Clinical utility of lung biopsy in fibrotic interstitial lung disease

Lung biopsy has traditionally played a fundamental role in addressing diagnostic uncertainty and guiding management of fibrotic interstitial lung disease (fILD). Multiple lung biopsy procedures are available for evaluation of fILD, including bronchoscopic techniques such as transbronchial biopsy and transbronchial lung cryobiopsy, as well as surgical lung biopsy, which is now almost exclusively conducted using minimally invasive video-assisted thoracoscopic surgery. The various evolving considerations for and against lung biopsy have led to substantial ambiguity regarding the optimal timing and choice of biopsy method. The rationale for performing a lung biopsy in fILD is multifaceted, shaped by its potential to enhance diagnostic confidence and inform therapeutic decisions, weighed against procedural risks, and further nuanced by patient values and preferences. The objective of this state-of-the-art document from a multidisciplinary group of experts and patient representatives is to summarize the rationale for and against lung biopsy in the evaluation and management of fILD. Amid ongoing technological innovations, we further emphasize that future research should prioritize the development and validation of minimally invasive and non-invasive modalities that may serve as either alternatives or adjuncts to biopsy in the diagnostic evaluation of fILD.

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Publication Details

Journal
American Journal of Respiratory and Critical Care Medicine
Published
2026-01-07
DOI
https://doi.org/10.1093/ajrccm/aamaf123
Primary Topic
Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
Type
article
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article

Clinical utility of lung biopsy in fibrotic interstitial lung disease

Andrew Churg, Kerri I. Aronson, Sara Piciucchi, W. CLARK COOPER et al.
American Journal of Respiratory and Critical Care Medicine
Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
article

Clinical utility of lung biopsy in fibrotic interstitial lung disease

Andrew Churg, Kerri I. Aronson, Sara Piciucchi, W. CLARK COOPER, Santosh K. Sangari, David J. Lederer, C Ravaglia, BRIDGET F COLLINS, Cameron John Hague, Y. Dotan, Elad Mor, Sara Tomassetti, Aurelie Fabre, Lida P. Hariri, Fernando J. Martinez, Christopher J Ryerson, Ayodeji Adegunsoye, Venerino Poletti, Jonathan Chung, Joseph Jacob, Kazuhiro Yasufuku, Marlies S Wijsenbeek, Jim Mcdonald, Vincent Cottin, Athol U Wells, Yoshikazu Inoue, Linda Dominy, Yet H Khor
article en

Abstract

Lung biopsy has traditionally played a fundamental role in addressing diagnostic uncertainty and guiding management of fibrotic interstitial lung disease (fILD). Multiple lung biopsy procedures are available for evaluation of fILD, including bronchoscopic techniques such as transbronchial biopsy and transbronchial lung cryobiopsy, as well as surgical lung biopsy, which is now almost exclusively conducted using minimally invasive video-assisted thoracoscopic surgery. The various evolving considerations for and against lung biopsy have led to substantial ambiguity regarding the optimal timing and choice of biopsy method. The rationale for performing a lung biopsy in fILD is multifaceted, shaped by its potential to enhance diagnostic confidence and inform therapeutic decisions, weighed against procedural risks, and further nuanced by patient values and preferences. The objective of this state-of-the-art document from a multidisciplinary group of experts and patient representatives is to summarize the rationale for and against lung biopsy in the evaluation and management of fILD. Amid ongoing technological innovations, we further emphasize that future research should prioritize the development and validation of minimally invasive and non-invasive modalities that may serve as either alternatives or adjuncts to biopsy in the diagnostic evaluation of fILD.

American Journal of Respiratory and Critical Care MedicineVol. 212(3)
Université Claude Bernard Lyon 1 (FR), University College Dublin (IE), The University of Sydney (AU), UMass Memorial Health Care (US), University Health Network (CA), University of British Columbia (CA), The University of Melbourne (AU), University of Washington (US), Aarhus University (DK), Cornell University (US), Royal Prince Alfred Hospital (AU), Rambam Health Care Campus (IL), Erasmus MC (NL), Aarhus University Hospital (DK), UNSW Sydney (AU), University of California San Diego (US), University of Chicago (US), Massachusetts General Hospital (US), Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (FR), Monash Alfred Psychiatry Research centre (AU), Royal Brompton Hospital (GB), Institute for Breathing and Sleep (AU), Lung Institute (US), St. Vincent's University Hospital (IE), Azienda Ospedaliero-Universitaria Careggi (IT), Rappaport Family Institute for Research in the Medical Sciences (IL), Ospedale G.B. Morgagni - L.Pierantoni (IT), Systems, Applications & Products in Data Processing (United Kingdom) (GB), Hôpital Louis Pradel (FR), The London College (GB), Fukujuji Hospital (JP), NHO Kinki Chuo Chest Medical Center (JP), UMass Memorial Medical Center (US), Austin Health (AU), University College London (GB), Imperial College London (GB), Erasmus University Rotterdam (NL), University of Bologna (IT)
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Openalex Percentile: Top 61%
Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
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