Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Interstitial Lung Disease
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INTERSTITIAL LUNG DISEASE
Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Interstitial Lung Disease Traci N. Adams1 · Kiran Batra2 · Leann Silhan1 · Vikram Anand1 · Elena K. Joerns3 · Samantha Moore4 · Yasmeen M. Butt5 · Jose Torrealba4 · Chad A. Newton1 · Craig S. Glazer1 Received: 21 May 2020 / Accepted: 20 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Bronchoalveolar lavage and transbronchial biopsy can be a useful tool in the evaluation of interstitial lung disease (ILD), but patient selection for this procedure remains poorly defined. Determining clinical characteristics that help with patient selection for bronchoscopy may improve confidence of ILD classification while limiting potential adverse outcomes associated with surgical lung biopsy. The purpose of this study is to identify factors that were associated with change in multidisciplinary ILD diagnosis (MDD) before and after incorporation of BAL and TBBx data. Methods We conducted a retrospective cohort study of ILD patients at a single center who underwent bronchoscopy in the diagnostic workup of ILD. We performed sequential MDD both pre- and post-bronchoscopy to calculate the frequency of change in diagnosis after incorporating information from BAL and TBBx and identify features associated with change in diagnosis. Results 245 patients were included in the study. Bronchoscopy led to a change in diagnosis in 58 patients (23.7%). The addition of TBBx to BAL increased diagnostic yield from 21.8 to 34.1% (p = 0.027). Identification of antigen, HRCT scan inconsistent with UIP, and absence of a pre-bronchoscopy diagnosis of CTD-ILD or IPAF were associated with a change in diagnosis after bronchoscopy. Conclusion Our study suggests clinical features that may assist with patient selection for bronchoscopy. We suggest bronchoscopy in patients with identified antigen or an HRCT that is consistent with a non-IPF diagnosis. Appropriate patient selection for bronchoscopy may improve ILD diagnostic confidence and avoid potential complications from more invasive and higher risk procedures. Keywords Bronchoscopy · Hypersensitivity pneumonitis · Interstitial lung disease
This abstract was presented at the Pulmonary Fibrosis Foundation Summit, November 7, 2019, San Antonio, TX. * Traci N. Adams [email protected] 1
Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75219, USA
2
Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
3
Division of Rheumatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
4
Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
5
Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA
Introduction The correct classification of interstitial lung disease (ILD) into specific subtypes requires assimilation of v
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