Isabelle Vachier, Alberto Cavazza, Jean Pierre Mallet, Maurizio Zompatori, Isabelle Serre, Giorgia Dalpiaz, Carey M. Suehs, Alessandra Cancellieri, Paul Reynaud, Nicolas Molinari, Jean Philippe Berthet, Andrea Dell’Amore, Rocco Trisolini, Arnaud Bourdin, Giampiero Dolci, Thomas V. Colby, Laurence Solovei, Stefano Nava, Aldo Guerrieri, Anne Sophie Gamez, Micaela Romagnoli, Sébastien Bommart, Policlinico S. Orsola-Malpighi, Mayo Clinic [Scottsdale], Mayo Clinic, Service de chirurgie thoracique et cardio-vasculaire, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Département pneumologie et addictologie [Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Maggiore and S'Orsola-Malpighi hospital, Bologna, Italy., Dept of Oncology and Advanced Technologies - Operative Unit of Oncology, Arcispedale Santa Maria Nuova (ASMN), S. Maria Nuova Hospital-I.R.C.C.S., Univ Bologna, Bellaria hospital, Radiology, Bologna, Italy., Università di Bologna, Malpighi Hospital, Centres de Ressources et de Compétences de la Mucoviscidose [Montpellier] (CRCM [Montpellier]), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve-Service des Maladies Respiratoires, Mathématiques, Informatique et STatistique pour l'Environnement et l'Agronomie (MISTEA), Institut National de la Recherche Agronomique (INRA)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Alma Mater Studiorum Università di Bologna [Bologna] (UNIBO), Institut Montpelliérain Alexander Grothendieck (IMAG), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Romagnoli M., Colby T.V., Berthet J.-P., Gamez A.S., Mallet J.-P., 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 C.M., Vachier I., Molinari N., and Bourdin A.
International audience; 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 ± 13.8 mm. Concordance coefficients and percentage agreement were: TBLC versus SLB: κ = 0.22 (95% confidence interval [CI], 0.01–0.44), percentage agreement = 38% (95% CI, 18–62%); MDA2 versus TBLC: κ = 0.31 (95% CI, 0.06–0.56), percentage agreement = 48% (95% CI, 26–70)%; MDA2 versus SLB: κ = 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