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Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Interstitial Lung Disease

  • INTERSTITIAL LUNG DISEASE
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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.

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Data Availability

De-identified data can be made available upon request.

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Funding

Author CN has Grant funding from NHLBI (NHLBI K23HL148498).

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Authors and Affiliations

  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

    Traci N. Adams, Leann Silhan, Vikram Anand, Chad A. Newton & Craig S. Glazer

  2. Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Kiran Batra

  3. Division of Rheumatology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Elena K. Joerns

  4. Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Samantha Moore & Jose Torrealba

  5. Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA

    Yasmeen M. Butt

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  1. Traci N. Adams
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  2. Kiran Batra
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  10. Craig S. Glazer
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Contributions

TNA, KB, LS, VA, TB, YB, JT, JAN, and CSG contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript.

Corresponding author

Correspondence to Traci N. Adams.

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The authors TNA, KB, LS, VA, EJ, SM, YB, JT, JAN, and CSG have no conflicts of interest to report.

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Adams, T.N., Batra, K., Silhan, L. et al. Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Interstitial Lung Disease. Lung 198, 803–810 (2020). https://doi.org/10.1007/s00408-020-00389-4

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  • DOI: https://doi.org/10.1007/s00408-020-00389-4

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