From the Guidelines
Lung biopsy plays a crucial role in the diagnosis and management of Interstitial Lung Disease (ILD), particularly in cases where a diagnosis cannot be made with sufficient confidence based on clinical, laboratory, and radiological data.
Types of Lung Biopsy
- Surgical Lung Biopsy (SLB) is considered the reference standard for diagnosing ILD, with a diagnostic yield of ~90% 1, but it is associated with significant morbidity and mortality, especially in older patients or those with severe lung function impairment.
- Transbronchial Lung Biopsy (TBLB) has a limited diagnostic yield, especially for complex histopathological patterns such as usual interstitial pneumonia (UIP) 1.
- Transbronchial Lung Cryobiopsy (TBLC) is a less invasive alternative to SLB, with larger samples and fewer crush artifacts, but its clinical application is still being explored and guidelines are needed 1.
Indications for Lung Biopsy
- Lung biopsy is recommended in patients with suspected IPF and without contraindications to surgery, especially when clinical or radiologic features are not typical for IPF 1.
- For patients with newly detected ILD and a high-resolution computed tomography (HRCT) scan pattern of probable UIP, indeterminate for UIP, or an alternative diagnosis, conditional recommendations are made for performing BAL and surgical lung biopsy 1.
- However, for patients with an HRCT pattern of UIP, strong recommendations are made against performing surgical lung biopsy, transbronchial lung biopsy, and lung cryobiopsy 1.
Diagnostic Algorithm
- The diagnostic algorithm for IPF involves a multidisciplinary discussion (MDD) and evaluation of HRCT patterns, with surgical lung biopsy considered in cases where the diagnosis is uncertain or the patient has a non-UIP pattern on HRCT 1.
- The algorithm also takes into account identifiable causes for ILD, such as domestic and occupational environmental exposures, connective tissue disease, or drug toxicity 1.
From the Research
Role of Lung Biopsy in ILD Diagnosis
- Lung biopsy plays a crucial role in the diagnosis and management of Interstitial Lung Disease (ILD) 2, 3, 4, 5, 6
- It helps in providing a definitive pathological diagnosis, which can differ from the clinical diagnosis in a significant number of cases 4
- The biopsy findings can guide the management of ILD, with a change in treatment following the procedure in a considerable number of patients 4
Diagnostic Utility of Lung Biopsy
- Surgical lung biopsy (SLB) can be diagnostic, especially when the combination of clinical context and imaging pattern on high-resolution CT (HRCT) chest scans is not sufficient for a confident diagnosis 2
- Transbronchial lung cryobiopsy (TBLC) is a valid alternative to SLB, with significantly lower morbidity and mortality, and can be used to identify the progressive fibrotic phenotype 3
- Lung biopsy findings, including the identification of specific patterns such as usual interstitial pneumonia (UIP), can help distinguish different disease entities and determine the effect of treatment and prognosis 3
Safety and Efficacy of Lung Biopsy Procedures
- Thoracoscopic lung biopsy under regional anesthesia can be a safer alternative to general anesthesia, with shorter operative time and hospital stay, and reduced risk of worsening ILD 5
- The choice of biopsy procedure should be individualized, taking into account the patient's clinical profile and the potential risks and benefits of each procedure 4, 5
Multidisciplinary Approach to ILD Management
- A multidisciplinary panel discussion is recommended before performing a lung biopsy, to select the most appropriate patients and ensure that the procedure is performed in a safe and effective manner 4
- Correlation with clinical and radiologic findings is essential for the accurate interpretation of lung biopsy specimens 6