Our Summary

The research paper is about a study conducted to identify certain factors that can help determine which patients with interstitial lung disease (ILD) should undergo bronchoscopy - a procedure that examines the inside of the lungs. ILD is a group of diseases that cause scarring and inflammation in the lungs, making it difficult for patients to breathe.

Currently, it’s not well-defined which ILD patients should receive bronchoscopy. The researchers wanted to improve this by identifying factors that could change the diagnosis of ILD before and after bronchoscopy, and thus improve the confidence in diagnosing ILD while reducing the potential risks associated with a more invasive procedure, the surgical lung biopsy.

The study found that bronchoscopy led to a change in diagnosis in around 24% of the 245 patients involved. Plus, adding a transbronchial biopsy (TBBx) to a bronchoalveolar lavage (BAL) - both components of bronchoscopy - increased the chances of getting a correct diagnosis from around 22% to 34%.

The researchers also identified certain features that could indicate a change in diagnosis after bronchoscopy. These included the identification of an antigen (a substance that triggers an immune response), an HRCT scan that is inconsistent with usual interstitial pneumonia (UIP), and the absence of a pre-bronchoscopy diagnosis of connective tissue disease-related ILD (CTD-ILD) or interstitial pneumonia with autoimmune features (IPAF).

The study suggests that bronchoscopy should be considered for patients who have an identified antigen or an HRCT scan that suggests a non-UIP diagnosis. This could help improve the diagnosis of ILD and avoid the potential complications of more invasive procedures.

FAQs

  1. What is the purpose of the study on bronchoalveolar lavage and transbronchial biopsy in evaluation of interstitial lung disease (ILD)?
  2. What factors were found to be associated with a change in multidisciplinary ILD diagnosis before and after incorporating BAL and TBBx data?
  3. How did bronchoscopy affect the initial diagnosis of the ILD patients in the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lung biopsy is to ensure they provide a detailed medical history and any relevant information about potential exposures to antigens or environmental factors that could be contributing to their lung disease. This can help guide the biopsy procedure and improve the chances of obtaining an accurate diagnosis. Additionally, patients should follow any pre-biopsy instructions given by their healthcare provider to ensure the procedure goes smoothly and safely.

Suitable For

Patients who are typically recommended for lung biopsy include those with interstitial lung disease (ILD) who have the following characteristics:

  • Identified antigen
  • High-resolution CT scan inconsistent with usual interstitial pneumonia (UIP)
  • Absence of a pre-bronchoscopy diagnosis of connective tissue disease (CTD)-associated ILD or interstitial pneumonia with autoimmune features (IPAF)

These factors were found to be associated with a change in multidisciplinary ILD diagnosis after incorporating bronchoalveolar lavage and transbronchial biopsy data. Selecting appropriate patients for bronchoscopy may improve diagnostic confidence and avoid potential complications from more invasive procedures.

Timeline

Before lung biopsy:

  1. Patients undergo a diagnostic workup for interstitial lung disease (ILD).
  2. Patients may undergo imaging tests such as high-resolution computed tomography (HRCT) scans.
  3. Patients may have a pre-bronchoscopy diagnosis of ILD or related conditions.
  4. Patients may have symptoms such as cough, shortness of breath, and fatigue.

After lung biopsy:

  1. Patients undergo bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy (TBBx).
  2. Multidisciplinary ILD diagnosis (MDD) is performed both before and after bronchoscopy.
  3. Bronchoscopy may lead to a change in diagnosis for some patients.
  4. The addition of TBBx to BAL can increase diagnostic yield.
  5. Factors such as identified antigen, HRCT scan inconsistent with usual interstitial pneumonia (UIP), and absence of pre-bronchoscopy diagnosis of connective tissue disease (CTD)-ILD or interstitial pneumonia with autoimmune features (IPAF) may be associated with a change in diagnosis.
  6. Appropriate patient selection for bronchoscopy may improve ILD diagnostic confidence and potentially avoid more invasive procedures.

What to Ask Your Doctor

  1. What is the purpose of the lung biopsy in my specific case?
  2. What are the potential risks and complications associated with the lung biopsy procedure?
  3. How will the results of the lung biopsy affect my treatment plan for interstitial lung disease?
  4. How will the information obtained from the bronchoscopy, including bronchoalveolar lavage and transbronchial biopsy, be used in conjunction with other diagnostic tests to determine a diagnosis?
  5. Are there any specific factors or characteristics about my condition that make me a good candidate for a lung biopsy?
  6. How long will it take to receive the results of the lung biopsy?
  7. Will I need to take any special precautions or follow any specific instructions after the lung biopsy procedure?
  8. Are there any alternative diagnostic tests or procedures that could be considered instead of a lung biopsy?
  9. Will I need to follow up with a specialist or undergo additional testing after the lung biopsy procedure?
  10. What are the potential implications of the lung biopsy results for my long-term prognosis and management of my interstitial lung disease?

Reference

Authors: Adams TN, Batra K, Silhan L, Anand V, Joerns EK, Moore S, Butt YM, Torrealba J, Newton CA, Glazer CS. Journal: Lung. 2020 Oct;198(5):803-810. doi: 10.1007/s00408-020-00389-4. Epub 2020 Sep 1. PMID: 32870374