European Respiratory Society Annual Congress 2013 Abstract Number: 5453 Publication Number: P2306 Abstract Group: 1.4. Interventional Pulmonology Keyword 1: Idiopathic pulmonary fibrosis Keyword 2: Interstitial lung disease Keyword 3: Bronchoscopy Title: The diagnostic role of cryobiopsy in the multidisciplinary diagnosis of idiopathic pulmonary fibrosis Dr. Sara 19089 Tomassetti [email protected] MD 1, Prof. Athol U. 19110 Wells [email protected] MD 2, Prof. Ulrich 19118 Costabel [email protected] MD 3, Dr. Cavazza 19127 Alberto [email protected] MD 4, Prof. Thomas V. 19136 Colby [email protected] MD 5, Dr. Rossi 19133 Giulio [email protected] MD 4, Dr. Carloni 19126 Angelo [email protected] MD 6, Dr. Sverzellati 19125 Nicola [email protected] MD 7, Prof. Jay H. 19142 Ryu [email protected] MD 8, Dr. Matteo 19152 Buccioli [email protected] 1, Dr. Paola 19153 Tantalocco [email protected] 1, Dr. Oriana 19149 Nanni [email protected] 9, Dr. Elisa 19150 Carretta [email protected] 9, Dr. Claudia 19094 Ravaglia [email protected] MD 1, Dr. Christian 19155 Gurioli [email protected] MD 1, Dr. Gian Luca 19544 Casoni [email protected] MD 1, Dr. Carlo 19545 Gurioli [email protected] MD 1, Dr. Micaela 19552 Romagnoli [email protected] MD 1, Dr. Alessandra 19554 Dubini [email protected] MD 10, Prof. Chilosi 29670 Marco [email protected] MD 11 and Prof. Venerino 19557 Poletti [email protected] MD 1. 1 Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy ; 2 Interstitial Lung Disease, Royal Brompton Hospital and NHLI, London, United Kingdom ; 3 Dept Pneumology/Allergy, Ruhrlandklinik, University Hospital, Essen, Germany ; 4 Pathology, Arcispedale S Maria Nuova - IRCCS, Reggio Emilia, Italy ; 5 Pathology, Mayo Clinic, Scottsdale, United States ; 6 Radiology, Ospedale S Maria, Terni, Italy ; 7 Radiology, Parma University, Parma, Italy ; 8 Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, United States ; 9 Biostatistics and Clinical Trials Unit, IRCCS Istituto Scientifico Romagnolo Per Lo Studio e La Cura Dei Tumori (IRST), Forlì, Italy ; 10 Pathology, GB Morgagni, Forlì, Italy and 11 Pathology, Università Di Verona, Verona, Italy . Body: OBJECTIVE The objective of this study is to address the diagnostic role of cryobiopsy in the multidisciplinary diagnosis (MDD) of idiophatic pulmonary fibrosis (IPF) compared to surgical lung biopsy (SLB). METHOD We evaluated 117 consecutive cases of fibrotic ILDs. 59 (50%) underwent SLB and a 58 (50%) cryobiopsies. Two clinicians (AUW and UC), two radiologists (AC and NS) and two pathologists (AC and GR) sequentially reviewed clinical-radiological findings and biopsies, recording at each step their diagnostic impression. RESULTS Biopsies were diagnostic in 55 cryobiopsy (93%), and in all but one SLB (98%). UIP pattern was detected with a high confidence level in 51% (20/39) and 84% (32/38) of cryobiopsy and SLB respectively. Kappa coefficient of agreement between pathologists was 0.73, 95% CI 0.54-0.91 and 0.83, 95% CI 0.69-0.99 for cryobiopsy and SLB respectively. The multidisciplinary team of experts changed the initial consensus diagnostic impression after SLB and cryobiopsy in 38 cases (64.4%) and 39 cases (67.2%) respectively (p=0.747). Unanimous agreement between experts in diagnosis of IPF with high level of confidence changed from 3.5% (2/58) to 17% (10/58) before and after cryobiopsy, respectively. Similarly in SLB changed from 3.4% (2/59) to 20% (12/59). 90 days mortality related to cryobiopsy was 1.7% compared to 3.4% for SLB. CONCLUSION Pathologists are less confident in the recognition of UIP pattern on cryobiopsy compared to SLB. However in the context of MDD the impact of cryobiopsy and SLB in the diagnosis of IPF is strikingly similar. Given the higher mortality of SLB, we conclude that transbronchial cryobiopsy could replace SLB in the evaluation of suspected IPF..