What is the role of lung biopsy in the workup of restrictive lung disease?

Updated: Sep 16, 2020
  • Author: Jonathan Robert Caronia, DO; Chief Editor: John J Oppenheimer, MD  more...
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A lung biopsy is not always required to make a diagnosis in patients suggestive of having iingnterstitial lung diseases. A lung biopsy can provide information that may help lead to a specific diagnosis, help assess for disease activity, exclude neoplastic and infectious processes, establish a definitive diagnosis, and predict the prognosis.Open lung biopsy can be as valuable in selected patients [40]  as high-resolution CT scanning, and the American Thoracic Society/European Respiratory Society (ATS/ERS) clinical criteria may misdiagnose patients with interstitial lung disease. [41] This is a bit confusing.

Fiberoptic bronchoscopy with transbronchial lung biopsy is often the initial procedure of choice, especially when sarcoidosis, lymphangitic carcinomatosis, eosinophilic pneumonia, Goodpasture syndrome, pulmonary Langerhans cell histiocytosis, hypersensitivity pneumonitis, or infection is suggested based on clinical evidence.

Despite the utility of transbronchial biopsy, certain forms of idiopathic interstitial pneumonias (ie, IPF, nonspecific interstitial pneumonia, lymphocytic interstitial pneumonitis ) require surgical biopsy to make an accurate diagnosis.

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