The following is a summary of “Role of Lung Biopsy for Diagnosis and Prognosis of Interstitial Lung Disease in Systemic Sclerosis: A Systematic Literature Review,” published in the March 2024 issue of Pulmonology by Damiani et al.

The prognostic and therapeutic significance of histopathological subsets in systemic sclerosis interstitial lung disease (SSc-ILD) has often been overlooked due to limited treatment options and the inherent risks associated with surgical lung biopsy. However, with the emergence of novel therapies for interstitial lung diseases (ILDs) and the availability of transbronchial cryo biopsy, lung biopsy has become increasingly feasible and potentially pivotal in guiding treatment decisions. This study aimed to investigate the utility of lung biopsy in SSc ILD through a systematic literature review (SLR).

A comprehensive search of PubMed, Embase, and Cochrane databases up to June 30, 2023, was conducted using database-specific controlled vocabulary terms and free-text terms relating to lung biopsy and SSc-ILD diagnostic and prognostic outcomes. The SLR adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Studies were selected based on the PEO (population, exposure, and outcomes) framework, and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) was employed for quality assessment.

Fourteen articles meeting inclusion criteria were identified, encompassing 364 SSc-ILD patients. However, the scarcity and heterogeneity of the studies precluded a systematic analysis. Diffuse cutaneous SSc was prevalent in 30–100% of cases, with a consistent female predominance (64–100%) and a mean age range of 42–64 years. Surgical lung biopsy was performed in all cases, with multiple lobes biopsied in a minority of studies. Poor correlation between high-resolution computed tomography (HRCT) and histopathology was noted, with HRCT patterns resembling nonspecific interstitial pneumonia (NSIP) exhibiting histopathological findings consistent with usual interstitial pneumonia (UIP) in up to one-third of cases. Limited data suggested that SSc-UIP patients may have a poorer prognosis and response to immunosuppressive therapy compared to other histopathological patterns.

This SLR underscores the scarcity and heterogeneity of studies investigating lung biopsy in SSc ILD and emphasizes further research to elucidate whether lung biopsy can refine the prognostic prediction and effectively guide therapeutic strategies.

Source: respiratory-research.biomedcentral.com/articles/10.1186/s12931-024-02725-1