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Interpretation of lung biopsy results in interstitial lung disease

Talmadge E King, Jr, MD
Section Editors
Kevin R Flaherty, MD, MS
Praveen N Mathur, MB;BS
Andrew Nicholson, MD
Deputy Editor
Helen Hollingsworth, MD


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".)


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 [1]. 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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Literature review current through: Nov 2017. | This topic last updated: Jul 01, 2016.
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