Abstract
Background: Previous studies have shown that histological information provide significant prognostic information and impact both diagnosis and diagnostic confidence in ILDs. However to date no studies have investigated the clinical management implications of lung biopsy. The aim of this study is to investigate whether the histological information changes clinicians' management decision and what are the factors contributing to this change.
Methods: We evaluated 426 consecutive patients without a definite usual interstitial pneumonia (UIP) pattern on HRCT high resolution computed tomography who presented for evaluation of ILDs to the GB Morgagni Hospital, Forlì, Italy, and who had lung biopsy (SLB or TBLC). Three pathologists reviewed the specimens, blind to clinical information. Cases were evaluated by the MDT that expressed a diagnosis with high or low confidence and made a management decision both before and after lung biopsy.
Results: Lung biopsy changed the clinical management of patients in 147 cases (35%).
The most notable differences were observed in the decrease in both the prevalence of untreated patients (from 15% to 4%, p<0.001) and of patients that would have been treated with steroids (from 54% to 37%, p<0.001). Both antifibrotic and immunosuppressive use significantly increased after lung biopsy revision (from 23% to 44%, p<0.001 and from 7% to 14%, p<0.001, respectively). Details are shown in the figure.
Conclusion: In uncertain clinical-radiological scenarios lung biopsy can be highly informative and can change patients' management decision in one third of cases.
Footnotes
Cite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 3780.
This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2020