Endobronchial OCT matched the final ILD diagnosis in 15 of 15 patients

Design

Prospective pilot diagnostic study with blinded interpretation

Population

15 patients with low-confidence ILD diagnosis referred for cryobiopsy

Primary outcome

Agreement with final multidisciplinary diagnosis

Effect

15/15 agreement, including 6 with non-diagnostic cryobiopsy

This pilot enrolled 15 patients with a low-confidence ILD diagnosis who were already referred for transbronchial cryobiopsy and a genomic classifier. They also underwent endobronchial optical coherence tomography, a bronchoscopic imaging method with near-microscopic resolution over a large lung volume.

Interpreted blind, EB-OCT agreed with the final multidisciplinary diagnosis in all 15, including the six (40%) in whom cryobiopsy was non-diagnostic. Combined with cryobiopsy and the classifier, it raised diagnostic confidence or narrowed the differential in every patient, at two independent centres, one without prior EB-OCT experience.

Fifteen patients from an expert centre is a small start, and the technique is not widely available. But it addresses a real gap: cryobiopsy is non-diagnostic in a meaningful share of patients, and surgical biopsy carries risk in older patients with fibrosis.

• EB-OCT is investigational and limited to specialist centres.
• Cryobiopsy was non-diagnostic in six of 15 patients in this cohort.
• Multidisciplinary discussion remains the standard for ILD diagnosis.
• Watch for multicentre validation before considering it in routine pathways.

Why it matters

It could reduce the need for surgical biopsy in patients for whom it is risky.

Don't overread it

A 15-patient pilot cannot establish diagnostic accuracy in routine practice.

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