Interventional Pulmonology · Hyderabad
Diagnosing Interstitial Lung Disease in Hyderabad: From CT to Confirmed Diagnosis
By Dr. Kunal Waghray, MD DM DNB MNAMS EDRM — Interventional Pulmonologist, Respire Airway Clinics. Last reviewed: 12 May 2026.
If your CT scan shows a pattern of lung scarring, your radiologist may use terms like "ground-glass changes," "honeycombing," or "interstitial thickening." These words can be alarming, and they raise a question that a scan alone cannot always answer: which type of ILD is this, exactly?
The difference between types of ILD is not academic. It determines whether your treatment involves steroids, immunosuppressants, anti-fibrotic medication, or watchful monitoring. Two patients with similar-looking scans can have very different conditions, and very different paths forward.
This page explains how interstitial lung disease (ILD) is diagnosed in Hyderabad, when a biopsy is needed, and why cryobiopsy through a bronchoscope is now the safer path to a confirmed diagnosis for many patients.
What Is Interstitial Lung Disease?
ILD is not a single disease. It is a family of more than 200 conditions in which the lung tissue, the delicate scaffolding that surrounds the air sacs, becomes inflamed or scarred. Because the scarring sits in the interstitium (the space between the air sacs and the blood vessels), oxygen has a harder time crossing into the bloodstream.
Common Types of ILD
A diagnosis of "ILD" on its own is incomplete. Knowing the subtype changes the treatment plan. Some of the more frequently seen subtypes in Indian clinical practice include:
How Does ILD Affect Breathing?
In healthy lungs, oxygen passes easily from the air sacs into the bloodstream. In ILD, the walls of the air sacs thicken with inflammation or scar tissue. The lung becomes stiffer and less able to expand. Patients typically notice breathlessness on exertion first, followed by a dry cough that does not settle. Some patients develop fatigue or finger clubbing.
How ILD Is Diagnosed: The Full Diagnostic Pathway
An ILD diagnosis involves several steps. Understanding where you are in this process helps you ask better questions at each stage.
History and Symptoms
When did the breathlessness start? Is the cough dry or productive? Do you have joint pain, skin tightening, or a history of tuberculosis? Each answer narrows the list of possible diagnoses.
High-Resolution CT Scan (HRCT)
An HRCT is a detailed chest scan that captures very thin slices of the lung. The radiologist describes the pattern: UIP, NSIP, organising pneumonia, or another recognisable signature. In some cases the pattern is sufficient for diagnosis; in many, tissue is required.
Pulmonary Function Tests (PFTs)
PFTs measure how much air your lungs hold, how quickly you can move it, and how well oxygen transfers into the blood. In ILD the typical picture is a restrictive pattern with a reduced DLCO. PFTs do not diagnose ILD on their own, but they establish a baseline.
Specialist Consultation and Biopsy Decision
An interventional pulmonologist reviews the CT, PFTs, and autoantibody profile together. The decision then is not whether you have ILD, but whether there is enough information to commit to a treatment plan or whether a tissue sample is needed.
Multidisciplinary Team (MDT) Review
A chest radiologist, histopathologist, and pulmonologist review the imaging, biopsy slides, and clinical history together. The MDT diagnosis is the standard of care recommended by international ILD guidelines.
When Is a Lung Biopsy Needed for ILD?
Not everyone with ILD needs a biopsy. But when the CT pattern is ambiguous, a tissue sample is often the only way to confirm the subtype and choose the right treatment.
Which ILD Patterns Require Biopsy?
A biopsy is usually considered when:
- The HRCT shows a pattern that does not fit cleanly into one category (for example, "possible UIP" or "indeterminate for UIP")
- The clinical picture and the imaging point in different directions
- The decision between anti-fibrotic therapy and immunosuppression depends on the histology (examination of the tissue sample under a microscope)
- A connective tissue disease is suspected but the autoantibody panel is negative
Which Patients May Not Need a Biopsy?
In a smaller group of patients, a tissue diagnosis is not needed. If the HRCT shows a classical UIP pattern in an older patient with no autoimmune features, international guidelines accept a diagnosis of IPF without biopsy. Equally, if a patient is too frail to tolerate any biopsy procedure, the MDT may agree on a working clinical diagnosis and treat accordingly.
Cryobiopsy: Lung Biopsy Through a Bronchoscope
Until recently, a lung biopsy for ILD required open chest surgery under general anaesthesia, with an inpatient stay of several days. Cryobiopsy changes this.
What Is Cryobiopsy?
Transbronchial cryobiopsy is a procedure in which a thin flexible bronchoscope is passed into the airway under sedation. A small cryoprobe is then guided to the area of abnormal lung. The probe tip is cooled to around minus 80 degrees Celsius for a few seconds. The lung tissue freezes onto the probe, and a sample is retrieved.
The frozen sample is larger and better preserved than the small fragments produced by conventional forceps biopsy. This is why cryobiopsy has displaced forceps biopsy for ILD diagnosis in most modern centres.
The procedure is performed as a day-care procedure in most patients. Sedation is used rather than general anaesthesia. A balloon is positioned to control any bleeding, and fluoroscopic guidance is used to place the probe accurately, as recommended in the Indian Association for Bronchology (IAB) position statement on bronchoscopic lung cryobiopsy.
Published meta-analyses report a diagnostic yield of around 77 to 82 percent for transbronchial cryobiopsy after MDT discussion, with higher yields in centres performing the procedure regularly.
How Does Cryobiopsy Compare to Surgical Lung Biopsy?
VATS (video-assisted thoracic surgery) is the surgical alternative to cryobiopsy. It produces a larger tissue sample with a slightly higher diagnostic yield, but at the cost of a more invasive procedure.
| Feature | Cryobiopsy (transbronchial) | VATS surgical lung biopsy |
|---|---|---|
| Anaesthesia | Sedation | General anaesthesia |
| Access | Through the mouth via bronchoscope | Small incisions in the chest wall |
| Hospital stay | Usually same-day discharge | Typically 3 to 5 days |
| Diagnostic yield (post-MDT) | ~77 to 82% | ~93% |
| Recovery | A day or two | Two to four weeks |
| Chest drain | Not routinely needed | Usually required |
| Suitable for frail patients | Often yes | Often no |
The COLD randomised controlled trial published in The Lancet Respiratory Medicine showed that a cryobiopsy-first strategy, with surgical biopsy reserved for inconclusive cases, gave a similar overall diagnostic yield to immediate surgical biopsy with fewer adverse events.
Is Cryobiopsy Available in Hyderabad?
Yes. Cryobiopsy for ILD is performed at Respire Airway Clinics. Dr. Kunal Waghray trained in advanced interventional pulmonology techniques at the Amrita Institute of Medical Sciences, which has been one of the early adopters of bronchoscopic cryobiopsy in India.
In our practice, we see patients who have been living with an uncertain CT pattern for months. The referral to an interventional pulmonologist for cryobiopsy is often the step that finally resolves the diagnostic uncertainty.
Cryobiopsy is performed via bronchoscopy in Hyderabad, and the same procedure room is used for related diagnostic steps such as bronchoalveolar lavage (BAL), a procedure in which sterile fluid is gently flushed into a section of lung through the bronchoscope and retrieved for cell analysis.
What to Expect at Your ILD Diagnostic Appointment at Respire
First Consultation: Reviewing Your CT and PFTs
Bring every CD and report you have: HRCT discs, PFT printouts, blood tests, and any rheumatology notes. The first hour is spent going through them. We will often request a fresh autoantibody panel if the existing one is incomplete, and a six-minute walk test to assess your oxygen on exertion. By the end of the visit, you will know whether the next step is observation, treatment based on the available evidence, or a biopsy.
The Cryobiopsy Procedure: What Happens on the Day
You will be asked to fast for six hours before the procedure. On arrival, an IV line is placed and sedation is given. The bronchoscope is passed through the mouth and into the lung. Two or three small samples are taken from the target area. The entire procedure takes 30 to 45 minutes.
You will rest in the recovery area for two to four hours. A short chest X-ray is done to confirm no pneumothorax. Most patients go home the same day with a relative or attendant.
Results and MDT Review: Typically 7 to 10 Days
The tissue is sent to a histopathologist who specialises in lung disease. The slides, the HRCT, and your clinical summary are then discussed at a multidisciplinary team meeting. You will receive a written diagnosis and a treatment plan, usually within seven to ten days of the procedure. This is also the point at which a treatment specialist, such as an interventional pulmonologist in Hyderabad or a rheumatologist, will take over the long-term management plan.
Frequently Asked Questions
Can ILD be diagnosed without a biopsy?
Yes, in some cases. If the HRCT shows a classical UIP pattern in an older patient with no autoimmune features, international guidelines accept a clinical diagnosis of IPF without tissue sampling. For most other patterns, particularly when the CT is described as indeterminate or possible UIP, a biopsy adds important information that changes the treatment plan.
Is cryobiopsy painful?
The procedure is done under sedation, so you should not feel pain during the biopsy itself. Some patients have a mild sore throat or chest tightness for a day or two afterwards. Strong painkillers are rarely needed. This is one of the main reasons cryobiopsy has become preferred over surgical biopsy for patients who are eligible.
How long does it take to get ILD biopsy results?
The initial histopathology report is usually ready within seven days. The final MDT diagnosis, which combines the histology with the imaging and clinical history, is typically issued within 7 to 10 days of the procedure.
My rheumatologist said I have ILD related to my RA. Do I need an interventional pulmonologist?
Often yes. Lung involvement in rheumatoid arthritis, scleroderma, and dermatomyositis is common in Indian patients, and the rheumatologist will usually want a clearer picture of the lung pattern before escalating immunosuppression or starting an anti-fibrotic. The interventional pulmonologist confirms the ILD subtype and provides a baseline against which response to treatment can be measured. The rheumatologist and pulmonologist then co-manage you.
What is the difference between cryobiopsy and surgical lung biopsy?
Cryobiopsy is performed through the mouth via a bronchoscope, under sedation, as a day-care procedure. Surgical lung biopsy (VATS) is performed through small incisions in the chest wall, under general anaesthesia, with a hospital stay of several days. Cryobiopsy has a slightly lower diagnostic yield but a much faster recovery, and it is suitable for many patients who would not tolerate surgery.
What happens after the ILD diagnosis is confirmed?
The treatment depends entirely on the subtype. IPF is treated with anti-fibrotic medication. Connective tissue disease-related ILD is usually treated with immunosuppression, sometimes alongside an anti-fibrotic. Hypersensitivity pneumonitis is treated by identifying and removing the trigger, with steroids in active disease. Your specialist team will explain the specific plan once the MDT diagnosis is finalised.
Ready to Resolve an Uncertain CT?
If you have an abnormal CT, an unconfirmed ILD pattern, or your rheumatologist has raised the question of lung involvement in a connective tissue disease, a consultation with Dr. Kunal Waghray at Respire is the next step. We offer the full diagnostic pathway, including cryobiopsy, without the need for surgery in eligible patients.