• Fayez Kheir, Ala Alkhatib, Gerald J Berry, Philip Daroca, Lisa Diethelm, Reinaldo Rampolla, Shigeki Saito, David L Smith, David Weill, Marjorie Bateman, Ramsy Abdelghani, and Joseph A Lasky.
• Division of Pulmonary and Critical Care, Department of Medicine, Tulane University School of Medicine, New Orleans, LA.
• Chest. 2020 Nov 1; 158 (5): 2015-2025.

BackgroundChallenges remain for establishing a specific diagnosis in cases of interstitial lung disease (ILD). Bronchoscopic lung cryobiopsy (BLC) has impacted the diagnostic impression and confidence of multidisciplinary discussions (MDDs) in the evaluation of ILD. Reports indicate that a genomic classifier (GC) can distinguish usual interstitial pneumonia (UIP) from non-UIP.Research QuestionWhat is the impact of sequentially presented data from BLC and GC on the diagnostic confidence of MDDs in diagnosing ILD?Study Design And MethodsTwo MDD teams met to discuss 24 patients with ILD without a definitive UIP pattern. MDD1 sequentially reviewed clinical-radiologic findings, BLC, and GC. MDD2 sequentially reviewed GC before BLC. At each step in the process the MDD diagnosis and confidence level were recorded.ResultsMDD1 had a significant increase in diagnostic confidence, from 43% to 93% (P = .023), in patients with probable UIP after the addition of GC to BLC. MDD2 had an increase in diagnostic confidence, from 27% to 73% (P = .074), after the addition of BLC to GC. The concordance coefficients and percentage agreement of categorical idiopathic pulmonary fibrosis (IPF) and non-IPF diagnoses were as follows: GC vs MDD1: 0.92, 96%; GC vs MDD2: 0.83, 92%; BLC1 vs MDD1: 0.67, 83%; BLC2 vs MDD2: 0.66, 83%.InterpretationGC increased diagnostic confidence when added to BLC for patients with a probable UIP pattern, and in appropriate clinical settings can be used without BLC. In contrast, BLC had the greatest impact regarding a specific diagnosis when the likelihood of UIP was considered low following clinical-radiographic review.Copyright © 2020 American College of Chest Physicians. All rights reserved.

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