LAUSR

but also with respect to the quality and size of the biopsies. In a previous study, Almeida and colleagues assessed 100 TBLCs performed in patients with suspected diffuse lung disease (2). When they compared the first 50 TBLCs with the next 50 TBLCs, they found that the length and area of the biopsies were smaller and the diagnostic yield was lower in the first group, and all parameters improved when the bronchoscopists gained more experience. In their study, Almeida and colleagues reported a median length of 5.0 mm in the first 50 biopsies and 6.0 mm in the next 50 biopsies. Romagnoli and colleagues reported a level of agreement between external blinded versus local pathology reports as fair to moderate, with k values of 0.22–0.51. The k values for individual pathologists are not presented, and as noted above for bronchoscopy, there may be a learning curve for pathologic evaluations of cryobiopsies. In support of this, previous studies (which included the same external pathologist as in the present study) reported k values between 0.59 and 0.61 (5, 6). With regard to the agreement between the pathologic diagnosis based on the two types of specimens and the final diagnosis at the second multidisciplinary assessment or thefinal treatment (Table 2 andTable E3 in the online supplement of Reference 1), there is no statistically significant difference by conventional standards between the two types of specimens in terms of performance when evaluated by a chi-square test or Fisher’s exact test on simple 23 2 tables, even though there is trend in favor of SLB. This emphasizes the need for further research into this important subject before any conclusions can be made. The TBLCs were compared with SLBs as the gold standard. However, the accuracy of SLB has never been proven, and previous studies (7) have clearly shown that SLBs can also provide discordant results when performed in different lobes; thus, the perception of SLB as the gold standard requires careful consideration. The study by Romagnoli and colleagues certainly indicates that more research into the accuracy of TBLC is warranted, but their results cannot stand alone and should not discourage the continued use of TBLC in interstitial lung disease. n