Guideline questions and recommendations
| PICO Question 1 | Question: In patients with undiagnosed ILD considered eligible to undergo SLB, is TBLC a valid replacement test? |
| Recommendation: For patients with undiagnosed ILD considered eligible to undergo SLB, the Task Force suggests performing TBLC if obtaining histopathological data is indicated (conditional recommendation for the intervention, “very low” certainty of evidence). | |
| Remark: This recommendation applies to centres experienced in performing TBLC. | |
| PICO Question 2 | Question: In patients with undiagnosed ILD not considered eligible to undergo SLB, does TBLC increase the diagnostic confidence of the multidisciplinary team discussion? |
| Recommendation: For patients with undiagnosed ILD not considered eligible to undergo SLB, the Task Force suggests TBLC if obtaining histopathological data is indicated (conditional recommendation, “very low” certainty of evidence). | |
| Remark: This recommendation applies to centres experienced in performing TBLC; the advantages of potentially increasing diagnostic certainty by performing TBLC against the disadvantages of potential serious adverse events should be weighed in each individual patient. | |
| PICO Question 3 | Question: In patients with undiagnosed ILD and a non-informative TBLC, is step-up SLB or a second TBLC a valid add-on test? |
| Recommendation: For patients with undiagnosed ILD and a non-informative TBLC, the Task Force suggests performing step-up SLB if obtaining histopathological data is indicated (conditional recommendation, “very low” certainty of evidence). For patients with undiagnosed ILD and a non-informative TBLC, the Task Force makes no recommendation about performing a second TBLC if obtaining histopathological data is indicated, as there is no evidence. | |
| PICO Question 4 | Question: Is formal training in TBLC recommended to optimise yield and minimise adverse events in patients with undiagnosed ILD? |
| Recommendation: The Task Force suggests that TBLC operators should undergo training (conditional recommendation, “very low” certainty of evidence), but a recommendation on the optimal type of training cannot be made due to lack of evidence. | |
| Narrative Question 1 | Question: Are there specific HRCT findings which would lead to TBLC as the first choice for biopsy? |
| Narrative Question 2 | Question: What are the procedural risks of TBLC in patients with undiagnosed ILD? |
Detailed questions are provided in supplementary appendix S1. ILD: interstitial lung diseases; SLB: surgical lung biopsy; TBLC: transbronchial lung biopsy; HRCT: high-resolution computed tomography.