• Sara Tomassetti, Athol U Wells, Ulrich Costabel, Alberto Cavazza, Thomas V Colby, Giulio Rossi, Nicola Sverzellati, Angelo Carloni, Elisa Carretta, Matteo Buccioli, Paola Tantalocco, Claudia Ravaglia, Christian Gurioli, Alessandra Dubini, Sara Piciucchi, Jay H Ryu, and Venerino Poletti.
• 1 Department of Diseases of the Thorax.
• Am. J. Respir. Crit. Care Med. 2016 Apr 1; 193 (7): 745-52.

RationaleSurgical 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.ObjectivesTo address the impact of BLC on diagnostic confidence in the multidisciplinary diagnosis of IPF.MethodsIn 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.Measurements And Main ResultsWe 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.ConclusionsBLC 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.

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