This European Respiratory Society Clinical Research Collaboration guideline, published in September, used GRADE to address screening and diagnosis of granulomatous-lymphocytic interstitial lung disease (GLILD) in common variable immunodeficiency disorders (CVID). Practice has varied widely between centres.
The panel recommends screening all adults with CVID for GLILD, preferably with high-resolution CT, and evaluation by a multidisciplinary team. Routine lung biopsy is not required but is necessary for atypical presentations. Infection should be excluded and lymphocytic alveolitis sought by bronchoalveolar lavage. Lung function, including gas transfer, should be measured to grade severity. Most recommendations are conditional because the evidence on health effects is of low certainty.
For radiologists, this means more HRCT requests from immunology clinics and a need to recognise the pattern — nodules, lymphadenopathy, ground-glass and reticulation — in a population where infection is the main alternative. The guideline standardises diagnosis; it does not address treatment.
- Expect HRCT requests for GLILD screening in all adults with CVID; the guideline recommends it.
- Report findings suspicious for GLILD and recommend multidisciplinary review rather than a definitive label on imaging alone.
- Flag features that could be infection, since exclusion of infection is part of the diagnostic pathway.
- Suggest biopsy only when the imaging pattern is atypical, in line with the guideline.
Why it matters
It is the first international standard for diagnosing a lung complication that has been handled differently in every centre.
Don't overread it
Most recommendations are conditional and based on low-certainty evidence; the guideline does not cover treatment.
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