---
title: "Chinese expert consensus on lung biopsy use in interstitial lung disease: 15 recommendations"
id: "pubmed-42811563"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42811563"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42811563/"
doi: "10.3760/cma.j.cn112147-20260524-00302"
published_at: "2026-10-12T00:00:00.000Z"
evidence_level: "Consensus Statement"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Chinese expert consensus on lung biopsy use in interstitial lung disease: 15 recommendations
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42811563
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42811563/)
- **DOI:** [10.3760/cma.j.cn112147-20260524-00302](https://doi.org/10.3760%2Fcma.j.cn112147-20260524-00302)
- **Published At:** 2026-10-12T00:00:00.000Z
- **Evidence Rating:** Consensus Statement
## Executive GIST (TL;DR)
- The Chinese Thoracic Society and allied experts produced a multidisciplinary, evidence-graded consensus to guide the clinical use of **lung biopsy** in interstitial lung disease (ILD). The document was developed using systematic literature review, evidence grading, and the Delphi method. - The consensus defines 15 recommendations covering pre-biopsy multidisciplinary discussion (MDD), indications, HRCT-based indication stratification, biopsy-site selection, technique selection among TBLB, TBLC, SLB, and PTNB, perioperative management, and post-biopsy integrated diagnosis. - A mandatory pre-biopsy **MDD** is recommended to assess diagnostic certainty, clinical utility, and to enable shared decision-making (Level 3 evidence, strong recommendation). - Biopsy is recommended when noninvasive evaluation is inconclusive or histologic subtyping will change management (Level 4, strong). Certain HRCT patterns (definite UIP) generally discourage biopsy; indeterminate or non-UIP patterns favor biopsy (Levels 4, conditional to strong). - For alveolar filling patterns, biopsy is recommended after exclusion of infection, hemorrhage, and edema and when empirical therapy fails or malignancy must be excluded (Level 2, strong). - For suspected rare ILDs, prioritize non- or minimally invasive tests; biopsy is conditional if noninvasive tests fail, but strongly recommended for suspected AFOP or PLCH (Level 2, conditional). - Numerous absolute contraindications to biopsy are listed: acute respiratory failure, severe functional impairment, recent cardiovascular events, hemodynamic instability, significant pulmonary hypertension, severe coagulopathy, or terminal systemic debilitation (Level 1, strong). - Biopsy site selection should target active lesions on HRCT, include disease–normal interfaces, avoid major vessels and bullae, and sample multiple lobes to capture heterogeneity (Level 4, strong). - Technique-specific guidance: TBLB for granulomatous disease and certain alveolar patterns (not fibrotic ILD); TBLC preferred in expert centers with standardization and hemorrhage control measures; SLB (VATS) for non-diagnostic TBLC when physiologically tolerated; PTNB for focal nodules/masses to exclude malignancy but not for diffuse fibrosing ILD (Levels 2–4). - Shared decision-making (SDM) is recommended throughout, with explicit counseling on benefits, risks, and alternatives (Level 4, strong). - Risk factors for acute exacerbation of ILD (AE-ILD) include UIP pattern, active disease phase, and decreased DLCO; routine prophylactic steroids or antifibrotics are not recommended—focus on meticulous perioperative care. If AE occurs, investigate cause and consider high-dose glucocorticoids plus supportive care (Level 2, strong). - Pathology reporting must follow international standardized nomenclature, describe predominant patterns, note features suggesting specific etiology, and declare limitations due to specimen quality (Level 4, strong). - Post-biopsy MDD by the same multidisciplinary team is essential to generate an integrated diagnosis; if discordant or unresolved, repeat MDD or expert referral and possible repeat biopsy should be considered (Level 2, strong).
## Clinical Analysis & Structured Key Points
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Zhonghua Jie He He Hu Xi Za Zhi. 2026. Show details Display options Display options Format Abstract PubMed PMID Zhonghua Jie He He Hu Xi Za Zhi Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Zhonghua+Jie+He+He+Hu+Xi+Za+Zhi%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Zhonghua+Jie+He+He+Hu+Xi+Za+Zhi%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42811563/) . 2026 Oct 12;49(10):1058-1071. doi: 10.3760/cma.j.cn112147-20260524-00302. ### Authors [Chinese Thoracic Society, Chinese Medical Association](https://pubmed.ncbi.nlm.nih.gov/?term=Chinese+Thoracic+Society%2C+Chinese+Medical+Association%5BCorporate+Author%5D); [Chinese Association of Chest Physicians](https://pubmed.ncbi.nlm.nih.gov/?term=Chinese+Association+of+Chest+Physicians%5BCorporate+Author%5D) * PMID: **42811563** * DOI: [ 10.3760/cma.j.cn112147-20260524-00302 ](https://doi.org/10.3760/cma.j.cn112147-20260524-00302) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract in [ English, ](https://pubmed.ncbi.nlm.nih.gov/42811563/#eng-abstract) [ Chinese ](https://pubmed.ncbi.nlm.nih.gov/42811563/#zho-abstract) Interstitial lung disease (ILD) comprises a highly heterogeneous group of pulmonary disorders, whose diagnosis often requires the integration of clinical, radiologic, and pathologic evidence. Lung biopsy is a key method for obtaining a histopathologic diagnosis, but unified standards are lacking for determining indications, selecting biopsy techniques, managing patients perioperatively, and integrating pathologic and clinical information. To address these gaps, the Respiratory Physicians Branch of the Chinese Medical Doctor Association and the ILD Group of the Chinese Thoracic Society spearheaded this initiative, collaborating with national experts in respiratory medicine, radiology, pathology, thoracic surgery, and rheumatology to formulate this consensus. Developed in strict adherence to evidence-based medicine principles, this consensus is founded on systematic literature reviews and evidence grading, utilizing the Delphi method for anonymous voting. It culminates in 15 recommendations, each explicitly annotated with the level of evidence and strength of recommendation. This consensus systematically delineates the multidisciplinary discussion (MDD)-centered full-process management of lung biopsy. The main contents encompass: assessment of the necessity and feasibility of lung biopsy; indication stratification strategies based on HRCT patterns; applicability scenarios and selection pathways for the four major lung biopsy techniques; shared decision-making; perioperative comprehensive management; management strategies for acute exacerbation of ILD (AE-ILD); standardization of tissue processing and pathological reporting; the post-biopsy MDD process for integrated diagnosis; and biopsy decision-making in special clinical contexts, such as ILD complicated by lung cancer or connective tissue disease-associated ILD (CTD-ILD). This consensus aims to provide clinicians with clear, safe, and practical guidance on lung biopsy, promote standardized and precise decision-making, and improve patient outcomes.**Summary of Recommendations****Recommendation 1:** For patients with suspected ILD, a comprehensive multidisciplinary discussion (MDD) is mandatory prior to lung biopsy. This evaluation should establish the diagnostic certainty of the preliminary clinical assessment, evaluate the clinical utility of the biopsy, and facilitate shared decision-making (SDM) that incorporates patient preferences (Level of evidence: 3, Recommendation: strong).**Recommendation 2:** For ILD patients in whom the diagnosis remains uncertain following a comprehensive non-invasive evaluation, or when precise histopathologic subtyping is required, a lung biopsy is recommended to establish a definitive diagnosis and guide the therapeutic management (Level of evidence: 4, Recommendation: strong).**Recommendation 3:** For patients with an interstitial pattern, a lung biopsy is strongly discouraged if HRCT demonstrates a definite UIP pattern and secondary etiologies have been excluded. A conditional recommendation for a lung biopsy applies to patients with a probable UIP patterns in whom NSIP or fibrotic HP cannot be ruled out. A lung biopsy is strongly recommended to achieve a definitive diagnosis in patients with an indeterminate or non-UIP patterns and insufficient clinical evidence (Level of evidence: 4, Recommendation: conditional).**Recommendation 4:** For patients with an alveolar filling pattern, a lung biopsy is recommended to clarify the etiology once infection, alveolar hemorrhage, and pulmonary edema have been systematically excluded, and there is either a lack of response to empirical therapy or a clinical necessity to differentiate the lesion from malignancy (Level of evidence: 2, Recommendation: strong).**Recommendation 5:** For suspected rare ILDs, including PAP, iEP, LAM, and LIP, non-invasive or minimally invasive diagnostic modalities should be prioritized; a lung biopsy is conditionally recommended if these approaches are non-diagnositic. Conversely, a lung biopsy is strongly recommended for patients with clinically suspected AFOP or PLCH (Level of evidence: 2, Recommendation: conditional).**Recommendation 6:** Lung biopsy is not recommended for patients with acute respiratory failure, severe pulmonary functional impairment, recent cardiovascular events, hemodynamic instability, significant pulmonary hypertension, severe coagulopathy, or end-stage systemic debilitation (Level of evidence: 1, Recommendation: strong).**Recommendation 7:** Site selection for lung biopsy should target active lesions identified on HRCT (e.g., ground-glass opacities or fine reticulation). Specimens must include the interface between diseased and normal parenchyma to facilitate pattern assessment. High-risk areas, such as major vessels and severe bullae, must be strictly avoided. Multi-lobar sampling from at least two sites of varying severity is recommended to adequately capture disease heterogeneity (Level of evidence: 4, Recommendation: strong).**Recommendation 8:** A TBLB is recommended as the first-line diagnostic approach for suspected granulomatous diseases (e.g., sarcoidosis) and specific alveolar filling patterns. If a TBLB is non-diagnostic, escalation to TBLC or SLB is advised. A TBLB is not recommended for the evaluation of predominantly fibrotic ILDs (e.g., UIP or NSIP) (Level of evidence: 4, Recommendation: strong).**Recommendation 9:** TBLC is recommended as the preferred modality in expert centers, particularly for patients who are poor candidates for or are averse to SLB. The procedure should be standardized under general anesthesia with prophylactic balloon placement for hemorrhage control and integrated with imaging or navigational guidance to optimize diagnostic yield while minimizing procedural complications (Level of evidence: 2, Recommendation: strong).**Recommendation 10:** SLB is recommended for patients in whom TBLC yields a non-diagnostic result, provided their cardiopulmonary physiological reserve permits surgical intervention. Video-assisted thoracoscopic surgery (VATS) is the preferred approach, requiring sampling from at least two distinct lobes. Biopsies should prioritize the dependent segments of the upper lobes or the superior segments of the lower lobes; sampling from the lingula or the right middle lobe should only be considered if these sites harbor the most representative lesions and no superior alternatives exist (Level of evidence: 2, Recommendation: strong).**Recommendation 11:** PTNB is recommended for the diagnosis and differential diagnosis in ILD patients presenting with solitary nodules, masses, or focal consolidations, particularly to rule out malignancy. However, it is not recommended for the histopathological evaluation of diffuse fibrosing ILDs (Level of evidence: 2, Recommendation: strong).**Recommendation 12:** A shared decision-making model is recommended throughout the biopsy selection process. Clinicians should thoroughly counsel patients regarding the benefits, risks, and alternatives of the procedure, ultimately formulating a clinical plan that aligns medical evidence with patient values (Level of evidence: 4, Recommendation: strong).**Recommendation 13:** Histological or imaging patterns of usual interstitial pneumonia (UIP), active disease phase, and reduced diffusing capacity for carbon monoxide (DLCO) are the main risk factors for acute exacerbation of interstitial lung disease (AE-ILD). Routine prophylactic use of glucocorticoids or antifibrotic therapy is not recommended for all patients; instead, meticulous perioperative management is recommended to prevent acute exacerbations. Once AE occurs, the underlying cause should be promptly investigated, and high-dose glucocorticoids along with supportive therapy may be considered (Level of evidence: 2, Recommendation: strong).**Recommendation 14:** Histopathological reports must adhere to current international standardized nomenclature, prioritizing the description of the predominant histological patterns and their salient features, while specifically noting any findings indicative of a specific etiology. Diagnostic limitations secondary to suboptimal specimen quality must be explicitly stated. Pathologists are required to provide a systematic and standardized microscopic description of the tissue pathology, formulate a histopathological classification, and offer etiological insights whenever feasible (Level of evidence: 4, Recommendation: strong).**Recommendation 15:** Post-biopsy MDD is central to formulating an integrated diagnosis and should be conducted by the same cohort of clinicians, radiologists, and pathologists involved in the initial evaluation. A systematic correlation between the histopathology and the clinical andradiologic data is required; any discordances must be thoroughly analyzed to achieve a consensus integrated diagnosis and guide therapeutic planning. If an integrated diagnosis cannot be established, a subsequent MDD or referral to an expert center for a repeat biopsy is warranted (Level of evidence: 2, Recommendation: strong). 间质性肺疾病（ILD）是一组高度异质性的肺疾病，其诊断常需整合临床、影像及病理学证据。肺活检是获取组织病理学诊断的关键手段，但在指征把握、技术选择、围手术期管理及病理与临床信息整合等方面，尚缺乏统一规范。为此，中国医师协会呼吸医师分会和中华医学会呼吸病学分会间质性肺疾病学组牵头，联合国内呼吸病学、影像学、病理学、胸外科学及风湿病学等领域专家，共同制定本共识。共识制定严格遵循循证医学原则，基于系统性文献检索与证据评价，采用德尔菲法进行匿名投票，最终形成15条推荐意见，并明确标注证据等级与推荐强度。本共识系统阐述了以多学科讨论为核心的肺活检全流程管理，主要内容包括：肺活检必要性与可行性的评估、基于HRCT表现的适应证分层策略、四种主要肺活检技术的适用场景与选择路径、医患共同决策、AE-ILD的管理策略、组织标本处理与病理报告标准化以及活检后多学科讨论整合诊断流程。本共识旨在为临床医生提供清晰、安全、可操作的肺活检实践指导，推动ILD肺活检决策的规范化与精准化，改善患者预后。. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement 所有作者声明无利益冲突 ## Similar articles * [ [Chinese expert consensus on the pathological diagnosis of interstitial lung disease with transbronchial lung cryobiopsy specimens]. ](https://pubmed.ncbi.nlm.nih.gov/39069847/) Respiratory Pathology Working Group of Respiratory Physicians Branch of Chinese Medical Doctor Association; Thoracic Disease Group of Pathology Branch of Chinese Medical Association.Respiratory Pathology Working Group of Respiratory Physicians Branch of Chinese Medical Doctor Association, et al.Zhonghua Jie He He Hu Xi Za Zhi. 2024 Aug 12;47(8):704-715. doi: 10.3760/cma.j.cn112147-20231127-00343.Zhonghua Jie He He Hu Xi Za Zhi. 2024.PMID: 39069847Chinese. * [ [Guidelines for the diagnosis and treatment of obstructive sleep apnea in adults (2025)]. ](https://pubmed.ncbi.nlm.nih.gov/41820035/) Chinese Thoracic Society.Chinese Thoracic Society.Zhonghua Jie He He Hu Xi Za Zhi. 2026 Mar 12;49(3):264-296. doi: 10.3760/cma.j.cn112147-20251108-00694.Zhonghua Jie He He Hu Xi Za Zhi. 2026.PMID: 41820035Chinese. * [ Vesicoureteral Reflux. ](https://pubmed.ncbi.nlm.nih.gov/33085409/) Leslie SW, Aeddula NR.Leslie SW, et al.2024 Apr 30. In: StatPearls [Internet
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