinical suspicion of interstitial lung disease (ILD) treated at a tertiary-care university hospital.
  
  
  METHODS
  We reviewed the medical records, radiology reports, and reports of transbronchial biopsies from all patients with suspected ILD who underwent TBB between January of 1999 and December of 2006 at the Hospital das Clínicas de Botucatu, located in the city of Botucatu, Brazil.
  
  
  RESULTS
  The study included 56 patients. Of those, 11 (19.6%) had a definitive diagnosis of idiopathic pulmonary fibrosis (IPF), the rate of which was significantly higher in the patients in which ILD was a possible diagnosis in comparison with those in which ILD was the prime suspect (p = 0.011), demonstrating the contribution of TBB to the diagnostic confirmation of these diseases. The histopathological examination of the biopsies revealed that 27.3% of the patients with IPF showed a pattern of organizing pneumonia, which suggests greater disease severity. The most common histological pattern was the indeterminate pattern, reflecting the peripheral characteristic of IPF. However, the fibrosis pattern showed high specificity and high negative predictive value. For CT scan patterns suggestive of IPF, the ROC curve showed that the best relationship between sensitivity and specificity occurred when five radiological alterations were present. Honeycombing was found to be strongly suggestive of IPF (p = 0.01).
  
  
  CONCLUSIONS
  For ILDs, chest CT should always be performed, and TBB should be used in specific situations, according to the suspicion and distribution of lesions.
authors.affiliation: Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil.
authors.forename: Cristiano Claudino
authors.initials: CC
authors.lastname: Oliveira
authors.forename: Alexandre Todorovic
authors.initials: AT
authors.lastname: Fabro
authors.forename: Sérgio Marrone
authors.initials: SM
authors.lastname: Ribeiro
authors.forename: Julio
authors.initials: J
authors.lastname: Defaveri
authors.forename: Vera Luiza
authors.initials: VL
authors.lastname: Capelozzi
authors.forename: Thais Helena Thomaz
authors.initials: TH
authors.lastname: Queluz
authors.forename: Hugo Hyung Bok
authors.initials: HH
authors.lastname: Yoo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D001999:Bronchoscopy; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D055815:Young Adult