Interstitial Lung Disease: What’s New for Pathologists?

Evaluation of lung biopsies from patients with ILD is challenging for surgical pathologists. Clinician expectations from pathologists have evolved with recent updates in clinical and diagnostic guidelines, the advent of a genomic classifier test for fibrotic ILD, and new clinical terms (e.g. IPAF, PPF). The size and number of biopsies encountered by pathologists have also changed over the last decade with the advent of transbronchial cryobiopsy techniques and a shift away from surgical lung biopsies. These changes have introduced more challenges for the pathologist but also new opportunities to increase the value of pathology for clinicians treating patients with ILD. Recent changes in ILD guidelines, ongoing shifts in clinical and surgical pathology practice, and potential opportunities for improvement and innovation in pathology will be discussed.
After viewing this lecture, participants should be able to:
1. List three reasons for clinicians’ general shift away from performing surgical lung biopsies for fibrotic ILD at most institutions.
2. Describe recent shift in clinical focus from “etiology” to “phenotype” of fibrotic ILD and potential benefits and consequences of the new concept “progressive pulmonary fibrosis”.
3. List three ways that pathologists might increase the value of lung biopsies for fibrotic ILD for their clinical colleagues and patients.
Brandon T. Larsen, MD, PhD Professor and Consultant, Mayo Clinic, Phoenix, Arizona
01/03/24