Interpretation of lung biopsy results in interstitial lung disease
- Talmadge E King, Jr, MD
Talmadge E King, Jr, MD
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Interstitial Lung Disease
- Dean, School of Medicine
- Vice Chancellor, Medical Affairs
- University of California San Francisco
- Section Editors
- Kevin R Flaherty, MD, MS
Kevin R Flaherty, MD, MS
- Section Editor — Interstitial Lung Disease
- Associate Professor of Medicine
- University of Michigan Health System
- Praveen N Mathur, MB;BS
Praveen N Mathur, MB;BS
- Section Editor — Interventional Pulmonology
- Professor of Clinical Medicine
- Indiana University School of Medicine
- Andrew Nicholson, MD
Andrew Nicholson, MD
- Section Editor — Pulmonary Pathology
- Professor of Respiratory Pathology
- Imperial College School of Medicine, London
The diffuse parenchymal lung diseases, often collectively referred to as the interstitial lung diseases (ILDs), are a heterogeneous group of disorders that are classified together because of similar clinical, radiographic, physiologic, or pathologic manifestations (algorithm 1). When the results of clinical evaluation, laboratory testing, imaging studies including high resolution computed tomography (HRCT), and pulmonary function testing do not allow the clinician to make a confident diagnosis of a given type or stage of ILD, lung biopsy with careful examination of lung tissue is often necessary (algorithm 2).
The clinicopathologic interpretation of lung biopsy results in adults with ILD will be reviewed here. The clinical evaluation, diagnostic testing, radiographic patterns, role of bronchoalveolar lavage, and role of lung biopsy in ILD are discussed separately. (See "Approach to the adult with interstitial lung disease: Clinical evaluation" and "Approach to the adult with interstitial lung disease: Diagnostic testing" and "High resolution computed tomography of the lungs" and "Basic principles and technique of bronchoalveolar lavage" and "Role of bronchoalveolar lavage in diagnosis of interstitial lung disease" and "Role of lung biopsy in the diagnosis of interstitial lung disease".)
CLINICIAN - PATHOLOGIST INTERACTION
Histologic abnormalities alone are rarely specific in ILD. More often, the findings are "characteristic" or "consistent with" a specific diagnosis. "Nonspecific" reaction patterns are common to several diseases that cause inflammation and/or fibrosis in the lungs . Small tissue samples and substantial inter-observer variability among pathologists further complicate interpretation [2-4]. As a result, most cases require careful clinical and pathological correlation to arrive at the most accurate final diagnosis [5-8].
With a multidisciplinary approach, surgical lung biopsy produces a definitive diagnosis in more than 90 percent of cases of ILD occurring in immunocompetent hosts [5,9].
Data provided to the pathologist by the clinician at the time of biopsy should include:
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- CLINICIAN - PATHOLOGIST INTERACTION
- INTERPRETATION OF HISTOPATHOLOGIC PATTERNS
- Interstitial pneumonias
- - Usual interstitial pneumonia
- - Nonspecific interstitial pneumonia
- - Desquamative interstitial pneumonia
- - Respiratory bronchiolitis
- - Organizing pneumonia
- - Lymphoid interstitial pneumonia
- - Diffuse alveolar damage
- Granulomatous lung diseases
- - Sarcoidosis
- - Chronic beryllium disease
- - Hypersensitivity pneumonitis
- - Langerhans cell granulomatosis
- - Erdheim-Chester disease
- - Foreign body granulomatosis
- - Diseases with associated vascular inflammation
- - Bronchocentric granulomatosis
- Other diffuse parenchymal lung diseases
- - Eosinophilic pneumonia
- - Pulmonary hemorrhage syndromes
- - Pulmonary alveolar proteinosis
- - Pulmonary amyloidosis
- - Smooth muscle proliferation
- - Honeycomb lung
- Rare histopathologic interstitial pneumonia patterns
- Unclassifiable interstitial pneumonia
- SUMMARY AND RECOMMENDATIONS