CHEST Guidelines-Moving-From-Multidisciplinary-Phenotyping-to-Biolo

Moving-From-Multidisciplinary-Phenotyping-to-Biolo

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The assessment and management of fibrotic interstitial lung disease (ILD) traditionally rely on a combination of clinical, radiological, and sometimes pathological data within a multidisciplinary discussion (MDD). Surgical lung biopsy (SLB), considered the gold standard, poses high risks and variability. Less invasive options like transbronchial biopsies often fall short in diagnosing fibrotic ILD.<br /><br />Recently, a genomic classifier (GC) has been introduced, assisting in distinguishing usual interstitial pneumonia (UIP) from non-UIP fibrosis patterns, thereby reducing interobserver variability in histopathology. GC has shown high specificity in differentiating UIP in both surgical and transbronchial lung biopsy specimens. Kheir et al. explored the application of GC alongside transbronchial lung cryobiopsy in 24 patients, finding that the addition of GC results to traditional clinical data improved diagnostic confidence, although the overall impact on management remains uncertain.<br /><br />The shift from invasive methods like SLB to safer diagnostics is emphasized, but challenges persist due to variability in test outcomes and MDD subjectivity. Although the GC enhances certainty, whether this translates into improved treatment outcomes is debated. Evidence shows anti-fibrotic therapies benefit patients with progressive fibrosing ILD, irrespective of detailed clinical diagnoses, questioning the need to differentiate UIP from non-UIP patterns. However, the GC might still be valuable by identifying specific patient groups benefitting more from treatments like nintedanib, guiding therapeutic choices between anti-fibrotic and immunomodulatory options, and enriching prognosis.<br /><br />Furthermore, aligning with trends in personalized medicine analogous to oncology, GC and similar tools could support the development of targeted ILD treatments based on patients' biological profiles. Additional research is crucial to verify if these advancements lead to significant management changes and better patient outcomes, advocating for a model where medical treatments are tailored based on biological understanding rather than morphological patterns.

Keywords

fibrotic interstitial lung disease

multidisciplinary discussion

surgical lung biopsy

genomic classifier

usual interstitial pneumonia

transbronchial lung cryobiopsy

diagnostic confidence

anti-fibrotic therapies

personalized medicine

targeted ILD treatments