title: Bronchoscopic Lung Cryobiopsy Increases Diagnostic Confidence in the Multidisciplinary Diagnosis of Idiopathic Pulmonary Fibrosis.
abstract: BACKGROUND
  Surgical lung biopsy is often required for a confident multidisciplinary diagnosis of idiopathic pulmonary fibrosis (IPF). Alternative, less-invasive biopsy methods, such as bronchoscopic lung cryobiopsy (BLC), are highly desirable.
  
  
  OBJECTIVE
  To address the impact of BLC on diagnostic confidence in the multidisciplinary diagnosis of IPF.
  
  
  METHODS
  In this cross-sectional study we selected 117 patients with fibrotic interstitial lung disease without a typical usual interstitial pneumonia pattern on high-resolution computed tomography. All cases underwent lung biopsies: 58 were BLC, and 59 were surgical lung biopsy (SLB). Two clinicians, two radiologists, and two pathologists sequentially reviewed clinical-radiologic findings and biopsy results, recording at each step in the process their diagnostic impressions and confidence levels.
  
  
  RESULTS
  We observed a major increase in diagnostic confidence after the addition of BLC, similar to SLB (from 29 to 63%, P = 0.0003 and from 30 to 65%, P = 0.0016 of high confidence IPF diagnosis, in the BLC group and SLB group, respectively). The overall interobserver agreement in IPF diagnosis was similar for both approaches (BLC overall kappa, 0.96; SLB overall kappa, 0.93). IPF was the most frequent diagnosis (50 and 39% in the BLC and SLB group, respectively; P = 0.23). After the addition of histopathologic information, 17% of cases in the BLC group and 19% of cases in the SLB group, mostly idiopathic nonspecific interstitial pneumonia and hypersensitivity pneumonitis, were reclassified as IPF.
  
  
  CONCLUSIONS
  BLC is a new biopsy method that has a meaningful impact on diagnostic confidence in the multidisciplinary diagnosis of interstitial lung disease and may prove useful in the diagnosis of IPF. This study provides a robust rationale for future studies investigating the diagnostic accuracy of BLC compared with SLB.
authors.affiliation: 1 Department of Diseases of the Thorax.
authors.forename: Sara
authors.identifier: http://orcid.org/0000-0002-4781-6539
authors.initials: S
authors.lastname: Tomassetti
authors.affiliation: 2 Interstitial Lung Disease Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, United Kingdom.
authors.forename: Athol U
authors.initials: AU
authors.lastname: Wells
authors.affiliation: 3 Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, Essen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Costabel
authors.affiliation: 4 Department of Pathology, Arcispedale S. Maria Nuova, Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cavazza
authors.affiliation: 5 Department of Pathology, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Colby
authors.affiliation: 6 Pathologic Anatomy, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Rossi
authors.affiliation: 7 Radiology Unit, Parma University, Parma, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Sverzellati
authors.affiliation: 8 U.O. Radiologia Diagnostica ed Interventistica Az. Osp. Santa Maria, Terni, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Carloni
authors.affiliation: 9 Bioscience Department, Bologna University, Bologna, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Carretta
authors.affiliation: 1 Department of Diseases of the Thorax.
authors.forename: Matteo
authors.initials: M
authors.lastname: Buccioli
authors.affiliation: 1 Department of Diseases of the Thorax.
authors.forename: Paola
authors.initials: P
authors.lastname: Tantalocco
authors.affiliation: 1 Department of Diseases of the Thorax.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ravaglia
authors.affiliation: 1 Department of Diseases of the Thorax.
authors.forename: Christian
authors.initials: C
authors.lastname: Gurioli
authors.affiliation: 10 Pathology Unit, and.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Dubini
authors.affiliation: 11 Radiology Unit, GB Morgagni Hospital, Forlì, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Piciucchi
authors.affiliation: 12 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota; and.
authors.forename: Jay H
authors.initials: JH
authors.lastname: Ryu
authors.affiliation: 1 Department of Diseases of the Thorax.|13 Department Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Venerino
authors.initials: V
authors.lastname: Poletti
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D001999:Bronchoscopy / Q000379:methods*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000175:diagnosis / Q000473:pathology*; D007558:Italy; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged
keywords: bronchoalveolar lavage; bronchoscopy; cryobiopsy; idiopathic pulmonary fibrosis; interstitial lung diseases