Poor concordance between sequential transbronchial lung cryobiopsy and surgical lung biopsy in the diagnosis of diffuse interstitial lung diseases

Micaela Romagnoli, Thomas V. Colby, Jean Philippe Berthet, Anne Sophie Gamez, Jean Pierre Mallet, Isabelle Serre, Alessandra Cancellieri, Alberto Cavazza, Laurence Solovei, Andrea Dell’Amore, Giampiero Dolci, Aldo Guerrieri, Paul Reynaud, Sébastien Bommart, Maurizio Zompatori, Giorgia Dalpiaz, Stefano Nava, Rocco Trisolini, Carey M. Suehs, Isabelle VachierNicolas Molinari, Arnaud Bourdin

Research output: Contribution to journalArticle

Abstract

Rationale: The diagnostic concordance between transbronchial lung cryobiopsy (TBLC)—versus surgical lung biopsy (SLB) as the current gold standard—in interstitial lung disease (ILD) cases requiring histology remains controversial. Objectives: To assess diagnostic concordance between TBLC and SLB sequentially performed in the same patients, the diagnostic yield of both techniques, and subsequent changes in multidisciplinary assessment (MDA) decisions. Methods: A two-center prospective study included patients with ILD with a nondefinite usual interstitial pneumonia pattern (on high-resolution computed tomography scan) confirmed at a first MDA. Patients underwent TBLC immediately followed by video-assisted thoracoscopy for SLB at the same anatomical locations. After open reading of both sample types by local pathologists and final diagnosis at a second MDA (MDA2), anonymized TBLC and SLB slides were blindly assessed by an external expert pathologist (T.V.C.). Kappa-concordance coefficients and percentage agreement were computed for: TBLC versus SLB, MDA2 versus TBLC, MDA2 versus SLB, and blinded pathology versus routine pathology. Measurements and Main Results: Twenty-one patients were included. The median TBLC biopsy size (longest axis) was 7 mm (interquartile range, 5–8 mm). SLB biopsy sizes averaged 46.1 6 13.8 mm. Concordance coefficients and percentage agreement were: TBLC versus SLB: k = 0.22 (95% confidence interval [CI], 0.01–0.44), percentage agreement = 38% (95% CI, 18–62%); MDA2 versus TBLC: k = 0.31 (95% CI, 0.06–0.56), percentage agreement = 48% (95% CI, 26–70)%; MDA2 versus SLB: k = 0.51 (95% CI, 0.27–0.75), percentage agreement = 62% (95% CI, 38–82%); two pneumothoraces (9.5%) were recorded during TBLC. TBLC would have led to a different treatment if SLB was not performed in 11 of 21 (52%) of cases. Conclusions: Pathological results from TBLC and SLB were poorly concordant in the assessment of ILD. SLBs were more frequently concordant with the final diagnosis retained at MDA.

Original languageEnglish
Pages (from-to)1249-1256
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume199
Issue number10
DOIs
Publication statusPublished - May 15 2019

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Interstitial Lung Diseases
Biopsy
Lung
Confidence Intervals
Pathology

Keywords

  • Bronchoscopy
  • Deep sedation
  • Idiopathic pulmonary fibrosis
  • Lung histology
  • Multidisciplinary approach

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Poor concordance between sequential transbronchial lung cryobiopsy and surgical lung biopsy in the diagnosis of diffuse interstitial lung diseases. / Romagnoli, Micaela; Colby, Thomas V.; Berthet, Jean Philippe; Gamez, Anne Sophie; Mallet, Jean Pierre; Serre, Isabelle; Cancellieri, Alessandra; Cavazza, Alberto; Solovei, Laurence; Dell’Amore, Andrea; Dolci, Giampiero; Guerrieri, Aldo; Reynaud, Paul; Bommart, Sébastien; Zompatori, Maurizio; Dalpiaz, Giorgia; Nava, Stefano; Trisolini, Rocco; Suehs, Carey M.; Vachier, Isabelle; Molinari, Nicolas; Bourdin, Arnaud.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 199, No. 10, 15.05.2019, p. 1249-1256.

Research output: Contribution to journalArticle

Romagnoli, M, Colby, TV, Berthet, JP, Gamez, AS, Mallet, JP, Serre, I, Cancellieri, A, Cavazza, A, Solovei, L, Dell’Amore, A, Dolci, G, Guerrieri, A, Reynaud, P, Bommart, S, Zompatori, M, Dalpiaz, G, Nava, S, Trisolini, R, Suehs, CM, Vachier, I, Molinari, N & Bourdin, A 2019, 'Poor concordance between sequential transbronchial lung cryobiopsy and surgical lung biopsy in the diagnosis of diffuse interstitial lung diseases', American Journal of Respiratory and Critical Care Medicine, vol. 199, no. 10, pp. 1249-1256. https://doi.org/10.1164/rccm.201810-1947OC
Romagnoli, Micaela ; Colby, Thomas V. ; Berthet, Jean Philippe ; Gamez, Anne Sophie ; Mallet, Jean Pierre ; Serre, Isabelle ; Cancellieri, Alessandra ; Cavazza, Alberto ; Solovei, Laurence ; Dell’Amore, Andrea ; Dolci, Giampiero ; Guerrieri, Aldo ; Reynaud, Paul ; Bommart, Sébastien ; Zompatori, Maurizio ; Dalpiaz, Giorgia ; Nava, Stefano ; Trisolini, Rocco ; Suehs, Carey M. ; Vachier, Isabelle ; Molinari, Nicolas ; Bourdin, Arnaud. / Poor concordance between sequential transbronchial lung cryobiopsy and surgical lung biopsy in the diagnosis of diffuse interstitial lung diseases. In: American Journal of Respiratory and Critical Care Medicine. 2019 ; Vol. 199, No. 10. pp. 1249-1256.
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abstract = "Rationale: The diagnostic concordance between transbronchial lung cryobiopsy (TBLC)—versus surgical lung biopsy (SLB) as the current gold standard—in interstitial lung disease (ILD) cases requiring histology remains controversial. Objectives: To assess diagnostic concordance between TBLC and SLB sequentially performed in the same patients, the diagnostic yield of both techniques, and subsequent changes in multidisciplinary assessment (MDA) decisions. Methods: A two-center prospective study included patients with ILD with a nondefinite usual interstitial pneumonia pattern (on high-resolution computed tomography scan) confirmed at a first MDA. Patients underwent TBLC immediately followed by video-assisted thoracoscopy for SLB at the same anatomical locations. After open reading of both sample types by local pathologists and final diagnosis at a second MDA (MDA2), anonymized TBLC and SLB slides were blindly assessed by an external expert pathologist (T.V.C.). Kappa-concordance coefficients and percentage agreement were computed for: TBLC versus SLB, MDA2 versus TBLC, MDA2 versus SLB, and blinded pathology versus routine pathology. Measurements and Main Results: Twenty-one patients were included. The median TBLC biopsy size (longest axis) was 7 mm (interquartile range, 5–8 mm). SLB biopsy sizes averaged 46.1 6 13.8 mm. Concordance coefficients and percentage agreement were: TBLC versus SLB: k = 0.22 (95{\%} confidence interval [CI], 0.01–0.44), percentage agreement = 38{\%} (95{\%} CI, 18–62{\%}); MDA2 versus TBLC: k = 0.31 (95{\%} CI, 0.06–0.56), percentage agreement = 48{\%} (95{\%} CI, 26–70){\%}; MDA2 versus SLB: k = 0.51 (95{\%} CI, 0.27–0.75), percentage agreement = 62{\%} (95{\%} CI, 38–82{\%}); two pneumothoraces (9.5{\%}) were recorded during TBLC. TBLC would have led to a different treatment if SLB was not performed in 11 of 21 (52{\%}) of cases. Conclusions: Pathological results from TBLC and SLB were poorly concordant in the assessment of ILD. SLBs were more frequently concordant with the final diagnosis retained at MDA.",
keywords = "Bronchoscopy, Deep sedation, Idiopathic pulmonary fibrosis, Lung histology, Multidisciplinary approach",
author = "Micaela Romagnoli and Colby, {Thomas V.} and Berthet, {Jean Philippe} and Gamez, {Anne Sophie} and Mallet, {Jean Pierre} and Isabelle Serre and Alessandra Cancellieri and Alberto Cavazza and Laurence Solovei and Andrea Dell’Amore and Giampiero Dolci and Aldo Guerrieri and Paul Reynaud and S{\'e}bastien Bommart and Maurizio Zompatori and Giorgia Dalpiaz and Stefano Nava and Rocco Trisolini and Suehs, {Carey M.} and Isabelle Vachier and Nicolas Molinari and Arnaud Bourdin",
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TY - JOUR

T1 - Poor concordance between sequential transbronchial lung cryobiopsy and surgical lung biopsy in the diagnosis of diffuse interstitial lung diseases

AU - Romagnoli, Micaela

AU - Colby, Thomas V.

AU - Berthet, Jean Philippe

AU - Gamez, Anne Sophie

AU - Mallet, Jean Pierre

AU - Serre, Isabelle

AU - Cancellieri, Alessandra

AU - Cavazza, Alberto

AU - Solovei, Laurence

AU - Dell’Amore, Andrea

AU - Dolci, Giampiero

AU - Guerrieri, Aldo

AU - Reynaud, Paul

AU - Bommart, Sébastien

AU - Zompatori, Maurizio

AU - Dalpiaz, Giorgia

AU - Nava, Stefano

AU - Trisolini, Rocco

AU - Suehs, Carey M.

AU - Vachier, Isabelle

AU - Molinari, Nicolas

AU - Bourdin, Arnaud

PY - 2019/5/15

Y1 - 2019/5/15

N2 - Rationale: The diagnostic concordance between transbronchial lung cryobiopsy (TBLC)—versus surgical lung biopsy (SLB) as the current gold standard—in interstitial lung disease (ILD) cases requiring histology remains controversial. Objectives: To assess diagnostic concordance between TBLC and SLB sequentially performed in the same patients, the diagnostic yield of both techniques, and subsequent changes in multidisciplinary assessment (MDA) decisions. Methods: A two-center prospective study included patients with ILD with a nondefinite usual interstitial pneumonia pattern (on high-resolution computed tomography scan) confirmed at a first MDA. Patients underwent TBLC immediately followed by video-assisted thoracoscopy for SLB at the same anatomical locations. After open reading of both sample types by local pathologists and final diagnosis at a second MDA (MDA2), anonymized TBLC and SLB slides were blindly assessed by an external expert pathologist (T.V.C.). Kappa-concordance coefficients and percentage agreement were computed for: TBLC versus SLB, MDA2 versus TBLC, MDA2 versus SLB, and blinded pathology versus routine pathology. Measurements and Main Results: Twenty-one patients were included. The median TBLC biopsy size (longest axis) was 7 mm (interquartile range, 5–8 mm). SLB biopsy sizes averaged 46.1 6 13.8 mm. Concordance coefficients and percentage agreement were: TBLC versus SLB: k = 0.22 (95% confidence interval [CI], 0.01–0.44), percentage agreement = 38% (95% CI, 18–62%); MDA2 versus TBLC: k = 0.31 (95% CI, 0.06–0.56), percentage agreement = 48% (95% CI, 26–70)%; MDA2 versus SLB: k = 0.51 (95% CI, 0.27–0.75), percentage agreement = 62% (95% CI, 38–82%); two pneumothoraces (9.5%) were recorded during TBLC. TBLC would have led to a different treatment if SLB was not performed in 11 of 21 (52%) of cases. Conclusions: Pathological results from TBLC and SLB were poorly concordant in the assessment of ILD. SLBs were more frequently concordant with the final diagnosis retained at MDA.

AB - Rationale: The diagnostic concordance between transbronchial lung cryobiopsy (TBLC)—versus surgical lung biopsy (SLB) as the current gold standard—in interstitial lung disease (ILD) cases requiring histology remains controversial. Objectives: To assess diagnostic concordance between TBLC and SLB sequentially performed in the same patients, the diagnostic yield of both techniques, and subsequent changes in multidisciplinary assessment (MDA) decisions. Methods: A two-center prospective study included patients with ILD with a nondefinite usual interstitial pneumonia pattern (on high-resolution computed tomography scan) confirmed at a first MDA. Patients underwent TBLC immediately followed by video-assisted thoracoscopy for SLB at the same anatomical locations. After open reading of both sample types by local pathologists and final diagnosis at a second MDA (MDA2), anonymized TBLC and SLB slides were blindly assessed by an external expert pathologist (T.V.C.). Kappa-concordance coefficients and percentage agreement were computed for: TBLC versus SLB, MDA2 versus TBLC, MDA2 versus SLB, and blinded pathology versus routine pathology. Measurements and Main Results: Twenty-one patients were included. The median TBLC biopsy size (longest axis) was 7 mm (interquartile range, 5–8 mm). SLB biopsy sizes averaged 46.1 6 13.8 mm. Concordance coefficients and percentage agreement were: TBLC versus SLB: k = 0.22 (95% confidence interval [CI], 0.01–0.44), percentage agreement = 38% (95% CI, 18–62%); MDA2 versus TBLC: k = 0.31 (95% CI, 0.06–0.56), percentage agreement = 48% (95% CI, 26–70)%; MDA2 versus SLB: k = 0.51 (95% CI, 0.27–0.75), percentage agreement = 62% (95% CI, 38–82%); two pneumothoraces (9.5%) were recorded during TBLC. TBLC would have led to a different treatment if SLB was not performed in 11 of 21 (52%) of cases. Conclusions: Pathological results from TBLC and SLB were poorly concordant in the assessment of ILD. SLBs were more frequently concordant with the final diagnosis retained at MDA.

KW - Bronchoscopy

KW - Deep sedation

KW - Idiopathic pulmonary fibrosis

KW - Lung histology

KW - Multidisciplinary approach

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