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The sex-specific prevalence of interstitial lung disease (ILD) subtypes in patients who require a full diagnostic work-up, including transbronchial cryobiopsy (TCB), after initial multidisciplinary discussion (MDD) is still unknown. Retrospective analysis of sex dispareties in patients with ILD who received an interdisciplinary indication for lung biopsy and underwent bronchoalveolar lavage, TCB and, if necessary, surgical lung biopsy at our ILD centre in Heidelberg between 11\/17 and 12\/21. The analysis included clinical parameters, visual assessment of computed tomography (CT), automated histogram analyses of lung density by validated software and final MDD-ILD classifications. A total of 402 patients (248 men, 154 women; mean age 68\u2009\u00b1\u200912 years) were analysed. Smoking behaviour was similar between the sexes, but women were more exposed to environmental factors, whereas men were more exposed to occupational factors. Women had higher rates of thyroid disease (29.9% vs. 12.5%; p\u2009&lt;\u20090.001) and extrathoracic malignancies (16.2% vs. 9.3%; p\u2009=\u20090.041), but lower rates of coronary heart disease (7.1% vs. 19.8%; p\u2009&lt;\u20090.001), stroke (1.3% vs. 6.5%; p\u2009=\u20090.014) and sleep apnoea (5.8% vs. 17.7%; p\u2009&lt;\u20090.001). There were no sex differences regarding CT lung density. On visual inspection, women were less likely to have reticular opacities (65% vs. 76%; p\u2009=\u20090.017) and features of usual interstitial pneumonia (17% vs. 34%; p\u2009&lt;\u20090.001). Among final diagnoses, hypersensitivity pneumonitis was more common in women (34.4%) compared to men (21.8%; p\u2009=\u20090.007). In contrast, IPF was more common in men (22.6%) than in women (7.1%; p\u2009&lt;\u20090.001), and unclassifiable interstitial lung disease was also more frequent in men (21.8%) compared to women (6.5%; p\u2009&lt;\u20090.001). This study highlights significant sex-based differences in the prevalence and characteristics of ILD requiring comprehensive diagnostic work-up. These findings underscore the importance of considering sex-specific factors in the diagnosis and management of ILD.<\/jats:p>","DOI":"10.1038\/s41598-025-94575-0","type":"journal-article","created":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T17:02:47Z","timestamp":1743872567000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sex-specific aspects in a population of patients undergoing evaluation for interstitial lung disease with transbronchial cryobiopsy"],"prefix":"10.1038","volume":"15","author":[{"given":"Janna","family":"Reinhard","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Polke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"Buschulte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monika","family":"Eichinger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claus Peter","family":"Heu\u00dfel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"G\u00fcttlein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia D.","family":"Michels-Zetsche","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark Oliver","family":"Wielp\u00fctz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathrin","family":"Kahnert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantina","family":"Kontogianni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura V.","family":"Klotz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Allg\u00e4uer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix J.","family":"Herth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralf","family":"Eberhardt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Kreuter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franziska C.","family":"Trudzinski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,4,5]]},"reference":[{"key":"94575_CR1","doi-asserted-by":"crossref","unstructured":"Ozaki, M. et al. 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FCT received payment lectures, or reimbursement of travel expenses from Novartis AG, GlaxoSmithKline, Chiesi, Boehringer Ingelheim GmbH, Grifols and AstraZeneca, CSL Behring and Grifols Deutschland GmbH. MOW reports study grants by Vertex Pharmaceuticals, and advisory board membership at Boehringer Ingelheim and Vertex Pharmaceuticals, KK received lecture fees from AstraZeneca, Boehringer Ingelheim, GSK, Insmed, GlaxoSmithKLine and Chiesi. JDMZ is a board member of the E&H Knorr Stiftung and reports funding by the innovation fund of the G-BA as well as payment or honoraria for lectures from AstraZeneca and reimbursement of travel expenses from CSL Behring. FJH received lecture fees from CSL Behring and Grifols Deutschland GmbH. KKo has received honoraria for lectures from Berlin-Chemie, Astra Zeneca and Boston Scientific, outside the submitted work. MA received lecture fees from Boehringer Ingelheim. KB reports on financial support from the Sarcoidosis Network e.V., consultancy fees from Boehringer-Ingelheim and Astra Zeneca as well as fees for lectures from Boehringer-Ingelheim, Astra Zeneca and Chiesi. CPH has stock ownership in GSK and is a co-inventor of a patent for a method and device for representing the microstructure of the lungs.Dr. Heussel has received consultation and fees from Boehringer Ingelheim, Pfizer, and Exscientia. His research has been funded by Boehringer Ingelheim and Exscientia. He has also received lecture fees from Boehringer Ingelheim and Pfizer. All the remaining authors declare no conflict of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The study was approved by the Institutional Review Board Ethics Committee of the Medical Faculty of Heidelberg University (S-382\/2023). Informed consent was waived by the Ethics Committee due to the retrospective nature of the study. The study was conducted in accordance with the principles of the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}],"article-number":"11730"}}