Genomic Classifier Improves Confidence in Interstitial Lung Disease Diagnosis

When added to bronchoscopic lung cryobiopsy (BLC) in patients with a probable usual interstitial pneumonia (UIP) pattern, a newly introduced genomic classifier significantly increased the diagnostic confidence of physicians practicing in referral centers for interstitial lung disease (ILD), according to study results published in CHEST.

BLC has become an accepted modality for obtaining lung tissue samples in patients with diffuse ILD and has a meaningful effect on confidence in the diagnosis of idiopathic pulmonary fibrosis (IPF). Recent reports indicate that a genomic classifier can distinguish UIP from non-UIP and can aid clinicians in confirming the diagnosis of IPF in patients without a definite UIP pattern on high-resolution computed tomography (HRCT) imaging.

Whether there is an advantage of employing both BLC and genomic classifier in the context of a multidisciplinary discussion with clinicians, radiologists, and pathologists remains unanswered. Therefore, 2 multidisciplinary discussion teams met to discuss 24 patients with ILD without a definitive UIP pattern; the first group sequentially reviewed clinical-radiologic findings, BLC, and genomic classifier, and the second group sequentially reviewed genomic classifier prior to BLC. Researchers found that the first team had a significant increase in diagnostic confidence, from 43% to 93% (P =.074) in patients with probable UIP after the addition of genomic classifier to BLC and the second team had an increase in diagnostic confidence from 27% to 73% (P =.074) after the addition of BLC to genomic classifier .   

The study researchers concluded, “[Genomic classifier] increased the diagnostic confidence when added to BLC in patients with a probable UIP pattern, and in appropriate clinical settings can be used without BLC.” They added, “In contrast, BLC had the greatest impact regarding a specific diagnosis in cases wherein the likelihood of UIP was considered low following clinical-radiographic review.”

Reference

Kheir F, Alkhatib A, Berry GJ, et al. Employing bronchoscopic lung cryobiopsy and a genomic classifier in the multidisciplinary diagnosis of diffuse interstitial lung diseases [published online May 25, 2020]. CHEST. doi:10.1016/j.chest.2020.05.532