ABSTRACT
Optimal management of patients with interstitial lung disease (ILD) is dependent on establishing an accurate, specific ILD diagnosis that allows clinicians to recommend appropriate therapeutic interventions that are likely to help and not harm patients (1,2). Because patients with different forms of ILD frequently have similar symptoms, signs and findings on routine chest radiographs as well as inconclusive laboratory test results, some form of invasive testing is often required to make or confirm a specific diagnosis. In many instances a high-resolution computed tomography (HRCT) scan of the thorax can reveal a pattern that is pathognomonic for a specific form of ILD (thereby obviating the need for invasive procedures) or reveals a pattern that narrows the differential diagnosis considerably (3–5). However, if the diagnosis remains unclear, clinicians can utilize a number of invasive procedures to identify and diagnose specific forms of ILD (Figures 6.1 and 6.2). Flexible bronchoscopy (FB) has been used for more than three decades to evaluate patients with ILD, and surgical lung biopsy (SLB) has been used for over half a century. With the development of advanced surgical techniques, the flexible bronchoscope, an improved ability to interpret diagnostic patterns in histopathologic specimens and the advent of pharmacologic therapies that can induce remission or significantly slow the tempo of disease progression for many types of ILD, invasive testing has become more commonplace and accepted in the evaluation of these patients (1,6–8).
