CHEST Guidelines-Rebuttal-From-Dr-Tomassetti-et al

Rebuttal-From-Dr-Tomassetti-et al_chest

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The debate in the document centers around the diagnostic approaches for interstitial lung disease (ILD), focusing on the use of surgical lung biopsy (SLB) versus transbronchial lung cryobiopsy (TBLC). Recent discussions highlight the hope for less invasive diagnostic tools to eventually replace both procedures. The article mentions the insights of Tomassetti et al., who suggest that the ultimate goal is to leverage the knowledge gained from tissue samples, irrespective of the method used to acquire them.<br /><br />Tomassetti and colleagues argue against considering TBLC merely as an alternative to surgery. Instead, they advocate for TBLC as a less invasive part of the diagnostic algorithm, which should precede SLB when diagnosing ILD. They assert that TBLC can provide sufficient diagnostic data with significantly less risk than surgery, and its safety profile allows its use even in less risky scenarios.<br /><br />Critics of TBLC argue that surgical biopsy has long been considered the gold standard due to the larger and more informative tissue samples it yields. However, Tomassetti and colleagues challenge this notion, emphasizing that diagnostic confidence can be achieved with smaller, less harmful samples obtained through TBLC. Furthermore, studies and meta-analyses demonstrate that TBLC's diagnostic accuracy closely rivals that of SLB.<br /><br />A pivotal study, COLDICE, highlighted that SLB contributed little when a multidisciplinary team arrived at a confident diagnosis with TBLC, with a 95% concordance rate between the two methods. The authors conclude that TBLC should be the initial investigative step for ILD needing a biopsy, with SLB only as a subsequent procedure if necessary. This stance is reinforced by modifying diagnostic algorithms to integrate cryobiopsy and surgical methods more effectively.

Keywords

interstitial lung disease

diagnostic approaches

surgical lung biopsy

transbronchial lung cryobiopsy

Tomassetti

less invasive diagnostics

diagnostic algorithm

COLDICE study

diagnostic accuracy

multidisciplinary team