Response

Abstract

I believe that Drs. Shorr, Lettieri, and Helman misinterpreted the message of our article (May 2006). 1 Berbescu E Katzenstein AL Snow J et al. Transbronchial biopsy in usual interstitial pneumonia. Chest. 2006; : 1126-1131 Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar This work generated a hypothesis that will require further testing. It was not intended to produce a clinical recommendation to use transbronchial lung biopsies (TBBs) to diagnose usual interstitial pneumonia (UIP). In our article, we clearly state that TBBs should be tested in a blinded fashion and in a cohort of diffuse lung diseases including UIP and non-UIP cases.1 However, it is undeniable, as we show in several of our figures, that features specific for UIP, such as patchwork pattern of interstitial fibrosis, fibroblastic foci, and honeycomb change, 2 Katzenstein A-LA Myers JL Transbronchial biopsy in usual interstitial pneumonia. Chest. 2006; : 1126-1131 PubMed Google Scholar , 3 Katzenstein A-LA Zisman DA Litzky LA Transbronchial biopsy in usual interstitial pneumonia. Chest. 2006; : 1126-1131 PubMed Google Scholar are readily recognizable in many TBB specimens. 1 Berbescu E Katzenstein AL Snow J et al. Transbronchial biopsy in usual interstitial pneumonia. Chest. 2006; : 1126-1131 Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar We did not report findings of nonspecific interstitial pneumonia in 9 of 21 patients, as Drs. Shorr, Lettieri, and Helman state. We make clear in the “Materials and Methods” section that findings were “nonspecific” if there was only interstitial fibrosis on TBB specimens. 1 Berbescu E Katzenstein AL Snow J et al. Transbronchial biopsy in usual interstitial pneumonia. Chest. 2006; : 1126-1131 Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar Unfortunately, it has become accepted, despite lack of convincing data, that TBBs are not useful in diagnosing idiopathic interstitial pneumonias. However, if in the future TBBs are found useful in diagnosing UIP from a pool of patients with diverse idiopathic interstitial pneumonias, many unnecessary surgical lung biopsies with associated morbidity and mortality could be prevented. 4 Utz JP Transbronchial biopsy in usual interstitial pneumonia. Chest. 2006; : 1126-1131 PubMed Google Scholar Role for Transbronchial Biopsy in the Diagnosis of Usual Interstitial PneumoniaChestVol. 131Issue 1PreviewWe read with interest the article by Berbescu et al1regarding the role for transbronchial biopsy (TBB) in the diagnosis of usual interstitial pneumonia (UIP). The authors conclude that TBB may be more useful than previously appreciated in the diagnosis of UIP. We do not believe their data support this conclusion. Full-Text PDF