A proposed pathological diagnosis flowchart for adult interstitial lung disease with transbronchial lung cryobiopsy: Position paper from the Japanese research group on diffuse lung disease

Transbronchial lung cryobiopsy for interstitial lung disease is described in guidelines as an “acceptable alternative” to surgical lung biopsy. However, the pathological diagnosis of interstitial lung disease by transbronchial lung cryobiopsy is difficult compared with surgical lung biopsy because of the small sample size, leading to diagnostic disagreement not only in pathological diagnosis but also in multidisciplinary discussion diagnosis. Therefore, a standardized approach for the pathological diagnosis of ILD using transbronchial cryobiopsy is necessary. We developed a diagnostic flowchart for the pathological diagnosis of ILD using transbronchial cryobiopsy based on the consensus reached by the Pathology and Cryobiopsy Subcommittee within the Study Group on Diffuse Pulmonary Disorders, Scientific Research/Research on Intractable Diseases of the Ministry of Health, Labour, and Welfare of Japan. This study reports the diagnostic flowchart.