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Wahidi MM, Argento AC, Mahmood K, Shofer SL, Giovacchini C, Pulsipher A, Hartwig M, Tong B, Carney JM, Colby T, Neely B, Wang X, Dematte J, Ninan N, Danoff S, Morrison LD, Yarmus L. Comparison of Forceps, Cryoprobe, and Thoracoscopic Lung Biopsy for the Diagnosis of Interstitial Lung Disease - The CHILL Study. Respiration 2021; 101:394-400. [PMID: 34784603 DOI: 10.1159/000519674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023] Open
Abstract
RATIONALE Transbronchial lung cryobiopsy (TBLC) has emerged as a less invasive method to obtain a tissue diagnosis in patients with interstitial lung disease (ILD). The diagnostic yield of TBLC compared to surgical lung biopsy (SLB) remains uncertain. OBJECTIVES The aim of this study was to determine the diagnostic accuracy of forceps transbronchial lung biopsy (TBLB) and TBLC compared to SLB when making the final diagnosis based on multidisciplinary discussion (MDD). METHODS Patients enrolled in the study underwent sequential TBLB and TBLC followed immediately by SLB. De-identified cases, with blinding of the biopsy method, were reviewed by a blinded pathologist and then discussed at a multidisciplinary conference. MAIN RESULTS Between August 2013 and October 2017, we enrolled 16 patients. The raw agreement between TBLC and SLB for the MDD final diagnosis was 68.75% with a Cohen's kappa of 0.6 (95% CI 0.39, 0.81). Raw agreement and Cohen's kappa of TBLB versus TBLC and TBLB versus SLB for the MDD final diagnosis were much lower (50%, 0.21 [95% CI 0, 0.42] and 18.75%, 0.08 [95% CI -0.03, 0.19], respectively). TBLC was associated with mild bleeding (grade 1 bleeding requiring suction to clear) in 56.2% of patients. CONCLUSIONS In patients with ILD who have an uncertain type based on clinical and radiographic data and require tissue sampling to obtain a specific diagnosis, TBLC showed moderate correlation with SLB when making the diagnosis with MDD guidance. TBLB showed poor concordance with both TBLC and SLB MDD diagnoses.
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Affiliation(s)
- Momen M Wahidi
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Angela Christine Argento
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kamran Mahmood
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Scott L Shofer
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Coral Giovacchini
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Aaron Pulsipher
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Matthew Hartwig
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Betty Tong
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - John M Carney
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Thomas Colby
- Department of Pathology and Laboratory Medicine (Emeritus), Mayo Clinic, Phoenix, Arizona, USA
| | - Ben Neely
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Xiaofei Wang
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Jane Dematte
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Neil Ninan
- Pulmonary and Critical Care Medicine, Touro Infirmary, New Orleans, Louisiana, USA
| | - Sonye Danoff
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lake Daniel Morrison
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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