title: Invasive diagnostic techniques in idiopathic interstitial pneumonias.
abstract: Fibrosing interstitial lung diseases (f-ILDs) represent a heterogeneous group of disorders in which the aetiology may be identified or, not infrequently, remain unknown. Establishing a correct diagnosis of a distinct f-ILD requires a multidisciplinary approach, integrating clinical profile, physiological and laboratory data, radiological appearance and, when appropriate, histological findings. Surgical lung biopsy is still considered the most important diagnostic tool as it is able to provide lung samples large enough for identification of complex patterns such as usual interstitial pneumonitis (UIP) and nonspecific interstitial pneumonitis. However, this procedure is accompanied by significant morbidity and mortality. Bronchoalveolar lavage is still a popular diagnostic tool allowing identification of alternative diagnoses in patients with suspected idiopathic pulmonary fibrosis (IPF) when an increase in lymphocytes is detected. Conventional transbronchial lung biopsy has a very low sensitivity in detecting the UIP pattern and its role in this clinical-radiological context is marginal. The introduction of less invasive methods such as transbronchial cryobiopsy show great promise to clinical practice as they can be used to obtain samples large enough to morphologically support a diagnosis of IPF or other idiopathic interstitial pneumonias, along with fewer complications. Recent advances in the field suggest that less invasive methods of lung sampling, without significant side effects, in combination with other diagnostic methods could replace the need for surgical lung biopsy in the future. Indeed, these new multidisciplinary procedures may become the main diagnostic work-up method for patients with suspected idiopathic interstitial pneumonia.
authors.affiliation: Pulmonology Unit, Department of Thoracic Diseases, GB Morgagni-L Pierantoni Hospital, Forlì, Italy.|Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Venerino
authors.initials: V
authors.lastname: Poletti
authors.affiliation: Pulmonology Unit, Department of Thoracic Diseases, GB Morgagni-L Pierantoni Hospital, Forlì, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ravaglia
authors.affiliation: Pulmonology Unit, Department of Thoracic Diseases, GB Morgagni-L Pierantoni Hospital, Forlì, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Gurioli
authors.affiliation: Departments of Radiology, GB Morgagni-L Pierantoni Hospital, Forlì, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Piciucchi
authors.affiliation: Pathology, GB Morgagni-L Pierantoni Hospital, Forlì, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Dubini
authors.affiliation: Operative Unit of Pathology, S. Maria Nuova Hospital, Reggio Emilia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cavazza
authors.affiliation: Department of Pathology, Verona University, Verona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Chilosi
authors.affiliation: Pulmonary Unit, University of Verona, Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Pulmonology Unit, Department of Thoracic Diseases, GB Morgagni-L Pierantoni Hospital, Forlì, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Tomassetti
mesh_terms: D001706:Biopsy / Q000379:methods; D018893:Bronchoalveolar Lavage; D006801:Humans; D054988:Idiopathic Interstitial Pneumonias / Q000175:diagnosis / Q000473:pathology* / Q000503:physiopathology; D054990:Idiopathic Pulmonary Fibrosis / Q000175:diagnosis / Q000473:pathology; D008168:Lung / Q000473:pathology*
keywords: bronchoscopy and interventional techniques; interstitial lung disease