TY - JOUR T1 - The diagnostic role of cryobiopsy in the multidisciplinary diagnosis of idiopathic pulmonary fibrosis JF - European Respiratory Journal JO - Eur Respir J VL - 42 IS - Suppl 57 SP - P2306 AU - Sara Tomassetti AU - Athol U. Wells AU - Ulrich Costabel AU - Cavazza Alberto AU - Thomas V. Colby AU - Rossi Giulio AU - Carloni Angelo AU - Sverzellati Nicola AU - Jay H. Ryu AU - Matteo Buccioli AU - Paola Tantalocco AU - Oriana Nanni AU - Elisa Carretta AU - Claudia Ravaglia AU - Christian Gurioli AU - Gian Luca Casoni AU - Carlo Gurioli AU - Micaela Romagnoli AU - Alessandra Dubini AU - Chilosi Marco AU - Venerino Poletti Y1 - 2013/09/01 UR - http://erj.ersjournals.com/content/42/Suppl_57/P2306.abstract N2 - OBJECTIVEThe objective of this study is to address the diagnostic role of cryobiopsy in the multidisciplinary diagnosis (MDD) of idiophatic pulmonary fibrosis (IPF) compared to surgical lung biopsy (SLB).METHODWe evaluated 117 consecutive cases of fibrotic ILDs. 59 (50%) underwent SLB and a 58 (50%) cryobiopsies. Two clinicians (AUW and UC), two radiologists (AC and NS) and two pathologists (AC and GR) sequentially reviewed clinical-radiological findings and biopsies, recording at each step their diagnostic impression.RESULTSBiopsies were diagnostic in 55 cryobiopsy (93%), and in all but one SLB (98%).UIP pattern was detected with a high confidence level in 51% (20/39) and 84% (32/38) of cryobiopsy and SLB respectively. Kappa coefficient of agreement between pathologists was 0.73, 95% CI 0.54-0.91 and 0.83, 95% CI 0.69-0.99 for cryobiopsy and SLB respectively.The multidisciplinary team of experts changed the initial consensus diagnostic impression after SLB and cryobiopsy in 38 cases (64.4%) and 39 cases (67.2%) respectively (p=0.747). Unanimous agreement between experts in diagnosis of IPF with high level of confidence changed from 3.5% (2/58) to 17% (10/58) before and after cryobiopsy, respectively. Similarly in SLB changed from 3.4% (2/59) to 20% (12/59).90 days mortality related to cryobiopsy was 1.7% compared to 3.4% for SLB.CONCLUSIONPathologists are less confident in the recognition of UIP pattern on cryobiopsy compared to SLB. However in the context of MDD the impact of cryobiopsy and SLB in the diagnosis of IPF is strikingly similar. Given the higher mortality of SLB, we conclude that transbronchial cryobiopsy could replace SLB in the evaluation of suspected IPF. ER -