Intérêt des biopsies transbronchiques et chirurgicales dans la prise en charge des pneumopathies interstitielles diffuses

Interpretation of lung material can be very difficult in patients with interstitial lung disease. The pathologist must be particularly familiar with this type of situation since, unlike tumor diseases, the diagnosis is not purely histological and must always be established in correlation with the clinical and radiological presentation. In patients with suspected interstitial lung disease, the first diagnostic step is to perform a transbronchial biopsy or bronchoalveolar lavage. In many cases the two minimally invasive techniques can be combined to guide the diagnosis or establish confirmation. The indications for surgical biopsy can thus be limited to very exceptional situations. We recall here the requirement for rigorous handling of the endoscopic or surgical specimens and discuss the specific difficulties in interpreting the pathological material, focusing on the contribution of the pathological study to clinical surveillance of the disease course and its complications, particularly in treated patients. A close collaboration between clinicians and pathologists is essential for optimal diagnosis and management of interstitial lung disease.