Cryobiopsy for Identification of Usual Interstitial Pneumonia and Other Interstitial Lung Disease Features. Further Lessons from COLDICE, a Prospective Multicenter Clinical Trial

Wendy A Cooper; Annabelle Mahar; Jeffrey L Myers; Christopher Grainge; Tamera J Corte; Jonathan P Williamson; Michael P Vallely; Simon Lai; Ellie Mulyadi; Paul J Torzillo; Martin J Phillips; Edmund M T Lau; Ganesh Raghu; Lauren K Troy

doi:10.1164/rccm.202009-3688OC

Cryobiopsy for Identification of Usual Interstitial Pneumonia and Other Interstitial Lung Disease Features. Further Lessons from COLDICE, a Prospective Multicenter Clinical Trial

Am J Respir Crit Care Med. 2021 May 15;203(10):1306-1313. doi: 10.1164/rccm.202009-3688OC.

Authors

Wendy A Cooper^{1

2

3}, Annabelle Mahar¹, Jeffrey L Myers⁴, Christopher Grainge⁵, Tamera J Corte^{6

2

7}, Jonathan P Williamson^{8

9}, Michael P Vallely², Simon Lai¹⁰, Ellie Mulyadi¹⁰, Paul J Torzillo^{6

2}, Martin J Phillips^{9

11}, Edmund M T Lau^{6

2}, Ganesh Raghu¹², Lauren K Troy^{6

2}

Affiliations

¹ Tissue Pathology and Diagnostic Oncology, New South Wales Health Pathology.
² Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
³ School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
⁴ Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
⁵ Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.
⁶ Respiratory and Sleep Medicine, and.
⁷ Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia.
⁸ Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia.
⁹ Macquarie Health, Respiratory and Sleep, Macquarie University Hospital, Sydney, New South Wales, Australia.
¹⁰ Department of Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
¹¹ Respiratory and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; and.
¹² Division of Pulmonary, Sleep, and Critical Care Medicine, University of Washington, Seattle, Washington.

PMID: 33285079
DOI: 10.1164/rccm.202009-3688OC

Abstract

Rationale: Transbronchial lung cryobiopsy (TBLC) is an emerging technique for interstitial lung disease diagnosis. Good histopathologic agreement between TBLC and surgical lung biopsy (SLB) was demonstrated in the COLDICE (Cryobiopsy versus Open Lung Biopsy in the Diagnosis of Interstitial Lung Disease Alliance) study; however, diagnostic confidence was frequently lower for TBLC than SLB. Objectives: To characterize specific features of TBLC predictive of usual interstitial pneumonia (UIP) in corresponding SLB and to identify clinical indices predictive of biopsy concordance. Methods: The COLDICE study was a prospective, multicenter study investigating diagnostic agreement between TBLC and SLB. The participants underwent both procedures with blinded pathologist analysis of specimens, applying international guideline criteria. The TBLC features predictive of UIP in the paired SLB and predictive features of overall concordance were analyzed. Measurements and Main Results: A total of 65 patients (66.1 ± 9.3 yr; FVC, 84.7 ± 14.2%; Dl_CO, 63.4 ± 13.8%) participated in the COLDICE study. UIP was identified in 33/65 (50.8%) SLB, and 81.5% were concordant with corresponding TBLC (κ, 0.61; 95% confidence interval [CI], 0.38-0.77). The UIP guideline criteria of "predominantly subpleural or paraseptal fibrosis" was infrequently reported in TBLC (8/33, 24.2%), whereas "patchy fibrosis," "fibroblast foci," and the "absence of alternative diagnostic features" were frequently observed in TBLC. The combination of these three features strongly predicted UIP in paired SLB (odds ratio [OR], 23.4; 95% CI, 6.36-86.1; P < 0.0001). Increased numbers of TBLC samples predicted histopathologic concordance with SLB (OR, 1.8; 95% CI, 1.08-3.01; P = 0.03). The predictors of discordance included older age, family history, and radiologic asymmetry. Conclusions: Subpleural and/or paraseptal fibrosis were not essential for diagnosing UIP in TBLC, provided that other guideline criteria features were present. The diagnostic accuracy of TBLC was strengthened when increased numbers of samples were taken. Clinical trial registered with www.anzctr.org.au (ACTRN12615000718549).

Keywords: biopsy; idiopathic pulmonary fibrosis; interstitial lung disease; pathology.

Publication types

Controlled Clinical Trial
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Biopsy*
Bronchoscopy*
Cryosurgery*
Diagnosis, Differential
Female
Humans
Idiopathic Pulmonary Fibrosis / pathology*
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Reproducibility of Results