Is conventional transbronchial lung biopsy out: The evaluation of clinical value in diffuse parenchymal lung disease

Abstract

Introduction: Transbronchial lung biopsy (TBLB) is a relatively safe technique routinely employed by pulmonologists for the diagnosis of diffuse parenchymal lung disease (DPLD). Cryobiopsy is associated with higher diagnostic yield and a favorable risk/benefit ratio. Nevertheless, TBLB remains the representative method for definite diagnosis in developing countries. Objectives: This study aimed to evaluate whether the results obtained from TBLB had clinical value to pulmonologists in the management of DPLD. Methods: We performed a retrospective analysis of patients who underwent conventional TBLB for the diagnosis of DPLD from May 1, 2017, to April 30, 2019, at the Beijing Chao-yang Hospital, Capital Medical University. The clinical value of TBLB was defined as leading to a specific histopathological diagnosis or being consistent with the clinical and radiological data. Results: Seven hundred and forty-three patients with suspected DPLD were recruited. Conventional TBLB was considered clinically valuable in 439 procedures (59.1%), including 360 cases provided with definitive histopathological diagnoses, and 79 cases that were consistent with the working diagnoses. Among the 439 cases of clinically valuable TBLBs, 88 (20.0%), 37, 77 (10.7%), and 61 (13.9%) cases were diagnosed as connective tissue disease-related interstitial lung disease, definite histopathological diagnoses, malignancies, and nonspecific interstitial pneumonia, respectively. Conclusions: Conventional TBLB served as a key determinant or provided supplementary information in the final diagnosis of non-infectious DPLDs. TBLB decision-making should therefore be based on clinical and radiological data.