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Li Q, Lafrance D, Liberman M, Leduc C, Charbonney E, Titova P, Manganas H, Chassé M. Transbronchial Lung Cryobiopsies, Transbronchial Forceps Lung Biopsies, and Surgical Lung Biopsies in Mechanically Ventilated Patients with Acute Hypoxemic Respiratory Failure: A Retrospective Cohort Study. J Intensive Care Med 2024; 39:985-993. [PMID: 38646814 DOI: 10.1177/08850666241247145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
IMPORTANCE Lung biopsies are sometimes performed in mechanically ventilated patients with acute hypoxemic respiratory failure (AHRF) of unknown etiology to guide patient management. While surgical lung biopsies (SLB) offer high diagnostic rates, they may also cause significant complications. Transbronchial forceps lung biopsies (TBLB) are less invasive but often produce non-contributive specimens. Transbronchial lung cryobiopsies (TBLC) yield specimens of potentially better quality than TBLB, but due to their novel implementation in the intensive care unit (ICU), their accuracy and safety are still unclear. OBJECTIVES Our main objective was to evaluate the risk of adverse events in patients with AHRF following the three biopsy techniques. Our secondary objectives were to assess the diagnostic yield and associated modifications of patient management of each technique. DESIGN, SETTINGS AND PARTICIPANTS We conducted a retrospective cohort study comparing TBLC, TBLB, and SLB in mechanically ventilated patients with AHRF. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of patients with at least one complication, and secondary outcomes included complication rates, diagnostic yields, treatment modifications, and mortality. RESULTS Of the 26 patients who underwent lung biopsies from 2018 to 2022, all TBLC and SLB patients and 60% of TBLB patients had at least one complication. TBLC patients had higher unadjusted numbers of total and severe complications, but also worse Sequential Organ Failure Assessment scores and P/F ratios. A total of 25 biopsies (25/26, 96%) provided histopathological diagnoses, 88% (22/25) of which contributed to patient management. ICU mortality was high for all modalities (63% for TBLC, 60% for TBLB and 50% for SLB). CONCLUSIONS AND RELEVANCE All biopsy methods had high diagnostic yields and the great majority contributed to patient management; however, complication rates were elevated. Further research is needed to determine which patients may benefit from lung biopsies and to determine the best biopsy modality.
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Affiliation(s)
- Qi Li
- Department of Medicine, Université de Montréal, Montréal, Canada
| | - Dominique Lafrance
- Department of Medicine, Université de Montréal, Montréal, Canada
- Division of Intensive Care, Centre Hospitalier de l'Université de Montréal, Canada
| | - Moishe Liberman
- Division of Thoracic Surgery, Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Charles Leduc
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Canada
| | - Emmanuel Charbonney
- Department of Medicine, Université de Montréal, Montréal, Canada
- Division of Intensive Care, Centre Hospitalier de l'Université de Montréal, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Polina Titova
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Hélène Manganas
- Department of Medicine, Université de Montréal, Montréal, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
- Division of Pulmonology, Centre Hospitalier de l'Université de Montréal, Canada
| | - Michaël Chassé
- Department of Medicine, Université de Montréal, Montréal, Canada
- Division of Intensive Care, Centre Hospitalier de l'Université de Montréal, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
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Tao X, Li S, Wu H, Jin F, Jin G, Wu L. Progress in the Application of Bronchoscopic Cryotherapy in Pediatric Pulmonary Diseases. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1130. [PMID: 39334662 PMCID: PMC11430481 DOI: 10.3390/children11091130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/11/2024] [Accepted: 08/28/2024] [Indexed: 09/30/2024]
Abstract
Cryotherapy in interventional bronchoscopy is a new treatment modality which has recently been made available for the pediatric airway. Lack of experience and safety concerns have led to hesitant adaptation. The aim of this work was to elaborate on the application progress of cryotherapy in pediatric pulmonary diseases and also to assess indications, success rates, and complications of airway cryotherapy in children. In summary, cryotherapy via flexible bronchoscopy is a safe and feasible method. The application scope in pediatrics is similar to that in adults, and it is mainly used in airway obstructive diseases. However, it is primarily caused by benign conditions, and the interventional treatment mainly seeks to provide long-lasting symptomatic alleviation. Thus, prevention, treatment, and prognosis of long-term complications are issues that should be carefully considered in pediatric applications.
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Affiliation(s)
- Xiaofen Tao
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
- Department of Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Shuxian Li
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
- Department of Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Hujun Wu
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
- Department of Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Fang Jin
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
- Department of Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Guoping Jin
- Department of Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Lei Wu
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
- Department of Endoscopy Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
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Koschel D, Behr J, Berger M, Bonella F, Hamer O, Joest M, Jonigk D, Kreuter M, Leuschner G, Nowak D, Raulf M, Rehbock B, Schreiber J, Sitter H, Theegarten D, Costabel U. [Diagnosis and Treatment of Hypersensitivity Pneumonitis - S2k Guideline of the German Respiratory Society and the German Society for Allergology and Clinical Immunology]. Pneumologie 2024. [PMID: 39227017 DOI: 10.1055/a-2369-8458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD) in sensitized individuals caused by a large variety of inhaled antigens. The clinical form of acute HP is often misdiagnosed, while the chronic form, especially the chronic fibrotic HP, is difficult to differentiate from other fibrotic ILDs. The present guideline for the diagnosis and treatment of HP replaces the former German recommendations for the diagnosis of HP from 2007 and is amended explicitly by the issue of the chronic fibrotic form, as well as by treatment recommendations for the first time. The evidence was discussed by a multidisciplinary committee of experts. Then, recommendations were formulated for twelve questions on important issues of diagnosis and treatment strategies. Recently published national and international guidelines for ILDs and HP were considered. Detailed background information on HP is useful for a deeper insight into HP and the handling of the guideline.
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Affiliation(s)
- Dirk Koschel
- Abteilung Innere Medizin und Pneumologie, Fachkrankenhaus Coswig, Lungenzentrum, Coswig, Deutschland
- Bereich Pneumologie, Medizinische Klinik 1, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland
- Ostdeutsches Lungenzentrum (ODLZ), Coswig/Dresden, Deutschland
| | - Jürgen Behr
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München, München, Deutschland
- Deutsches Zentrum für Lungenforschung, Gießen, Deutschland
| | - Melanie Berger
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln
- Lehrstuhl für Pneumologie, Universität Witten/Herdecke, Fakultät für Gesundheit, Köln, Deutschland
| | - Francesco Bonella
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen, Essen, Deutschland
| | - Okka Hamer
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Abteilung für Radiologie, Lungenfachklinik Donaustauf, Donaustauf, Deutschland
| | - Marcus Joest
- Praxis für Pneumologie und Allergologie, Bonn, Deutschland
| | - Danny Jonigk
- Deutsches Zentrum für Lungenforschung, Gießen, Deutschland
- Institut für Pathologie, RWTH Aachen, Universität Aachen, Aachen, Deutschland
| | - Michael Kreuter
- Lungenzentrum Mainz, Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Marienhaus Klinikum Mainz und Klinik für Pneumologie, ZfT, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Gabriela Leuschner
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München, München, Deutschland
- Deutsches Zentrum für Lungenforschung, Gießen, Deutschland
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München, München, Deutschland
| | - Monika Raulf
- Abteilung Kompetenz-Zentrum Allergologie/Immunologie, Institut für Prävention und Arbeitsmedizin der DGUV, Institut der Ruhr-Universität Bochum (IPA), Bochum, Deutschland
| | - Beate Rehbock
- Privatpraxis für Diagnostische Radiologie und Begutachtung, Berlin, Deutschland
| | - Jens Schreiber
- Universitätsklinik für Pneumologie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland
| | - Helmut Sitter
- Institut für Theoretische Chirurgie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Dirk Theegarten
- Institut für Pathologie, Universitätsklinikum Essen, Essen, Deutschland
| | - Ulrich Costabel
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen, Essen, Deutschland
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Ravaglia C, Vignigni G, Vizzuso A, Dubini A, Petrella E, Giampalma E, Maitan S, De Grauw AJ, Piciucchi S, Poletti V. Cone-Beam Computed Tomography Improves Location of Transbronchial Cryobiopsy in Interstitial Lung Disease with Limited Extent. Respiration 2024; 103:641-650. [PMID: 39074460 DOI: 10.1159/000540574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024] Open
Abstract
INTRODUCTION Transbronchial lung cryobiopsy has been recommended as an acceptable alternative to surgical approach for making a histopathological diagnosis in patients with interstitial lung disease (ILD) of undetermined type. In limited diseases (especially if distributed along the subpleural region), sampling the specific area in which the pathological process is more represented could be challenging. Aim of the study was to determine the potential benefit of utilizing cone-beam computed tomography-guided cryobiopsy in patients with limited extent of ILD on CT scan and determine the single impact of each sequential biopsy progressively increasing the total number of biopsies. METHODS This study is a prospective analysis of patients with undetermined ILD and CT scan extent <15% undergoing cone-beam CT-guided cryobiopsy. Each biopsy sample was collected and processed individually and pathologic interpretations were performed sequentially with the pathologist reformulating a new report with the addition of each sample (cumulative yield). RESULTS Thirty six patients were enrolled. Pathological diagnostic yield was >90%, with almost 80% of diagnostic samples being the first one; when a second biopsy was performed, mean diagnostic yield increased with only a moderately significant difference. No severe adverse events were observed; pneumothorax was documented in 27.8% of the cases. CONCLUSION Sequential individual collection and pathologic interpretation of each biopsy sample has confirmed the possibility of obtaining a diagnostic specimen at the first pass if transbronchial cryobiopsy is performed under cone-beam CT.
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Affiliation(s)
- Claudia Ravaglia
- Department of Medical and Surgical Sciences (DIMEC), Bologna University, Pulmonology Unit, G.B. Morgagni Hospital, Forlì, Italy
| | | | | | | | | | | | - Stefano Maitan
- Intensive Care Unit, G.B. Morgagni Hospital, Forlì, Italy
| | | | | | - Venerino Poletti
- Department of Medical and Surgical Sciences (DIMEC), Bologna University, Pulmonology Unit, G.B. Morgagni Hospital, Forlì, Italy
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Guo C, Zhang Q, Zhou P, Cheng Y, Nie L, Wang G. The application of bronchoscopy in the assessment of immune checkpoint inhibitor-related pneumonitis severity and recurrence. Sci Rep 2024; 14:17137. [PMID: 39060280 PMCID: PMC11282261 DOI: 10.1038/s41598-024-66768-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
To explore the role of bronchoscopy for the assessment of checkpoint inhibitor pneumonitis (CIP), a retrospective single-center study was conducted to assess patients diagnosed with CIP at grade 2 or above and also underwent bronchoscopy between January 2020 and December 2022. Clinical data and bronchoscopic findings were recorded. The treatment data and prognosis information were collected. Twenty-one patients who underwent bronchoscopy and were diagnosed with CIP were enrolled in this study. All patients underwent bronchoalveolar lavage fluid (BALF) analysis. Of them, T lymphocyte subsets of BALF were tested in 15 cases. Transbronchial cryobiopsy (TBCB) was performed in 8 patients, and transbronchial lung biopsy was performed in 5 patients. 3 patients developed pneumothorax after TBCB and all recovered without serious compilations.14 patients experienced grade 2 CIP, while 7 patients ≥ grade 3 CIP. Symptoms were improved in 19 (90.5%) patients after standard treatment adhering to CIP guidelines. However, 5 patients relapsed during steroid tapering. Factors related to the severity and recurrence of CIP were analyzed. Patients with previous interstitial lung disease (ILD) were more likely to develop high grade CIP than those without [83.3% (5/6) versus 15.4% (3/15), P = 0.011].The odds ratio (OR) was 32.5 (95% CI 2.284-443.145, P = 0.009). Increased BALF lymphocyte percentage was associated with high grade CIP, OR 1.095 (95% CI 1.001-1.197, P = 0.047), and higher possibility of CIP relapse, OR 1.123 (95% CI, 1.005-1.225, P = 0.040). Lymphocyte subsets were tested in 15 patients. CD4/CD8 > 1 was found in 80% (4/5) of relapsed patients and 20% (2/10) of patients without relapse (P = 0.047). The OR was 16.00 (95% CI 1.093-234.24, P = 0.043). In this retrospective study, patients with previous ILD was more likely to develop high grade CIP. Higher lymphocyte percentage in BALF was associated with high grade CIP and susceptibility to relapse during treatment of CIP. A CD4/CD8 ratio greater than 1 in lymphocyte subsets of BALF was associated with higher possibility of CIP relapse. We found that TBCB is a safe procedure in CIP patients.
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Affiliation(s)
- Cuiyan Guo
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Qi Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Peining Zhou
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yuan Cheng
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Ligong Nie
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Guangfa Wang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, NO.8 Xishiku Street, Xicheng District, Beijing, 100034, China
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Salton F, Biolo M, Trotta L, Mondini L, Andrisano AG, Reccardini N, Confalonieri P, Antonaglia C, Confalonieri M, Ruaro B. A novel technique for conducting flexible bronchoscopy cryobiopsy under conscious sedation: An observational study. Medicine (Baltimore) 2024; 103:e38493. [PMID: 39029057 PMCID: PMC11398742 DOI: 10.1097/md.0000000000038493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
Transbronchial lung cryobiopsy (TBCB) is a reliable method for obtaining histopathological findings in interstitial lung diseases. TBCB is traditionally performed during rigid bronchoscopy, positioning an endobronchial balloon blocker to facilitate bleeding management. Therefore, it can be challenging to implement in Centers without access to anesthesiologic support or dedicated beds for endoscopic procedures. We present a series of 11 patients who underwent 12 TBCBs using a flexible bronchoscope and a 5 Fr endobronchial blocker passing through an uncuffed endotracheal tube, under moderate sedation and spontaneous breathing. All procedures were carried out in an endoscopy suite, using fluoroscopy guidance but without requiring anesthesiologic assistance. TBCB was feasible in all cases, and it demonstrated similar or improved diagnostic yield (90.1%) and safety compared to rigid bronchoscopy. In 1 case, it was successfully repeated due to an inconclusive histological definition at the first attempt. The size of the samples was consistent with the literature, as it was the incidence of pneumothorax (16.6%). Four cases of moderate bleeding and 4 cases of severe bleeding were managed without further complications. To our knowledge, this is the first description of a technique allowing to perform TBCB through an artificial airway without need for either rigid bronchoscopy or general anesthesia. We believe this technique could make TBCB faster, cost-effective, and feasible even in resource-limited settings without compromising on safety. However, further studies are needed to validate these findings.
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Affiliation(s)
- Francesco Salton
- Department of Medical Surgical and Health Sciences, Pulmonology Unit, University Hospital of Cattinara, University of Trieste, Trieste, Italy
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Long W, Luo J, Ma L, Wei J, Xiang H, Hong L, Luo M. The efficacy and safety of modified transbronchial cryobiopsy in the diagnosis of interstitial lung disease. Medicine (Baltimore) 2024; 103:e38269. [PMID: 38996169 PMCID: PMC11245189 DOI: 10.1097/md.0000000000038269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/26/2024] [Indexed: 07/14/2024] Open
Abstract
The objective of this study is to investigate the efficacy and safety of flexible transbronchial cryobiopsy (TBCB) in the diagnosis of diffuse parenchymal lung disease (DPLD) in a routine bronchoscopy examination room under analgesia and sedation, using neither endotracheal intubation or rigid bronchoscope nor fluoroscopy or general anesthesia. The data from 50 DPLD patients with unknown etiology who were treated in the Affiliated Hospital of Guilin Medical College from May 2018 to September 2020 were collected, and 43 were eventually included. The specimens obtained from these 43 patients were subjected to pathological examination, pathogenic microorganism culture, etc, and were analyzed in the clinical-radiological-pathological diagnosis mode to confirm the efficacy of TBCB in diagnosing the cause of DPLD. Subsequently, the intraoperative and postoperative complications of TBCB and their severity were closely observed and recorded to comprehensively evaluate the safety of TBCB. For the 43 patients included, a total of 85 TBCB biopsies were performed (1.98 [1, 4] times/case), and 82 valid tissue specimens were obtained (1.91 [1, 4] pieces/case), accounting for 96.5% (82/85) of the total sample. The average specimen size was 12.41 (1, 30) mm2. Eventually, 38 cases were diagnosed, including 11 cases of idiopathic pulmonary fibrosis, 5 cases of connective tissue-related interstitial lung disease, 5 cases of nonspecific interstitial pneumonia, 4 cases of tuberculosis, 4 cases of occupational lung injury, 3 cases of interstitial pneumonia with autoimmune characteristics, 1 case of lung cancer, 2 cases of interstitial lung disease (unclassified interstitial lung disease), 1 case of hypersensitivity pneumonitis, 1 case of pulmonary alveolar proteinosis, and 1 case of fungal infection. The remaining 5 cases were unclarified. For infectious diseases, the overall etiological diagnosis rate was 88.4% (38/43). With respect to complications, pneumothorax occurred in 4 cases (9.3%, 4/43, including 1 mild case and 3 moderate cases), of which 3 cases (75%) were closed by thoracic drainage and 1 case (25%) was absorbed without treatment. In addition, 22 cases experienced no bleeding (51.2%) and 21 cases suffered bleeding to varying degrees based on different severity assessment methods. TBCB is a minimally invasive, rapid, economical, effective, and safe diagnostic technique.
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Affiliation(s)
| | | | - Libing Ma
- Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Jianghong Wei
- Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Hui Xiang
- Guilin Medical University, Guilin, China
| | | | - Miao Luo
- Affiliated Hospital of Guilin Medical University, Guilin, China
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Marcoux V, Lok SD, Mondal P, Assayag D, Fisher JH, Shapera S, Morisset J, Manganas H, Fell CD, Hambly N, Cox PG, Kolb M, Gershon AS, To T, Sadatsafavi M, Khalil N, Wong AW, Wilcox PG, Ryerson CJ, Vu T, Johannson KA. Impact of surgical lung biopsy on lung function and survival in patients with idiopathic pulmonary fibrosis in a multi-centre registry cohort. Respirology 2024; 29:596-604. [PMID: 38436522 DOI: 10.1111/resp.14695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/14/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND OBJECTIVE Establishing an accurate and timely diagnosis of idiopathic pulmonary fibrosis (IPF) is essential for appropriate management and prognostication. In some cases, surgical lung biopsy (SLB) is performed but carries non-negligible risk. The objective of this retrospective study was to determine if SLB is associated with accelerated lung function decline in patients with IPF using the Canadian Registry for Pulmonary Fibrosis. METHODS Linear mixed models and Cox proportional hazards regression models were used to compare decline in forced vital capacity (FVC)%, diffusion capacity of the lung (DLCO%) and risk of death or lung transplantation between SLB and non-SLB patients. Adjustments were made for baseline age, sex, smoking history, antifibrotic use, and lung function. A similar analysis compared lung function changes 12 months pre- and post-SLB. RESULTS A total of 81 SLB patients and 468 non-SLB patients were included. In the SLB group, the post-biopsy annual FVC% decline was 2.0% (±0.8) in unadjusted, and 2.1% (±0.8) in adjusted models. There was no difference in FVC% decline, DLCO% decline, or time to death or lung transplantation between the two groups, in adjusted or unadjusted models (all p-values >0.07). In the pre-post SLB group, no differences were identified in FVC% decline in unadjusted or adjusted models (p = 0.07 for both). CONCLUSION No association between SLB and lung function decline or risk of death or lung transplantation was identified in this multi-centre study of patients with IPF.
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Affiliation(s)
- Veronica Marcoux
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Stacey D Lok
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Prosanta Mondal
- Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Deborah Assayag
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Jolene H Fisher
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shane Shapera
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Julie Morisset
- Department of Medicine, Université de Montreal, Montreal, Quebec, Canada
| | - Hélène Manganas
- Department of Medicine, Université de Montreal, Montreal, Quebec, Canada
| | - Charlene D Fell
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nathan Hambly
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - P Gerard Cox
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Martin Kolb
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Andrea S Gershon
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Teresa To
- The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alyson W Wong
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Pearce G Wilcox
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Thao Vu
- Population Health, Quality and Research, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan, Canada
| | - Kerri A Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
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Lachowicz JA, Smallwood NE, Prasad JD, Patel P, Voutier C, Khor YH, Steinfort DP. A systematic review of procedural and sampling techniques for cryobiopsy in interstitial lung disease. Eur Respir Rev 2024; 33:240035. [PMID: 39142710 PMCID: PMC11322826 DOI: 10.1183/16000617.0035-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/11/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Transbronchial lung cryobiopsy (TBLC) is an alternative to surgical lung biopsy for histopathological evaluation of unclassifiable interstitial lung disease (ILD) or ILD diagnosed with low confidence. This meta-analysis synthesised current literature regarding cryobiopsy diagnostic performance and safety, focusing on procedural and sampling techniques. METHODS Medline and Embase were searched on 11 April 2022. Studies included adults with unclassifiable ILD, reporting diagnostic yield, complications and methodological techniques of TBLC. Meta-analyses were performed for diagnostic yield, pneumothorax and bleeding. Subgroup analyses and meta-regression assessed methodological variables. PROSPERO registration: CRD42022312386. RESULTS 70 studies were included with 6183 participants. Diagnostic yield of TBLC was 81% (95% CI 79-83%, I2=97%), with better yield being observed with general anaesthesia (p=0.007), ILD multidisciplinary meeting prior to cryobiopsy (p=0.02), 2.4 mm cryoprobe (p=0.04), higher mean forced vital capacity (p=0.046) and higher mean diffusing capacity for carbon monoxide (p=0.023). Pneumothorax rate was 5% (95% CI 4-5%, I2=91%), with higher rates associated with a 2.4 mm cryoprobe (p<0.00001), routine post-procedure imaging (p<0.00001), multiple lobe sampling (p<0.0001), reduced mean diffusing capacity for carbon monoxide (p=0.028) and general anaesthesia (p=0.05). Moderate-to-severe bleeding rate was 12% (11-14%, I2=95%) and higher rates were associated with a 2.4 mm cryoprobe (p=0.001) and bleeding score selection (p=0.04). INTERPRETATION Patient characteristics and modifiable factors, including procedural methods and anaesthetic techniques, impacted diagnostic yield and safety outcomes of TBLC in people with unclassifiable ILD and contributed to heterogeneity of clinical outcomes. These variables should be considered for individualised clinical decision making and guideline development and warrant routine reporting in future research.
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Affiliation(s)
- Julia A Lachowicz
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Natasha E Smallwood
- Department of Respiratory Medicine, The Alfred, Melbourne, Australia
- Faculty of Medicine, Monash University, Melbourne, Australia
| | - Jyotika D Prasad
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, Monash University, Melbourne, Australia
- Department of Respiratory Medicine and Lung Transplant Unit, The Alfred, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Purab Patel
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Catherine Voutier
- Health Sciences Library, Royal Melbourne Hospital, Melbourne, Australia
| | - Yet H Khor
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
| | - Daniel P Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Australia
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10
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Kalverda KA, Ninaber MK, Wijmans L, von der Thüsen J, Jonkers RE, Daniels JM, Miedema JR, Dickhoff C, Hölters J, Heineman D, Kant M, Radonic T, Shahin G, Cohen D, Boerrigter B, Nijman S, Nossent E, Braun J, Mathot B, Poletti V, Hetzel J, Dijkgraaf M, Korevaar DA, Bonta PI, Annema JT. Transbronchial cryobiopsy followed by as-needed surgical lung biopsy versus immediate surgical lung biopsy for diagnosing interstitial lung disease (the COLD study): a randomised controlled trial. THE LANCET. RESPIRATORY MEDICINE 2024; 12:513-522. [PMID: 38640934 DOI: 10.1016/s2213-2600(24)00074-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND An adequate diagnosis for interstitial lung disease (ILD) is important for clinical decision making and prognosis. In most patients with ILD, an accurate diagnosis can be made by clinical and radiological data assessment, but in a considerable proportion of patients, a lung biopsy is required. Surgical lung biopsy (SLB) is the most common method to obtain tissue, but it is associated with high morbidity and even mortality. More recently, transbronchial cryobiopsy has been introduced, with fewer adverse events but a lower diagnostic yield than SLB. The aim of this study is to compare two diagnostic strategies: a step-up strategy (transbronchial cryobiopsy, followed by SLB if the cryobiopsy is insufficiently informative) versus immediate SLB. METHODS The COLD study was a multicentre, randomised controlled trial in six hospitals across the Netherlands. We included patients with ILD with an indication for lung biopsy as assessed by a multidisciplinary team discussion. Patients were randomly assigned in a 1:1 ratio to the step-up or immediate SLB strategy, with follow-up for 12 weeks from the initial procedure. Patients, clinicians, and pathologists were not masked to the study treatment. The primary endpoint was unexpected chest tube drainage, defined as requiring any chest tube after transbronchial cryobiopsy, or prolonged (>24 h) chest tube drainage after SLB. Secondary endpoints were diagnostic yield, in-hospital stay, pain, and serious adverse events. A modified intention-to-treat analysis was performed. This trial is registered with the Dutch Trial Register, NL7634, and is now closed. FINDINGS Between April 8, 2019, and Oct 24, 2021, 122 patients with ILD were assessed for study participation; and 55 patients were randomly assigned to the step-up strategy (n=28) or immediate SLB (n=27); three patients from the immediate SLB group were excluded. Unexpected chest tube drainage occurred in three of 28 patients (11%; 95% CI 4-27%) in the step-up group, and the number of patients for whom the chest tube could not be removed within 24 h was 11 of 24 patients (46%; 95% CI 2-65%) in the SLB group, with an absolute risk reduction of 35% (11-56%; p=0·0058). In the step-up strategy, the multidisciplinary team diagnostic yield after transbronchial cryobiopsy alone was 82% (64-92%), which increased to 89% (73-96%) when subsequent SLB was performed after inconclusive transbronchial cryobiopsy. In the immediate surgery strategy, the multidisciplinary team diagnostic yield was 88% (69-97%). Total in-hospital stay was 1 day (IQR 1-1) in the step-up group versus 5 days (IQR 4-6) in the SLB group. One (4%) serious adverse event occurred in step-up strategy versus 12 (50%) in the immediate SLB strategy. INTERPRETATION In ILD diagnosis, if lung tissue assessment is required, a diagnostic strategy starting with transbronchial cryobiopsy, followed by SLB when transbronchial cryobiopsy is inconclusive, appears to result in a significant reduction of patient burden and in-hospital stay with a similar diagnostic yield versus immediate SLB. FUNDING Netherlands Organisation for Health Research and Development (ZonMW) and Amsterdam University Medical Centers.
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Affiliation(s)
- Kirsten A Kalverda
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.
| | - Maarten K Ninaber
- Department of Respiratory Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Lizzy Wijmans
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, Netherlands
| | - René E Jonkers
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Johannes M Daniels
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jelle R Miedema
- Department of Respiratory Diseases, Erasmus Medical Center, Rotterdam, Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jürgen Hölters
- Department of Respiratory Diseases, Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands
| | - David Heineman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Merijn Kant
- Department of Respiratory Diseases, Amphia Hospital, Breda, Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ghada Shahin
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Danielle Cohen
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Bart Boerrigter
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Suzan Nijman
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Esther Nossent
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jerry Braun
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Bas Mathot
- Department of Respiratory Diseases, Erasmus Medical Center, Rotterdam, Netherlands
| | - Venerino Poletti
- Department of Medical Specialties, Giovan Battista Morgagni Hospital, University of Forlì, Forlì, Italy; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Jürgen Hetzel
- Department of Medical Oncology and Pneumology, Eberhard Karls University, Tübingen, Germany; Department of Pneumology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Marcel Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Daniel A Korevaar
- Department of Respiratory Diseases, Amsterdam University Medical Centers, Vrij Universiteit Amsterdam, Amsterdam, Netherlands
| | - Peter I Bonta
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jouke T Annema
- Department of Respiratory Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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11
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Takatsuka M, Yamakawa H, Takemura T, Sato S, Ohta H, Kusano K, Oba T, Kawabe R, Akasaka K, Sasaki H, Amano M, Araya J, Matsushima H. Usefulness of Transbronchial Lung Cryobiopsy When Starting Antifibrotic Treatment and Predicting Progressive Fibrosing Interstitial Lung Disease: Descriptive Research. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13809. [PMID: 39013830 PMCID: PMC11251805 DOI: 10.1111/crj.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/22/2024] [Accepted: 06/29/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Although transbronchial lung cryobiopsy (TBLC) is widely used in diagnostic algorithms for various interstitial lung diseases (ILDs), its real-world utility in the therapeutic decision-making strategy for ILD patients remains unclear, in particular, when judging the time to start antifibrotic agents. METHODS We analyzed medical records of 40 consecutive patients with idiopathic or fibrotic hypersensitivity pneumonitis who underwent TBLC. A TBLC-based usual interstitial pneumonia (UIP) score was used to assess three morphologic descriptors: patchy fibrosis, fibroblastic foci, and honeycombing. RESULTS In our 40 patients with ILD, the most frequent radiological feature was indeterminate for UIP (45.0%). Final diagnosis included idiopathic pulmonary fibrosis (22.5%), fibrotic nonspecific interstitial pneumonia (5.0%), fibrotic hypersensitivity pneumonitis (35.0%), and unclassifiable ILD (37.5%). Linear mixed-effects analysis showed that declines in the slopes of %FVC and %DLCO in patients with TBLC-based UIP "Score ≥ 2" were significantly steeper than those of patients with "Score ≤ 1." During follow-up of patients with Score ≥ 2 (n = 24), more than half of them (n = 17) received an antifibrotic agent, with most patients (n = 13) receiving early administration of the antifibrotic agent within 6 months after the TBLC procedure. CONCLUSIONS TBLC-based UIP Score ≥ 2 indicated the increased possibility of a progressive fibrosis course that may prove helpful in predicting progressive pulmonary fibrosis/progressive fibrosing ILD even if disease is temporarily stabilized due to anti-inflammatory agents. Patients may benefit from early introduction of antifibrotic agents by treating clinicians.
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Affiliation(s)
- Makiko Takatsuka
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
- Department of Respiratory MedicineTokyo Jikei University HospitalTokyoJapan
| | - Hideaki Yamakawa
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
- Department of Respiratory MedicineTokyo Jikei University HospitalTokyoJapan
| | - Tamiko Takemura
- Department of PathologyKanagawa Cardiovascular and Respiratory CenterYokohamaJapan
| | - Shintaro Sato
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
| | - Hiroki Ohta
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
| | - Kenji Kusano
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
| | - Tomohiro Oba
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
| | - Rie Kawabe
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
| | - Keiichi Akasaka
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
| | - Hiroki Sasaki
- Department of RadiologySaitama Red Cross HospitalSaitamaJapan
| | - Masako Amano
- Department of Respiratory MedicineSaitama Red Cross HospitalSaitamaJapan
| | - Jun Araya
- Department of Respiratory MedicineTokyo Jikei University HospitalTokyoJapan
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12
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Salisbury ML, Flaherty KR. Optimising the approach to ILD diagnosis: the balance of procedural complications against diagnostic accuracy. THE LANCET. RESPIRATORY MEDICINE 2024; 12:500-501. [PMID: 38640935 DOI: 10.1016/s2213-2600(24)00113-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Margaret L Salisbury
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Kevin R Flaherty
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
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13
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Garner JL, Shah PL, Herth F, Slebos DJ. ERJ Advances: interventional bronchoscopy. Eur Respir J 2024; 64:2301946. [PMID: 38991719 DOI: 10.1183/13993003.01946-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/14/2024] [Indexed: 07/13/2024]
Affiliation(s)
- Justin L Garner
- Department of Lung Cancer and Interventional Bronchoscopy, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Pallav L Shah
- Department of Lung Cancer and Interventional Bronchoscopy, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center, Universität Heidelberg, Heidelberg, Germany
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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14
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Zamora AC, Wesselius LJ, Gotway MB, Tazelaar HD, Diaz-Arumir A, Nagaraja V. Diagnostic Approach to Interstitial Lung Diseases Associated with Connective Tissue Diseases. Semin Respir Crit Care Med 2024; 45:287-304. [PMID: 38631369 DOI: 10.1055/s-0044-1785674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Interstitial lung disorders are a group of respiratory diseases characterized by interstitial compartment infiltration, varying degrees of infiltration, and fibrosis, with or without small airway involvement. Although some are idiopathic (e.g., idiopathic pulmonary fibrosis, idiopathic interstitial pneumonias, and sarcoidosis), the great majority have an underlying etiology, such as systemic autoimmune rheumatic disease (SARD, also called Connective Tissue Diseases or CTD), inhalational exposure to organic matter, medications, and rarely, genetic disorders. This review focuses on diagnostic approaches in interstitial lung diseases associated with SARDs. To make an accurate diagnosis, a multidisciplinary, personalized approach is required, with input from various specialties, including pulmonary, rheumatology, radiology, and pathology, to reach a consensus. In a minority of patients, a definitive diagnosis cannot be established. Their clinical presentations and prognosis can be variable even within subsets of SARDs.
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Affiliation(s)
- Ana C Zamora
- Division of Pulmonary and Sleep Medicine, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Lewis J Wesselius
- Division of Pulmonary and Sleep Medicine, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Michael B Gotway
- Division of Cardiothoracic Radiology, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Henry D Tazelaar
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Alejandro Diaz-Arumir
- Division of Pulmonary and Sleep Medicine, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Vivek Nagaraja
- Division of Rheumatology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
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15
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Taverner J, Lucena CM, Garner JL, Orton CM, Nicholson AG, Desai SR, Wells AU, Shah PL. Low bleeding rates following transbronchial lung cryobiopsy in unclassifiable interstitial lung disease. Respirology 2024; 29:489-496. [PMID: 38355891 DOI: 10.1111/resp.14678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND OBJECTIVE Bronchoscopic transbronchial lung cryobiopsy (TBLC) is a guideline-endorsed alternative to surgical lung biopsy for tissue diagnosis in unclassifiable interstitial lung disease (ILD). The reported incidence of post-procedural bleeding has varied widely. We aimed to characterize the incidence, severity and risk factors for clinically significant bleeding following TBLC using an expert-consensus airway bleeding scale, in addition to other complications and diagnostic yield. METHODS A retrospective cohort study of consecutive adult outpatients with unclassifiable ILD who underwent TBLC following multidisciplinary discussion at a single centre in the UK between July 2016 and December 2021. TBLC was performed under general anaesthesia with fluoroscopic guidance and a prophylactic endobronchial balloon. RESULTS One hundred twenty-six patients underwent TBLC (68.3% male; mean age 62.7 years; FVC 86.2%; DLCO 54.5%). Significant bleeding requiring balloon blocker reinflation for >20 min, admission to ICU, packed red blood cell transfusion, bronchial artery embolization, resuscitation or procedural abandonment, occurred in 10 cases (7.9%). Significant bleeding was associated with traction bronchiectasis on HRCT (OR 7.1, CI 1.1-59.1, p = 0.042), a TBLC histological pattern of UIP (OR 4.0, CI 1.1-14, p = 0.046) and the presence of medium-large vessels on histology (OR 37.3, CI 6.5-212, p < 0.001). BMI ≥30 (p = 0.017) and traction bronchiectasis on HRCT (p = 0.025) were significant multivariate predictors of longer total bleeding time (p = 0.017). Pneumothorax occurred in nine cases (7.1%) and the 30-day mortality was 0%. Diagnostic yield was 80.6%. CONCLUSION TBLC has an acceptable safety profile in experienced hands. Radiological traction bronchiectasis and obesity increase the risk of significant bleeding following TBLC.
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Affiliation(s)
- John Taverner
- Royal Brompton and Harefield Hospitals, London, UK
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
- Alfred Health, Melbourne, Victoria, Australia
| | | | - Justin L Garner
- Royal Brompton and Harefield Hospitals, London, UK
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Christopher M Orton
- Royal Brompton and Harefield Hospitals, London, UK
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Andrew G Nicholson
- Royal Brompton and Harefield Hospitals, London, UK
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Sujal R Desai
- Royal Brompton and Harefield Hospitals, London, UK
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Athol U Wells
- Royal Brompton and Harefield Hospitals, London, UK
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Pallav L Shah
- Royal Brompton and Harefield Hospitals, London, UK
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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16
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Maher TM. Interstitial Lung Disease: A Review. JAMA 2024; 331:1655-1665. [PMID: 38648021 DOI: 10.1001/jama.2024.3669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Importance Interstitial lung disease (ILD) consists of a group of pulmonary disorders characterized by inflammation and/or fibrosis of the lung parenchyma associated with progressive dyspnea that frequently results in end-stage respiratory failure. In the US, ILD affects approximately 650 000 people and causes approximately 25 000 to 30 000 deaths per year. Observations The most common forms of ILD are idiopathic pulmonary fibrosis (IPF), which accounts for approximately one-third of all cases of ILD, hypersensitivity pneumonitis, accounting for 15% of ILD cases, and connective tissue disease (CTD), accounting for 25% of ILD cases. ILD typically presents with dyspnea on exertion. Approximately 30% of patients with ILD report cough. Thoracic computed tomography is approximately 91% sensitive and 71% specific for diagnosing subtypes of ILDs such as IPF. Physiologic assessment provides important prognostic information. A 5% decline in forced vital capacity (FVC) over 12 months is associated with an approximately 2-fold increase in mortality compared with no change in FVC. Antifibrotic therapy with nintedanib or pirfenidone slows annual FVC decline by approximately 44% to 57% in individuals with IPF, scleroderma associated ILD, and in those with progressive pulmonary fibrosis of any cause. For connective tissue disease-associated ILD, immunomodulatory therapy, such as tocilizumab, rituximab, and mycophenolate mofetil, may slow decline or even improve FVC at 12-month follow-up. Structured exercise therapy reduces symptoms and improves 6-minute walk test distance in individuals with dyspnea. Oxygen reduces symptoms and improves quality of life in individuals with ILD who desaturate below 88% on a 6-minute walk test. Lung transplant may improve symptoms and resolve respiratory failure in patients with end-stage ILD. After lung transplant, patients with ILD have a median survival of 5.2 to 6.7 years compared with a median survival of less than 2 years in patients with advanced ILD who do not undergo lung transplant. Up to 85% of individuals with end-stage fibrotic ILD develop pulmonary hypertension. In these patients, treatment with inhaled treprostinil improves walking distance and respiratory symptoms. Conclusions and Relevance Interstitial lung disease typically presents with dyspnea on exertion and can progress to respiratory failure. First-line therapy includes nintedanib or pirfenidone for IPF and mycophenolate mofetil for ILD due to connective tissue disease. Lung transplant should be considered for patients with advanced ILD. In patients with ILD, exercise training improves 6-minute walk test distance and quality of life.
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Affiliation(s)
- Toby M Maher
- University of Southern California, Los Angeles
- National Heart and Lung Institute, Imperial College, London, UK
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17
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Kobe H, Hamao N, Niwa T, Ishida T. Cryobiopsy for Secondary Pulmonary Alveolar Proteinosis. Cureus 2024; 16:e60530. [PMID: 38887334 PMCID: PMC11180966 DOI: 10.7759/cureus.60530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
Secondary pulmonary alveolar proteinosis (SPAP) is one of the diffuse parenchymal lung diseases, and the utility and safety of transbronchial lung cryobiopsy (TBLC) for diagnosing SPAP are unknown. A case of SPAP diagnosed by TBLC is presented. Specimens that were useful for diagnosis were collected, and there was no adverse event following TBLC. The usefulness of TBLC for interstitial lung disease has been widely reported, but there are few reports of SPAP. We present the clinical course of TBLC in the diagnosis of SPAP.
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Affiliation(s)
- Hiroshi Kobe
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, JPN
| | - Nobuyoshi Hamao
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, JPN
| | - Takashi Niwa
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, JPN
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, JPN
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18
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Enomoto N. Relationship between idiopathic interstitial pneumonias (IIPs) and connective tissue disease-related interstitial lung disease (CTD-ILD): A narrative review. Respir Investig 2024; 62:465-480. [PMID: 38564878 DOI: 10.1016/j.resinv.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/17/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
While idiopathic interstitial pneumonia (IIP) centering on idiopathic pulmonary fibrosis (IPF) is the most prevalent interstitial lung disease (ILD), especially in the older adult population, connective tissue disease (CTD)-related ILD is the second most prevalent ILD. The pathogenesis of IPF is primarily fibrosis, whereas that of other ILDs, particularly CTD-ILD, is mainly inflammation. Therefore, a precise diagnosis is crucial for selecting appropriate treatments, such as antifibrotic or immunosuppressive agents. In addition, some patients with IIP have CTD-related features, such as arthritis and skin eruption, but do not meet the criteria for any CTD, this is referred to as interstitial pneumonia with autoimmune features (IPAF). IPAF is closely associated with idiopathic nonspecific interstitial pneumonia (iNSIP) and cryptogenic organizing pneumonia (COP). Furthermore, patients with iNSIP or those with NSIP with OP overlap frequently develop polymyositis/dermatomyositis after the diagnosis of IIP. Acute exacerbation of ILD, the most common cause of death, occurs more frequently in patients with IPF than in those with other ILDs. Although acute exacerbation of CTD-ILD occurs at a low rate of incidence, patients with rheumatoid arthritis, microscopic polyangiitis, or systemic sclerosis experience more acute exacerbation of CTD-ILD than those with other CTD. In this review, the features of each IIP, focusing on CTD-related signatures, are summarized, and the pathogenesis and appropriate treatments to improve the prognoses of patients with various ILDs are discussed.
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Affiliation(s)
- Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan; Health Administration Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan.
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19
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Althobiani MA, Russell AM, Jacob J, Ranjan Y, Folarin AA, Hurst JR, Porter JC. Interstitial lung disease: a review of classification, etiology, epidemiology, clinical diagnosis, pharmacological and non-pharmacological treatment. Front Med (Lausanne) 2024; 11:1296890. [PMID: 38698783 PMCID: PMC11063378 DOI: 10.3389/fmed.2024.1296890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/26/2024] [Indexed: 05/05/2024] Open
Abstract
Interstitial lung diseases (ILDs) refer to a heterogeneous and complex group of conditions characterized by inflammation, fibrosis, or both, in the interstitium of the lungs. This results in impaired gas exchange, leading to a worsening of respiratory symptoms and a decline in lung function. While the etiology of some ILDs is unclear, most cases can be traced back to factors such as genetic predispositions, environmental exposures (including allergens, toxins, and air pollution), underlying autoimmune diseases, or the use of certain medications. There has been an increase in research and evidence aimed at identifying etiology, understanding epidemiology, improving clinical diagnosis, and developing both pharmacological and non-pharmacological treatments. This review provides a comprehensive overview of the current state of knowledge in the field of interstitial lung diseases.
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Affiliation(s)
- Malik A. Althobiani
- Royal Free Campus, UCL Respiratory, University College London, London, United Kingdom
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Anne-Marie Russell
- School of Health and Care Professions, University of Exeter, Exeter, United Kingdom
- School of Medicine and Health, University of Birmingham, Birmingham, United Kingdom
| | - Joseph Jacob
- UCL Respiratory, University College London, London, United Kingdom
- Satsuma Lab, Centre for Medical Image Computing, University College London Respiratory, University College London, London, United Kingdom
| | - Yatharth Ranjan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Amos A. Folarin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at University College London Hospitals, NHS Foundation Trust, London, United Kingdom
| | - John R. Hurst
- Royal Free Campus, UCL Respiratory, University College London, London, United Kingdom
| | - Joanna C. Porter
- UCL Respiratory, University College London, London, United Kingdom
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20
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Zhang Z, Li S, Bao Y. Endobronchial Ultrasound-Guided Transbronchial Mediastinal Cryobiopsy versus Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Mediastinal Disorders: A Meta-Analysis. Respiration 2024; 103:359-367. [PMID: 38588649 DOI: 10.1159/000538609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC), a novel technique, has been reported to improve the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal lesions in recent studies. Current literature suggests that this procedure has greater diagnostic efficacy compared to conventional EBUS-TBNA. This systematic review and meta-analysis aimed to evaluate the diagnostic yield and complications associated with EBUS-TMC in comparison to EBUS-TBNA, thereby exploring the potential of this novel technique in enhancing the diagnostic utility for mediastinal lesions. METHODS A comprehensive literature review was conducted by searching the PubMed, Embase, and Google Scholar databases for articles published from inception to December 31, 2023. The objective of this review was to evaluate the utilization of EBUS-TMC in diagnosing mediastinal disease, while also assessing the quality of each study using the QUADAS-2 tool. The diagnostic yield estimates were subjected to a meta-analysis utilizing inverse variance weighting. Furthermore, a comprehensive analysis of the complications associated with this procedure was performed. RESULTS The meta-analysis included 10 studies involving a total of 538 patients. The findings of the meta-analysis demonstrated that EBUS-TMC yielded an overall diagnostic rate of 89.59% (482/538), while EBUS-TBNA yielded a rate of 77.13% (415/538). The calculated inverse variance-weighted odds ratio was 2.63 (95% confidence interval, 1.86-3.72; p < 0.0001), and I2 value was 11%, indicating a statistically significant difference between the two techniques. The associated complications consisted of pneumothorax, pneumomediastinum, mediastinitis, and bleeding, with an incidence of 0.74% (4/538), 0.37% (2/538), 0.0% (0/538), and 1.12% (6/538), respectively. Moreover, the funnel plot displayed no discernible publication bias. Further subgroup analysis revealed a notable improvement in the diagnosis value for lymphoma (86.36% vs. 27.27%, p = 0.0006) and benign disorder (87.62% vs. 60.00%, p < 0.0001). CONCLUSION This review of the current available studies indicated that EBUS-TMC enhanced overall diagnostic yields compared to EBUS-TBNA, particularly for diagnosing benign disease and lymphoma. This procedure was not associated with any serious complications.
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Affiliation(s)
- Zhenming Zhang
- Department of Endoscopy Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China,
| | - Shengping Li
- Department of Endoscopy Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Yu Bao
- Department of Endoscopy Center, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
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21
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Wang S, Yang J, Luo S, Geng J, Ren Y, Zhao L, Liu M, Wang D, Li Y, Tian Z, Liu W, Zhou G, Dai H. The accuracy of electromagnetic navigation bronchoscopy compared to fluoroscopy in navigation of transbronchial lung cryobiopsy in patients with interstitial lung disease. BMC Pulm Med 2024; 24:108. [PMID: 38438922 PMCID: PMC10910665 DOI: 10.1186/s12890-024-02925-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/22/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Safely implementing transbronchial lung cryobiopsy (TBLC) in patients with interstitial lung disease (ILD) requires accurate navigation. Traditional fluoroscopy falls short in reducing the risk of post-procedure pneumothorax. The potential of electromagnetic navigation bronchoscopy (ENB) as a more precise navigation method warrants further exploration. METHODS A prospective cohort study was conducted on ILD patients undergoing TBLC. Patients were assigned either fluoroscopy or ENB for cryoprobe positioning. Navigation accuracy was evaluated using cone beam computed tomography (CBCT) images as the standard. Safety and diagnostic yield were also observed. RESULTS Seventeen patients underwent TBLC, with 10 guided by fluoroscopy and seven by ENB. Fluoroscopy-guided cryoprobe navigation required more adjustments [9/15 (60%) v.s. 1/9 (11%), p = 0.018] for subsequent TBLC compared to ENB, as confirmed by CBCT images. Clinical characteristics, post-procedure complications, and biopsy specimen size showed no significant differences between the groups. Fourteen patients obtained a pathological diagnosis, and 15 received a multidisciplinary discussion (MDD) diagnosis. In the fluoroscopy group, three patients failed to obtain a pathological diagnosis, and two failed to obtain an MDD diagnosis. CONCLUSIONS ENB demonstrates significantly superior accuracy in TBLC navigation compared to traditional fluoroscopy when CBCT images are used as a reference. Further studies are necessary to determine the value of ENB in TBLC navigation for ILD patients.
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Affiliation(s)
- Shiyao Wang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Jinmi Yang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Inner Mongolia Autonomous Region People's Hospital, Hohhot, 010017, Inner Mongolia Autonomous Region, China
| | - Sa Luo
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Jing Geng
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Yanhong Ren
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Ling Zhao
- Department of Pathology, China-Japan Friendship Hospital, 100029, Beijing, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, 100029, Beijing, China
| | - Dan Wang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Ying Li
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Zheng Tian
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Wei Liu
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China
| | - Guowu Zhou
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China.
| | - Huaping Dai
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, #2 Yinghuayuan East Street, 100029, Beijing, China.
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22
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Ali SO, Castellani C, Benn BS. Transbronchial Lung Cryobiopsy Performed with Cone Beam Computed Tomography Guidance Versus Fluoroscopy: A Retrospective Cohort Review. Lung 2024; 202:73-81. [PMID: 38129333 DOI: 10.1007/s00408-023-00663-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/19/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Determining the cause of interstitial lung disease (ILD) remains challenging. While surgical lung biopsy remains the gold standard approach, risks associated with it may be prohibitive. Transbronchial lung cryobiopsy (TBLC) is a minimally invasive alternative with an improved safety profile and acceptable diagnostic accuracy. We retrospectively assessed whether the use of Cone Beam computed tomography guidance for TBLC (TBLC-CBCT) improves safety and diagnostic yield compared to performing TBLC with fluoroscopic guidance (TBLC-F). METHODS A retrospective cohort review of 120 patients presenting for evaluation of newly diagnosed ILD was performed. Demographic data, pulmonary function test values, chest imaging pattern, procedural information, and final multidisciplinary discussion (MDD) diagnosis were recorded. RESULTS 62 patients underwent TBLC-F and 58 underwent TBLC-CBCT. Patients undergoing TBLC-CBCT were older (67.86 ± 10.97 vs 61.45 ± 12.77 years, p = 0.004) and had a higher forced vital capacity percent predicted (73.80 ± 17.32% vs 66.00 ± 17.45%, p = 0.03) compared to the TBLC-F group. The average probe-to-pleura distance was 5.1 ± 2.3 mm in the TBLC-CBCT group with 4.0 ± 0.3 CBCT spins performed. Pneumothorax occurred more often in the TBLC-F group (n = 6, 9.7%) compared to the TBLC-CBCT group (n = 1, 1.7%, p = 0.06). Grade 2 bleeding only occurred in the TBLC-F group (n = 4, 6.5%). A final MDD diagnosis was obtained in 89% (n = 57) of TBLC-F patients and 95% (n = 57) of TBLC-CBCT patients. CONCLUSIONS TBLC-CBCT appears to be safer compared to TBLC-F with both approaches facilitating an MDD diagnosis. Further studies from multiple institutions randomizing patients to each modality are needed to confirm these findings.
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Affiliation(s)
- Syed O Ali
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carson Castellani
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bryan S Benn
- Division of Pulmonary and Critical Care, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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23
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Katsuragawa H, Sumiyoshi S, Ikegami N, Hashimoto S, Hajiro T, Taguchi Y, Kobashi Y, Haga H, Yoshizawa A. Histopathological significance of connective tissue disease-associated interstitial lung disease in transbronchial lung cryobiopsy specimens. Pathol Res Pract 2024; 254:155078. [PMID: 38262268 DOI: 10.1016/j.prp.2023.155078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 01/25/2024]
Abstract
Differentiating between idiopathic interstitial pneumonia (IIP) and secondary interstitial pneumonia, particularly connective tissue disease-associated interstitial lung disease (CTD-ILD), can be challenging histopathologically, and there may be discrepancies among pathologists. While surgical lung biopsy has traditionally been considered the gold standard for diagnosing interstitial pneumonia, the usefulness of transbronchial lung cryobiopsy (TBLC) has been reported. If TBLC could effectively distinguish between primary and secondary diseases, it would provide a less invasive option for patients. The aim of this study was to identify specific pathologic findings in TBLC specimens that could assist in distinguishing CTD-ILD from IIP. A total of 93 underwent TBLC at Tenri Hospital between 2018 and 2022. We retrospectively reviewed cases of CTD-ILD exhibiting a nonspecific interstitial pneumonia (NSIP) pattern (CTD-NSIP) and cases of NSIP with an unknown etiology (NSIP-UE), as determined through multidisciplinary discussion. Nineteen patients with CTD-NSIP and 26 patients with NSIP-UE were included in the study for clinicopathological analysis. The CTD-NSIP group had a significantly higher proportion of female patients compared to the NSIP-UE group (79% vs. 31%; p = 0.002). The presence of both fresh and old intraluminal fibrosis within the same TBLC specimen was significantly more frequent in CTD-NSIP group than in the NSIP-UE group (p = 0.023). The presence of an NSIP pattern with co-existing fresh and old intraluminal fibrosis in TBLC specimens raised suspicion for CTD-ILD.
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Affiliation(s)
- Hiroyuki Katsuragawa
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan; Department of Diagnostic pathology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan
| | - Shinji Sumiyoshi
- Department of Diagnostic pathology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan
| | - Naoya Ikegami
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho,Tenri, Nara 632-8552, Japan
| | - Seishu Hashimoto
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho,Tenri, Nara 632-8552, Japan
| | - Takashi Hajiro
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho,Tenri, Nara 632-8552, Japan
| | - Yoshio Taguchi
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho,Tenri, Nara 632-8552, Japan
| | - Yoichiro Kobashi
- Department of Diagnostic pathology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Akihiko Yoshizawa
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan; Department of Diagnostic pathology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan.
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24
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Smith ML, Mino-Kenudson M, Butterfield RJ, Dacic S, Colby TV, Churg A, Beasley MB, Hariri LP. Pulmonary Pathology Society Survey on Practice Approaches in the Histologic Diagnosis of Fibrotic Interstitial Lung Disease: Consensus and Opportunities. Arch Pathol Lab Med 2024; 148:168-177. [PMID: 37226833 DOI: 10.5858/arpa.2022-0530-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 05/26/2023]
Abstract
CONTEXT.— The pathologic diagnosis of usual interstitial pneumonia (UIP) remains a challenging area, and application of histologic UIP guidelines has proved difficult. OBJECTIVE.— To understand current practice approaches by pulmonary pathologists for the histologic diagnosis of UIP and other fibrotic interstitial lung diseases (ILDs). DESIGN.— The Pulmonary Pathology Society (PPS) ILD Working Group developed and sent a 5-part survey on fibrotic ILD electronically to the PPS membership. RESULTS.— One hundred sixty-one completed surveys were analyzed. Of the respondents, 89% reported using published histologic features in clinical guidelines for idiopathic pulmonary fibrosis (IPF) in their pathologic diagnosis; however, there was variability in reporting terminology, quantity and quality of histologic features, and the use of guideline categorization. Respondents were very likely to have access to pulmonary pathology colleagues (79%), pulmonologists (98%), and radiologists (94%) to discuss cases. Half of respondents reported they may alter their pathologic diagnosis based on additional clinical and radiologic history if it is pertinent. Airway-centered fibrosis, granulomas, and types of inflammatory infiltrates were considered important, but there was poor agreement on how these features are defined. CONCLUSIONS.— There is significant consensus among the PPS membership on the importance of histologic guidelines/features of UIP. There are unmet needs for (1) consensus and standardization of diagnostic terminology and incorporation of recommended histopathologic categories from the clinical IPF guidelines into pathology reports, (2) agreement on how to incorporate into the report relevant clinical and radiographic information, and (3) defining the quantity and quality of features needed to suggest alternative diagnoses.
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Affiliation(s)
- Maxwell L Smith
- From the Departments of Laboratory Medicine and Pathology (Smith, Colby)
| | - Mari Mino-Kenudson
- the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston (Mino-Kenudson, Hariri)
| | | | - Sanja Dacic
- the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dacic)
| | - Thomas V Colby
- From the Departments of Laboratory Medicine and Pathology (Smith, Colby)
| | - Andrew Churg
- the Department of Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada (Churg)
| | - Mary Beth Beasley
- the Department of Pathology, Mount Sinai Health System, Icahn School of Medicine, New York, New York (Beasley)
| | - Lida P Hariri
- the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston (Mino-Kenudson, Hariri)
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25
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Calaras D, David A, Vasarmidi E, Antoniou K, Corlateanu A. Hypersensitivity Pneumonitis: Challenges of a Complex Disease. Can Respir J 2024; 2024:4919951. [PMID: 38283656 PMCID: PMC10810695 DOI: 10.1155/2024/4919951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/19/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Hypersensitivity pneumonitis (HP) is a complex interstitial lung disease caused by chronic inhalation of a wide variety of antigens in susceptible and sensitized individuals, commonly associated with an occupational exposure. An impressive number of inciting antigens causing hypersensitivity pneumonitis have been found to cover a wide range of occupations. As working practices have changed over time, especially in industrialized countries, new names for occupational HP have emerged. This review emphasizes the main diagnostic issues arising from the high variability of clinical presentation and the broad spectrum of causal antigens. Furthermore, it provides an overview of current methods to unveil possible causes of hypersensitivity pneumonitis, highlights HP's current diagnostic and treatment challenges and the remaining areas of uncertainty, and presents prevention strategies.
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Affiliation(s)
- Diana Calaras
- Department of Pulmonology and Allergology, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
| | - Aliona David
- Outpatient Department, Institute of Phtisiopneumology “Chiril Draganiuc”, Chisinau, Moldova
| | - Eirini Vasarmidi
- Department of Respiratory Medicine, Laboratory of Molecular and Cellular Pulmonology, School of Medicine, University of Crete, Heraklion, Greece
| | - Katerina Antoniou
- Department of Respiratory Medicine, Laboratory of Molecular and Cellular Pulmonology, School of Medicine, University of Crete, Heraklion, Greece
| | - Alexandru Corlateanu
- Department of Pulmonology and Allergology, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
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26
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Patirelis A, Elia S, Cristino B, Puxeddu E, Cavalli F, Rogliani P, Pompeo E. Spontaneous Ventilation Thoracoscopic Lung Biopsy in Undetermined Interstitial Lung Disease: Systematic Review and Meta-Analysis. J Clin Med 2024; 13:374. [PMID: 38256508 PMCID: PMC10815978 DOI: 10.3390/jcm13020374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/27/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Thoracoscopic surgical biopsy has shown excellent histological characterization of undetermined interstitial lung diseases, although the morbidity rates reported are not negligible. In delicate patients, interstitial lung disease and restrictive ventilatory impairment morbidity are thought to be due at least in part to tracheal intubation with single-lung mechanical ventilation; therefore, spontaneous ventilation thoracoscopic lung biopsy (SVTLB) has been proposed as a potentially less invasive surgical option. This systematic review summarizes the results of SVTLB, focusing on diagnostic yield and operative morbidity. A systematic search for original studies regarding SVTLB published between 2010 to 2023 was performed. In addition, articles comparing SVTLB to mechanical ventilation thoracoscopic lung biopsy (MVTLB) were selected for a meta-analysis. Overall, 13 studies (two before 2017 and eleven between 2018 and 2023) entailing 675 patients were included. Diagnostic yield ranged from 84.6% to 100%. There were 64 (9.5%) complications, most of which were minor. There was no 30-day operative mortality. When comparing SVTLB to MVTLB, the former group showed a significantly lower risk of complications (p < 0.001), whereas no differences were found in diagnostic accuracy. The results of this review suggest that SVTLB is being increasingly adopted worldwide and has proven to be a safe procedure with excellent diagnostic accuracy.
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Affiliation(s)
- Alexandro Patirelis
- Unit of Thoracic Surgery, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy; (A.P.); (B.C.)
- Division of Thoracic Surgery, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Stefano Elia
- Division of Thoracic Surgery, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy;
- Department of Medicine and Health Sciences, Università degli Studi del Molise, 86100 Campobasso, Italy
| | - Benedetto Cristino
- Unit of Thoracic Surgery, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy; (A.P.); (B.C.)
- Division of Thoracic Surgery, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Ermanno Puxeddu
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (E.P.); (P.R.)
- Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Francesco Cavalli
- Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Paola Rogliani
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (E.P.); (P.R.)
- Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy;
| | - Eugenio Pompeo
- Unit of Thoracic Surgery, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy; (A.P.); (B.C.)
- Division of Thoracic Surgery, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy;
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27
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Otoshi R, Kitamura H, Baba T, Muraoka T, Sekine A, Takemura T, Okudela K, Sawazumi T, Ogura T. Concordance between transbronchial lung cryobiopsy and surgical lung biopsy in patients with idiopathic multicentric Castleman disease: A report of four cases. Respir Investig 2024; 62:1-8. [PMID: 37925882 DOI: 10.1016/j.resinv.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/02/2023] [Accepted: 09/07/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Idiopathic multicentric Castleman disease (iMCD) is a rare polyclonal lymphoproliferative disease often associated with pulmonary involvement. Recently, transbronchial lung cryobiopsy (TBLC) has been reported to be useful for the diagnosis of diffuse interstitial lung disease. However, there have been no reports of pathological assessment of TBLC for iMCD. METHOD To clarify the efficacy of TBLC in the diagnosis of iMCD, we retrospectively reviewed four iMCD patients who had undergone both TBLC and surgical lung biopsy (SLB). RESULTS The median age was 44 years; 2 males and 2 females. Two or three TBLC specimens were taken from each patient. All patients had no complications other than minimal bleeding. The size of the TBLC specimens was approximately 5-6 × 3-4 mm, and the alveolar region, and centrilobular and perilobular areas were adequately sampled. As with SLB, the extent of lung lesions and inflammatory cell infiltration could be sufficiently evaluated by TBLC. The presence of lymphoid follicles could also be assessed by TBLC; however, the germinal centers with lymphoid follicles were difficult to evaluate. The TBLC specimens could also be evaluated for immunostaining, especially IgG4 immunostaining, to rule out IgG4-related lung disease. Pulmonary pathological grading showed a high concordance rate between major pathological findings of TBLC and SLB. The pathologist's confidence level of TBLC for the diagnosis of iMCD was high in all cases. CONCLUSIONS TBLC exhibits a high concordance rate with SLB in the pathological evaluation of iMCD, which may be useful for the diagnosis of iMCD.
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Affiliation(s)
- Ryota Otoshi
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
| | - Hideya Kitamura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Tatsuya Muraoka
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Koji Okudela
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tomoe Sawazumi
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
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28
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Kondoh Y. Challenges in the diagnosis of interstitial lung disease. Respir Investig 2024; 62:75-76. [PMID: 37952289 DOI: 10.1016/j.resinv.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/07/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Japan.
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29
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Spagnolo P, Ryerson CJ, Guler S, Feary J, Churg A, Fontenot AP, Piciucchi S, Udwadia Z, Corte TJ, Wuyts WA, Johannson KA, Cottin V. Occupational interstitial lung diseases. J Intern Med 2023; 294:798-815. [PMID: 37535448 DOI: 10.1111/joim.13707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Millions of workers are exposed to substances known to cause occupational interstitial lung diseases (ILDs), particularly in developing countries. However, the burden of the disease is likely to be underestimated due to under-recognition, under-reporting or both. The diagnosis of occupational ILD requires a high level of suspicion and a thorough occupational history, as occupational and non-occupational ILDs may be clinically, functionally and radiologically indistinguishable, leading to delayed diagnosis and inappropriate management. A potential occupational aetiology should always be considered in the differential diagnosis of ILD, as removal from the workplace exposure, with or without treatment, is a key therapeutic intervention and may lead to significant improvement. In this article, we provide an overview of the 'traditional' inorganic dust-related ILDs but also address idiopathic pulmonary fibrosis and the immunologically mediated chronic beryllium disease, sarcoidosis and hypersensitivity pneumonitis, with emphasis on the importance of surveillance and prevention for reducing the burden of these conditions. To this end, health-care professionals should be specifically trained about the importance of occupational exposures as a potential cause of ILD.
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Affiliation(s)
- Paolo Spagnolo
- Respiratory, Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Christopher J Ryerson
- Department of Medicine, St. Paul's Hospital, University of British Columbia and Centre for Heart Lung Innovation, Vancouver, Canada
| | - Sabina Guler
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johanna Feary
- Department of Occupational and Environmental Medicine, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew Churg
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew P Fontenot
- Department of Medicine, University of Colorado Anschutz Medical Campus Aurora, Aurora, Colorado, USA
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus Aurora, Aurora, Colorado, USA
| | - Sara Piciucchi
- Department of Radiology, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - Zarir Udwadia
- Hinduja Hospital and Research Center, Breach Candy Hospital, Mumbai, Maharashtra, India
| | - Tamera J Corte
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Camperdown, New South Wales, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Wim A Wuyts
- Unit for Interstitial Lung Diseases, University of Leuven, Leuven, Belgium
| | - Kerri A Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Vincent Cottin
- Department of Respiratory Medicine, National Reference Coordinating Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, UMR754, IVPC, Lyon, France
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Lin YT, Lin CH, Wang SC, Huang YJ, Wu RC, Lee CS, Chang CH. Mucinous Adenocarcinoma of the Lung Diagnosed by Radial Endobronchial Ultrasound-guided Bronchoscopic Cryobiopsy and Presenting as Interstitial Lung Disease in a Patient with Systemic Sclerosis. J Med Ultrasound 2023; 31:314-317. [PMID: 38264591 PMCID: PMC10802878 DOI: 10.4103/jmu.jmu_56_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/10/2022] [Accepted: 08/09/2022] [Indexed: 01/25/2024] Open
Abstract
We report a patient with systemic sclerosis who was diagnosed with advanced-stage mucinous adenocarcinoma of the lungs. The clinical presentation, imaging findings, pathological results, and molecular diagnoses are presented. A 64-year-old woman with systemic sclerosis was administered prednisolone and hydroxychloroquine sulfate to control her disease. High-resolution computed tomography (HRCT) revealed an interstitial pattern in both lungs during annual imaging. Connective tissue disease-associated interstitial lung disease (CTD-ILD) was diagnosed using blood tests, pulmonary function tests, and imaging findings. One year later, the patient underwent follow-up chest HRCT, which showed progressive lung disease. The patient underwent endobronchial ultrasound (EBUS)-guided transbronchial lung cryobiopsy and computed tomography-guided biopsy for a pathological diagnosis. The pathology reports of bilateral lungs disclosed mucinous adenocarcinoma. After tumor staging and mutation testing, the patient received chemotherapy with pemetrexed and cisplatin. The bilateral lung lesions subsided after four cycles of first-line chemotherapy. Patients with CTD and lung involvement may be diagnosed with CTD-ILD. Although histopathological results are not mandatory for ILD diagnosis, EBUS-guided transbronchial lung biopsy or lung cryobiopsy should be considered when ILD has atypical or unexplained features.
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Affiliation(s)
- Yan-Ting Lin
- Department of Internal Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan
| | - Chiung-Hung Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan
| | - Shao-Chung Wang
- Department of Medical Imaging and Intervention, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Ju Huang
- Department of Allergy, Immunology, Rheumatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Department of Anatomic Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Shu Lee
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan
- Department of Pulmonary and Critical Care Medicine, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan
| | - Chih-Hao Chang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan
- Department of Pulmonary and Critical Care Medicine, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan
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31
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Husnain SMN, Sarkar A, Huseini T. Utility and Safety of Bronchoscopic Cryotechniques-A Comprehensive Review. Diagnostics (Basel) 2023; 13:2886. [PMID: 37761254 PMCID: PMC10530195 DOI: 10.3390/diagnostics13182886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Cryosurgical techniques are employed for diagnostic and therapeutic bronchoscopy and serve as important tools for the management of pulmonary diseases. The diagnosis of interstitial lung disease requires multidisciplinary team discussions after a thorough assessment of history, physical exam, computed tomography, and lung-function testing. However, histological diagnosis is required in selected patients. Surgical lung biopsy has been the gold standard but this can be associated with increased morbidity and mortality. Transbronchial lung cryobiopsy is an emerging technique and multiple studies have shown that it has a high diagnostic yield with a good safety profile. There is wide procedural variability and the optimal technique for cryobiopsy is still under investigation. There is emerging data that demonstrate that cryobiopsy is safe and highly accurate in the diagnosis of thoracic malignancies. Furthermore, cryorecanalization procedures are a useful adjunct for the palliation of tumors in patients with central airway obstruction. One should keep in mind that these procedures are not free from complications and should be carried out in a specialized center by a trained and experienced bronchoscopy team. We present a review of the literature on the diagnostic and therapeutic utility of bronchoscopy-guided cryosurgical procedures and their safety profile.
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Affiliation(s)
- Shaikh M. Noor Husnain
- Department of Internal Medicine, Division of Interventional Pulmonary Medicine, Westchester Medical Center, New York, NY 10595, USA
| | - Abhishek Sarkar
- Department of Internal Medicine, Division of Interventional Pulmonary Medicine, Westchester Medical Center, New York, NY 10595, USA
| | - Taha Huseini
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA 6150, Australia
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Freund O, Wand O, Schneer S, Barel N, Shalmon T, Borsekofsky S, Hershko T, Gershman E, Adir Y, Bar-Shai A, Shitrit D, Unterman A. Transbronchial Cryobiopsy Is Superior to Forceps Biopsy for Diagnosing both Fibrotic and Non-Fibrotic Interstitial Lung Diseases. Respiration 2023; 102:852-860. [PMID: 37634496 DOI: 10.1159/000533197] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/19/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) evaluation often requires lung biopsy for definite diagnosis. In recent years, transbronchial cryobiopsy (TBCB) emerged as a procedure with higher diagnostic yield than transbronchial forceps biopsy (TBFB), especially for fibrotic ILDs. Nonetheless, studies comparing these modalities in non-fibrotic ILDs and for specific ILD diagnoses are scarce. OBJECTIVES The aim of this study was to evaluate the diagnostic yield and safety of TBCB and TBFB in patients with fibrotic and non-fibrotic ILDs. METHOD An observational retrospective multicenter study including patients with ILD diagnosis by multidisciplinary discussion that underwent TBCB or TBFB between 2017 and 2021. Chest CT scans were reviewed by a chest radiologist. Biopsy specimens were categorized as diagnostic (with specific histological pattern), nondiagnostic, or without lung parenchyma. Nondiagnostic samples were reassessed by a second lung pathologist. TBCB and TBFB diagnostic yields were analyzed by multivariate regression. Procedural complications were evaluated as well. RESULTS 276 patients were included, 116 (42%) underwent TBCB and 160 (58%) TBFB. Fibrotic ILDs were present in 148 patients (54%). TBCB diagnostic yield was 78% and TBFB 48% (adjusted odds ratio [AOR] 4.2, 95% CI: 2.4-7.6, p < 0.01). The diagnostic yield of TBCB was higher than TBFB among patients with fibrotic ILD (AOR 3.8, p < 0.01), non-fibrotic ILD (AOR 5.8, p < 0.01), and across most ILD diagnoses. TBCB was associated with higher risk for significant bleeding (10% vs. 3%, p < 0.01), but similar risk for pneumothorax. CONCLUSIONS Diagnostic yield of TBCB was superior to that of TBFB for both fibrotic and non-fibrotic ILDs, and across most diagnoses.
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Affiliation(s)
- Ophir Freund
- Center of Excellence for Interstitial Lung Diseases, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel,
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel,
| | - Ori Wand
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sonia Schneer
- Pulmonary Division, Lady Davis Carmel Medical Center, Faculty of Medicine, The Technion Institute of Technology, Haifa, Israel
| | - Nevo Barel
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Shalmon
- Department of Radiology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Sarah Borsekofsky
- Pathology Department, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Tzlil Hershko
- Center of Excellence for Interstitial Lung Diseases, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Evgeni Gershman
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Yochai Adir
- Pulmonary Division, Lady Davis Carmel Medical Center, Faculty of Medicine, The Technion Institute of Technology, Haifa, Israel
| | - Amir Bar-Shai
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - David Shitrit
- Pulmonary Department, Meir Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Avraham Unterman
- Center of Excellence for Interstitial Lung Diseases, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
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Baba T, Takemura T, Okudela K, Hebisawa A, Matsushita S, Iwasawa T, Yamakawa H, Nakagawa H, Ogura T. Concordance between transbronchial lung cryobiopsy and surgical lung biopsy for interstitial lung disease in the same patients. BMC Pulm Med 2023; 23:279. [PMID: 37507693 PMCID: PMC10385958 DOI: 10.1186/s12890-023-02571-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The diagnostic accuracy and safety of transbronchial lung cryobiopsy (TBLC) via a flexible bronchoscope under sedation compared with that of surgical lung biopsy (SLB) in the same patients is unknown. METHODS Retrospectively the data of fifty-two patients with interstitial lung diseases (median age: 63.5 years; 21 auto-antibody positive) who underwent TBLC followed by SLB (median time from TBLC to SLB: 57 days) was collected. The samples from TBLC and SLB were randomly labelled to mask the relationship between the two samples. Diagnosis was made independently by pathologists, radiologists, and pulmonary physicians in a stepwise manner, and a final diagnosis was made at multidisciplinary discussion (MDD). In each diagnostic step the specific diagnosis, the diagnostic confidence level, idiopathic pulmonary fibrosis (IPF) diagnostic guideline criteria, and treatment strategy were recorded. RESULTS Without clinical and radiological information, the agreement between the histological diagnoses by TBLC and SLB was 42.3% (kappa [κ] = 0.23, 95% confidence interval [CI]: 0.08-0.39). However, the agreement between the TBLC-MDD and SLB-MDD diagnoses and IPF/non-IPF diagnosis using the two biopsy methods was 65.4% (κ = 0.57, 95% CI: 0.42-0.73) and 90.4% (47/52), respectively. Out of 38 (73.1%) cases diagnosed with high or definite confidence at TBLC-MDD, 29 had concordant SLB-MDD diagnoses (agreement: 76.3%, κ = 0.71, 95% CI: 0.55-0.87), and the agreement for IPF/non-IPF diagnoses was 97.4% (37/38). By adding the pathological diagnosis, the inter-observer agreement of clinical diagnosis improved from κ = 0.22 to κ = 0.42 for TBLC and from κ = 0.27 to κ = 0.38 for SLB, and the prevalence of high or definite diagnostic confidence improved from 23.0% to 73.0% and from 17.3% to 73.0%, respectively. Of all 383 TBLC performed during the same period, pneumothorax occurred in 5.0% of cases, and no severe bleeding, acute exacerbation of interstitial lung disease, or fatal event was observed. CONCLUSIONS TBLC via a flexible bronchoscope under deep sedation is safely performed, and the TBLC-MDD diagnosis with a high or definite confidence level is concordant with the SLB-MDD diagnosis in the same patients.
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Affiliation(s)
- Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Tomioka-Higashi 6-16-1, Kanazawa-Ku, Yokohama, Japan.
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Koji Okudela
- Department of Pathology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Akira Hebisawa
- Department of Clinical Research, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Shoichiro Matsushita
- Department of Radiology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Hideaki Yamakawa
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Hiroaki Nakagawa
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Tomioka-Higashi 6-16-1, Kanazawa-Ku, Yokohama, Japan
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Sanduzzi Zamparelli S, Sanduzzi Zamparelli A, Bocchino M. The Evolving Concept of the Multidisciplinary Approach in the Diagnosis and Management of Interstitial Lung Diseases. Diagnostics (Basel) 2023; 13:2437. [PMID: 37510180 PMCID: PMC10378270 DOI: 10.3390/diagnostics13142437] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/19/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Interstitial lung diseases (ILDs) are a group of heterogeneous diseases characterized by inflammation and/or fibrosis of the lung interstitium, leading to a wide range of clinical manifestations and outcomes. Over the years, the literature has demonstrated the increased diagnostic accuracy and confidence associated with a multidisciplinary approach (MDA) in assessing diseases involving lung parenchyma. This approach was recently emphasized by the latest guidelines from the American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Association for the diagnosis of ILDs. METHODS In this review, we will discuss the role, composition, and timing of multidisciplinary diagnosis (MDD) concerning idiopathic pulmonary fibrosis, connective tissue disease associated with ILDs, hypersensitive pneumonia, and idiopathic pneumonia with autoimmune features, based on the latest recommendations for their diagnosis. RESULTS The integration of clinical, radiological, histopathological, and, often, serological data is crucial in the early identification and management of ILDs, improving patient outcomes. Based on the recent endorsement of transbronchial cryo-biopsy in idiopathic pulmonary fibrosis guidelines, an MDA helps guide the choice of the sampling technique, obtaining the maximum diagnostic performance, and avoiding the execution of more invasive procedures such as a surgical lung biopsy. A multidisciplinary team should include pulmonologists, radiologists, pathologists, and, often, rheumatologists, being assembled regularly to achieve a consensus diagnosis and to review cases in light of new features. CONCLUSIONS The literature highlighted that an MDA is essential to improve the accuracy and reliability of ILD diagnosis, allowing for the early optimization of therapy and reducing the need for invasive procedures. The multidisciplinary diagnosis of ILDs is an ongoing and dynamic process, often referred to as a "working diagnosis", involving the progressive integration and re-evaluation of clinical, radiological, and histological features.
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Affiliation(s)
| | - Alessandro Sanduzzi Zamparelli
- Department of Clinical Medicine and Surgery, Section of Respiratory Diseases, University Federico II, Azienda Ospedaliera dei Colli-Monaldi Hospital, 80131 Naples, Italy
- Staff of UNESCO Chair for Health Education and Sustainable Development, University Federico II, 80131 Naples, Italy
| | - Marialuisa Bocchino
- Department of Clinical Medicine and Surgery, Section of Respiratory Diseases, University Federico II, Azienda Ospedaliera dei Colli-Monaldi Hospital, 80131 Naples, Italy
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Fortin M, Liberman M, Delage A, Dion G, Martel S, Rolland F, Soumagne T, Trahan S, Assayag D, Albert E, Kelly MM, Johannson KA, Guenther Z, Leduc C, Manganas H, Prenovault J, Provencher S. Transbronchial Lung Cryobiopsy and Surgical Lung Biopsy: A Prospective Multi-Centre Agreement Clinical Trial (CAN-ICE). Am J Respir Crit Care Med 2023; 207:1612-1619. [PMID: 36796092 DOI: 10.1164/rccm.202209-1812oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 02/16/2023] [Indexed: 02/18/2023] Open
Abstract
Rationale: Transbronchial cryobiopsy (TBCB) for the diagnosis of interstitial lung disease (ILD) has shown promising results, but prospective studies with matched surgical lung biopsy (SLB) have yielded conflicting results. Objectives: We aimed to assess within- and between-center diagnostic agreement between TBCB and SLB at both the histopathologic and multidisciplinary discussion (MDD) levels in patients with diffuse ILD. Methods: In a multicenter prospective study, we performed matched TBCB and SLB in patients referred for SLB. After a blinded review by three pulmonary pathologists, all cases were reviewed by three independent ILD teams in an MDD. MDD was performed first with TBCB, then with SLB in a second session. Within-center and between-center diagnostic agreement was evaluated using percentages and correlation coefficients. Measurements and Main Results: Twenty patients were recruited and underwent contemporaneous TBCB and SLB. Within-center diagnostic agreement between TBCB-MDD and SLB-MDD was reached in 37 of the 60 (61.7%) paired observations, resulting in a Cohen's κ value of 0.46 (95% confidence interval [CI], 0.29-0.63). Diagnostic agreement increased among high-confidence or definitive diagnoses on TBCB-MDD (21 of 29 [72.4%]), but not significantly, and was more likely among cases with SLB-MDD diagnoses of idiopathic pulmonary fibrosis than fibrotic hypersensitivity pneumonitis (13 of 16 [81.2%] vs. 16 of 31 [51.6%]; P = 0.047). Between-center agreement for cases was markedly higher for SLB-MDD (κ = 0.71 [95% CI, 0.52-0.89]) than TBCB-MDD (κ = 0.29 [95% CI, 0.09-0.49]). Conclusions: This study demonstrated moderate TBCB-MDD and SLB-MDD diagnostic agreement for ILD, while between-center agreement was fair for TBCB-MDD and substantial for SLB-MDD. Clinical trial registered with www.clinicaltrials.gov (NCT02235779).
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Affiliation(s)
- Marc Fortin
- Department of Pulmonary Medicine and Thoracic Surgery
| | | | - Antoine Delage
- Department of Medicine, Charles-Lemoyne Hospital, Sherbrooke University, Longueuil, Canada
| | | | - Simon Martel
- Department of Pulmonary Medicine and Thoracic Surgery
| | - Fabien Rolland
- Departement of Pulmonary Medicine, Cannes Medical Center, Cannes, France
| | - Thibaud Soumagne
- Departement of Pulmonary Medicine and Intensive Care, Georges Pompidou European Hospital, Paris Hospital Public Assistance, Paris, France
| | | | - Deborah Assayag
- Department of Medicine, McGill University Health Center, McGill University, Montreal, Quebec, Canada; and
| | - Elisabeth Albert
- Department of Radiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Zachary Guenther
- Department of Radiology, South Health Campus, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Julie Prenovault
- Department of Radiology, University of Montreal Health Center, University of Montreal, Montreal, Quebec, Canada
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Trisolini R. Lung Cryobiopsy Versus Surgical Lung Biopsy for Diagnosing Fibrotic Interstitial Lung Disease: Still Looking for the "Perfect" Trial. Am J Respir Crit Care Med 2023; 207:1551-1553. [PMID: 36921148 PMCID: PMC10273107 DOI: 10.1164/rccm.202303-0381ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Affiliation(s)
- Rocco Trisolini
- Unitá Operativa Complessa di Pneumologia Interventistica Fondazione Policlinico Universitario Agostino Gemelli IRCCS Roma, Italia and Dipartimento di Scienze Cardiovascolari e Polmonari Universitá Cattolica del Sacro Cuore Roma, Italia
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37
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Ozasa M, Bychkov A, Zaizen Y, Tabata K, Uegami W, Yamano Y, Kataoka K, Johkoh T, Mukae H, Kondoh Y, Fukuoka J. Effect of the 2020 hypersensitivity pneumonitis guideline on the pathologic diagnosis of interstitial pneumonia. Sci Rep 2023; 13:9318. [PMID: 37291357 PMCID: PMC10250339 DOI: 10.1038/s41598-023-35986-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
It was reported that the 2020 guideline for hypersensitivity pneumonitis (HP) might result in the overdiagnosis of fibrotic HP (fHP). fHP and other types of interstitial pneumonias have several overlapping characteristics, and a high diagnostic concordance rate of fHP is rarely obtained. Therefore, we investigated the impact of the 2020 HP guideline on the pathological diagnosis of cases previously diagnosed as interstitial pneumonia. We identified 289 fibrotic interstitial pneumonia cases from 2014 to 2019 and classified them into four categories according to the 2020 HP guideline: typical, probable, and indeterminate for fHP and alternative diagnosis. The original pathological diagnosis of 217 cases were compared to their classification as either typical, probable, or indeterminate for fHP according to the 2020 guideline. The clinical data, including serum data and pulmonary function tests, were compared among the groups. Diagnoses changed from non-fHP to fHP for 54 (25%) of the 217 cases, of which, 8 were typical fHP and 46 were probable fHP. The ratio of typical and probable fHP cases to the total number of VATS cases was significantly lower when using transbronchial lung cryobiopsy (p < 0.001). The clinical data of these cases bore a more remarkable resemblance to those diagnosed as indeterminate for fHP than to those diagnosed as typical or probable. The pathological criteria in the new HP guidelines increase the diagnosis of fHP. However, it is unclear whether this increase leads to overdiagnosis, and requires further investigation. Transbronchial lung cryobiopsy may not be helpful when using the new criteria to impart findings for fHP diagnosis.
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Affiliation(s)
- Mutsumi Ozasa
- Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Andrey Bychkov
- Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Yoshiaki Zaizen
- Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Kazuhiro Tabata
- Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Wataru Uegami
- Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Yasuhiko Yamano
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Kensuke Kataoka
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Junya Fukuoka
- Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan.
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38
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Menigoz C, Dirou S, Sagan C, Corne F, Moui A, Defrance C, Liberge R, Morla O, Patarin V, Nicolas A, Kandel-Aznar C, Lacoste P, Clarke JP, Cavailles A, Cellerin L, Blanc FX. [Transbronchial lung cryobiopsy in interstitial lung diseases]. Rev Mal Respir 2023; 40:469-478. [PMID: 37308261 DOI: 10.1016/j.rmr.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/13/2023] [Indexed: 06/14/2023]
Abstract
In some cases of interstitial lung disease (ILD), clinical and biological findings associated with CT scan pattern during multidisciplinary discussion (MDD) fail to yield a confident diagnosis. In these cases, histology may be necessary. Transbronchial lung cryobiopsy (TBLC) is a bronchoscopic procedure that has been developed in recent years and currently contributes to diagnostic work-up in patients with ILD. TBLC provides tissue samples for histological analysis with an acceptable risk of complications, consisting mainly in pneumothorax or bleeding. In addition to higher diagnostic yield than conventional forceps biopsies, the procedure shows a better safety profile than surgical biopsies. The indication to perform TBLC is decided during a 1st MDD and during a 2nd MDD, results can provide a diagnostic yield approximating 80%. TBLC appears to be an attractive, minimally invasive technique to be proposed as a first-line procedure in selected patients in experienced centers, while surgical lung biopsy may be considered as a second-line solution.
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Affiliation(s)
- C Menigoz
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France.
| | - S Dirou
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France
| | - C Sagan
- Nantes Université, CHU Nantes, service d'anatomopathologie, Nantes, France
| | - F Corne
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France; Clinique Jules Verne, consultation de pneumologie, Nantes, France
| | - A Moui
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France
| | - C Defrance
- Nantes Université, CHU Nantes, service d'imagerie médicale, Nantes, France
| | - R Liberge
- Nantes Université, CHU Nantes, service d'imagerie médicale, Nantes, France
| | - O Morla
- Nantes Université, CHU Nantes, service d'imagerie médicale, Nantes, France
| | - V Patarin
- Nantes Université, CHU Nantes, service d'imagerie médicale, Nantes, France
| | - A Nicolas
- Nantes Université, CHU Nantes, service d'imagerie médicale, Nantes, France
| | - C Kandel-Aznar
- Nantes Université, CHU Nantes, service d'anatomopathologie, Nantes, France
| | - P Lacoste
- Nantes Université, CHU Nantes, service de chirurgie thoracique et cardiovasculaire, l'institut du thorax, Nantes, France
| | - J P Clarke
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France; Clinique ELSAN Santé Atlantique, consultation de pneumologie, Saint-Herblain, France
| | - A Cavailles
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France
| | - L Cellerin
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France
| | - F-X Blanc
- Nantes Université, CHU Nantes, service de pneumologie, l'institut du thorax, Nantes, France
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Ohno S, Zaizen Y, Matama G, Chikasue T, Tokisawa S, Okamoto M, Tabata K, Tominaga M, Akiba J, Fujimoto K, Fukuoka J, Hoshino T. The Characteristic of Transbronchial Lung Cryobiopsy in the Pathological Diagnosis of Hypersensitivity Pneumonitis. J Clin Med 2023; 12:jcm12113663. [PMID: 37297858 DOI: 10.3390/jcm12113663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/21/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Transbronchial lung cryobiopsy (TBLC) has widely used for the diagnosis of diffuse lung disease. However, it remains unclear whether TBLC is useful for the diagnosis in hypersensitivity pneumonitis (HP). METHODS We investigated 18 patients who underwent TBLC and were diagnosed with HP based on pathology or multidisciplinary discussion (MDD). Of the 18 patients, 12 had fibrotic HP (fHP), 2 had non-fibrotic HP (non-fHP) diagnosed with MDD. The remaining 4 patients were diagnosed with fHP by pathology but not by MDD because of clinical features. The radiology and pathology of these cases were compared. RESULTS All patients with fHP showed radiological findings of inflammation, fibrosis, and airway disease. Conversely, pathology showed fibrosis and inflammation in 11 of 12 cases (92%), but airway disease was significantly less common with 5 cases (42%) (p = 0.014). Non-fHP showed inflammatory cell infiltration mainly in the centrilobule on pathology, which was consistent with radiology. Granulomas were found in 5 patients with HP (36%). In the non-HP group, airway-centered interstitial fibrosis was observed in 3 patients (75%) with pathology. CONCLUSIONS The pathology with TBLC is difficult to evaluate airway disease of HP. We need to understand this characteristic of TBLC to make a MDD diagnosis of HP.
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Affiliation(s)
- Shuuhei Ohno
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Yoshiaki Zaizen
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
- Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Goushi Matama
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Tomonori Chikasue
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Saeko Tokisawa
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Masaki Okamoto
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyouhama, Chuo-ku, Fukuoka 810-8563, Japan
| | - Kazuhiro Tabata
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Masaki Tominaga
- Department of Community Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Jun Akiba
- Department of Pathology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Kiminori Fujimoto
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
| | - Junya Fukuoka
- Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan
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Mancini M, Bargiacchi L, De Vitis C, D'Ascanio M, De Dominicis C, Ibrahim M, Rendina EA, Ricci A, Di Napoli A, Mancini R, Vecchione A. Histologic Analysis of Idiopathic Pulmonary Fibrosis by Morphometric and Fractal Analysis. Biomedicines 2023; 11:biomedicines11051483. [PMID: 37239155 DOI: 10.3390/biomedicines11051483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrotic lung disorder, ultimately leading to respiratory failure and death. Despite great research advances in understanding the mechanisms underlying the disease, its diagnosis, and its treatment, IPF still remains idiopathic without known biological or histological markers able to predict disease progression or response to treatment. The histologic hallmark of IPF is usual interstitial pneumonia (UIP), with its intricate architectural distortion and temporal inhomogeneity. We hypothesize that normal lung alveolar architecture can be compared to fractals, such as the Pythagoras tree with its fractal dimension (Df), and every pathological insult, distorting the normal lung structure, could result in Df variations. In this study, we aimed to assess the UIP histologic fractal dimension in relationship to other morphometric parameters in newly diagnosed IPF patients and its possible role in the prognostic stratification of the disease. Clinical data and lung tissue specimens were obtained from twelve patients with IPF, twelve patients with non-specific interstitial pneumonia (NSIP), and age-matched "healthy" control lung tissue from patients undergoing lung surgery for other causes. Histology and histomorphometry were performed to evaluate Df and lacunarity measures, using the box counting method on the FracLac ImageJ plugin. The results showed that Df was significantly higher in IPF patients compared to controls and fibrotic NSIP patients, indicating greater architectural distortion in IPF. Additionally, high Df values were associated with higher fibroblastic foci density and worse prognostic outcomes in IPF, suggesting that Df may serve as a potential novel prognostic marker for IPF. The scalability of Df measurements was demonstrated through repeated measurements on smaller portions from the same surgical biopsies, which were selected to mimic a cryobiopsy. Our study provides further evidence to support the use of fractal morphometry as a tool for quantifying and determining lung tissue remodeling in IPF, and we demonstrated a significant correlation between histological and radiological Df in UIP pattern, as well as a significant association between Df and FF density. Furthermore, our study demonstrates the scalability and self-similarity of Df measurements across different biopsy types, including surgical and smaller specimens.
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Affiliation(s)
- Massimiliano Mancini
- Morphologic and Molecular Pathology Unit, Sant'Andrea University Hospital, 00189 Rome, Italy
| | - Lavinia Bargiacchi
- Morphologic and Molecular Pathology Unit, Sant'Andrea University Hospital, 00189 Rome, Italy
| | - Claudia De Vitis
- Department of Clinical and Molecular Medicine Sant'Andrea University Hospital, "Sapienza" University of Rome", 00189 Rome, Italy
| | - Michela D'Ascanio
- UOC Respiratory Disease, Sant'Andrea University Hospital, 00189 Rome, Italy
| | | | - Mohsen Ibrahim
- Thoracic Surgery Unit, Sant'Andrea University Hospital, "Sapienza" University of Rome, 00189 Rome, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery Unit, Sant'Andrea University Hospital, "Sapienza" University of Rome, 00189 Rome, Italy
| | - Alberto Ricci
- Department of Clinical and Molecular Medicine Sant'Andrea University Hospital, "Sapienza" University of Rome", 00189 Rome, Italy
| | - Arianna Di Napoli
- Department of Clinical and Molecular Medicine Sant'Andrea University Hospital, "Sapienza" University of Rome", 00189 Rome, Italy
| | - Rita Mancini
- Department of Clinical and Molecular Medicine Sant'Andrea University Hospital, "Sapienza" University of Rome", 00189 Rome, Italy
| | - Andrea Vecchione
- Department of Clinical and Molecular Medicine Sant'Andrea University Hospital, "Sapienza" University of Rome", 00189 Rome, Italy
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Ravaglia C, Sultani F, Piciucchi S, Dubini A, De Grauw AJ, Martinello S, Oldani S, Maitan S, Stella F, Poletti V. Diagnostic yield and safety of transbronchial lung cryobiopsy for diffuse parenchymal lung diseases diagnosis: Comparison between 1.7-mm and 1.9-mm probes. Pulmonology 2023:S2531-0437(23)00081-8. [PMID: 37210342 DOI: 10.1016/j.pulmoe.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/22/2023] Open
Abstract
PURPOSE OF THE RESEARCH transbronchial lung cryobiopsy has been recently accepted as a valid and less invasive alternative to surgical lung biopsy. The purpose of this randomized controlled study was to evaluate, for the first time, the quality and safety of biopsy specimens obtained by using the new disposable 1.7-mm cryoprobe compared with the standard re-usable 1.9 mm cryoprobe in the diagnosis of diffuse parenchymal lung diseases. METHODS 60 consecutive patients were prospectively enrolled and randomly assigned to two different groups: 1.9 mm (group A) and 1.7 mm (group B); primary endpoints were pathological and multidisciplinary diagnostic yield, sample size and complication rate. PRINCIPAL RESULTS the pathological diagnostic yield of cryobiopsy was 100% in group A and 93.3% in group B (p = 0.718); cryobiopsy median diameter was 6.8 mm in group A and 6.7 mm in group B (p = 0,5241). Pneumothorax occurred in 9 patients in group A and 10 in group B (p = 0.951); mild-to-moderate bleeding in 7 cases and 9 cases in group A and B respectively (p = 0.559). No death or severe adverse events were observed. CONCLUSIONS there was no statistically significant difference between the two groups, regarding diagnostic yield, adverse events and sampling adequacy.
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Affiliation(s)
- C Ravaglia
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy.
| | - F Sultani
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - S Piciucchi
- Radiology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - A Dubini
- Pathology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - A J De Grauw
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - S Martinello
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - S Oldani
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - S Maitan
- Anesthesiology and Intensive Care Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - F Stella
- Alma Mater Studiorum University of Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Bologna, Italy; Thoracic Surgery Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy
| | - V Poletti
- Pulmonology Unit, G.B. Morgagni Hospital/University of Bologna, Forlì, Italy; Alma Mater Studiorum University of Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Bologna, Italy
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42
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Patel P, Anamika F, Ali R. Pulmonary Langerhans Cell Histiocytosis Masquerading as Lymphangioleiomyomatosis. Cureus 2023; 15:e38486. [PMID: 37273350 PMCID: PMC10237305 DOI: 10.7759/cureus.38486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Pulmonary Langerhans cell histiocytosis (PLCH) is an uncommon lung disease that affects young adults aged 20 to 40 years with current or prior history of smoking. The pathologic cell type in PLCH is a dendritic cell of the monocyte-macrophage line that resembles cutaneous Langerhans cells. This report presents the case of a 42-year-old woman with PLCH. We discuss her clinical symptoms, diagnostic tests, and treatment plan, with a specific focus on the radiologic features. The patient exhibited a radiologic appearance similar to that of lymphangiomyomatosis with histologic evidence of PLCH.
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Affiliation(s)
- Priya Patel
- Sleep Medicine, Hackensack Meridian Health Ocean University Medical Center, Brick Township, USA
| | - Fnu Anamika
- Internal Medicine, Hackensack Meridian Health Ocean University Medical Center, Brick Township, USA
| | - Rana Ali
- Pulmonary and Sleep Medicine, Hackensack Meridian Health Ocean University Medical Center, Brick Township, USA
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43
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Gupta N, McCarthy C. Recommendations for the diagnosis and management of LAM: Looking towards the future. Respir Med Res 2023; 83:101016. [PMID: 37087907 DOI: 10.1016/j.resmer.2023.101016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/25/2023]
Affiliation(s)
- Nishant Gupta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA; Medical Service, Veterans Affairs Medical Center, Cincinnati, OH, USA.
| | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
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Yamakawa H, Takemura T, Sato S, Takatsuka M, Ohta H, Nishizawa T, Oba T, Kawabe R, Akasaka K, Horikoshi M, Amano M, Kuwano K, Matsushima H. Can transbronchial lung cryobiopsy benefit adaptive treatment strategies in connective tissue disease-associated interstitial lung disease? BMC Pulm Med 2023; 23:126. [PMID: 37072760 PMCID: PMC10111663 DOI: 10.1186/s12890-023-02429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/11/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Some patients with connective tissue disease (CTD)-associated interstitial lung disease (ILD) progress to pulmonary fibrosis over their disease course despite initial improvement, potentially indicating a poor prognosis. Transbronchial lung cryobiopsy (TBLC) is a new bioptic approach used in diffuse parenchymal lung diseases. This study of CTD-ILD assessed the utility of TBLC in determining therapeutic decision-making strategies. METHODS We analyzed medical records of 31 consecutive CTD-ILD patients who underwent TBLC focusing on radio-pathological correlation and disease course. A TBLC-based usual interstitial pneumonia (UIP) score was used that assessed three morphologic descriptors: i) patchy fibrosis, ii) fibroblastic foci, and iii) honeycombing. RESULTS Among the patients with CTD-ILD, 3 had rheumatoid arthritis, 2 systemic sclerosis, 5 polymyositis/dermatomyositis, 8 anti-synthetase syndrome, 6 Sjögren's syndrome, and 5 had microscopic polyangiitis. Pulmonary function test results showed a mean %FVC of 82.4% and %DLCO of 67.7%. Among the 10 CTD patients and TBLC-proven pathological UIP, 3 patients had prominent inflammatory cells in addition to a framework of UIP, and pulmonary function of most patients improved with anti-inflammatory agents. Six (40%) of 15 patients with TBLC-based UIP score ≥ 1 had a progressive disease course during follow-up, of whom 4 patients received anti-fibrotic agents. CONCLUSIONS TBLC in patients with CTD-ILD can help determine an appropriate medication strategy, particularly when UIP-like lesions are present. TBLC may be useful when judging which agents to prioritize, anti-inflammatory or anti-fibrotic, is difficult. Moreover, additional information from TBLC may be beneficial when considering early intervention with anti-fibrotic agents in clinical practice.
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Affiliation(s)
- Hideaki Yamakawa
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan.
- Department of Respiratory Medicine, Tokyo Jikei University Hospital, Tokyo, Japan.
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Shintaro Sato
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - Makiko Takatsuka
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
- Department of Respiratory Medicine, Tokyo Jikei University Hospital, Tokyo, Japan
| | - Hiroki Ohta
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - Tomotaka Nishizawa
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - Tomohiro Oba
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - Rie Kawabe
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - Keiichi Akasaka
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | | | - Masako Amano
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
| | - Kazuyoshi Kuwano
- Department of Respiratory Medicine, Tokyo Jikei University Hospital, Tokyo, Japan
| | - Hidekazu Matsushima
- Department of Respiratory Medicine, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan
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Comes A, Sgalla G, Ielo S, Magrì T, Richeldi L. Challenges in the diagnosis of idiopathic pulmonary fibrosis: the importance of a multidisciplinary approach. Expert Rev Respir Med 2023; 17:1-11. [PMID: 37005289 DOI: 10.1080/17476348.2023.2199156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
INTRODUCTION The diagnosis of Idiopathic pulmonary fibrosis (IPF) requires the careful exclusion of secondary causes of interstitial lung disease (ILD), and the collaboration among different specialists is considered paramount to establish a diagnosis with high diagnostic confidence. The multidisciplinary discussion (MDD) has assumed an increasing importance over the years in the different phases of the IPF diagnostic work-up. AREAS COVERED The role of MDD in the diagnosis and management of IPF will be described. Practical insights will be provided into how and when to perform MDD based on the available scientific evidence. Current limitations and future perspectives will be discussed. EXPERT OPINION In the absence of high diagnostic confidence, agreement between different specialists during MDD is recognized as a surrogate indicator of diagnostic accuracy. Often, despite a lengthy evaluation, the diagnosis remains unclassifiable in a significant percentage of patients. MDD therefore appears to be pivotal in attaining an accurate diagnosis of ILDs. The discussion among different specialists can also include other specialists, such as rheumatologists and thoracic surgeons, in addition to the core group of pulmonologists, radiologists, and pathologists. Such discussions can allow greater diagnostic accuracy and have important effects on management, pharmacologic therapies, and prognosis.
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Affiliation(s)
- Alessia Comes
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giacomo Sgalla
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Simone Ielo
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Tonia Magrì
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - L Richeldi
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Roma, Italy
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
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Ruaro B, Tavano S, Confalonieri P, Pozzan R, Hughes M, Braga L, Volpe MC, Ligresti G, Andrisano AG, Lerda S, Geri P, Biolo M, Baratella E, Confalonieri M, Salton F. Transbronchial lung cryobiopsy and pulmonary fibrosis: A never-ending story? Heliyon 2023; 9:e14768. [PMID: 37025914 PMCID: PMC10070648 DOI: 10.1016/j.heliyon.2023.e14768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Background The diagnostic process of pulmonary fibrosis (PF) is often challenging, requires a collaborative effort of several experts, and often requires bioptic material, which can be difficult to obtain, both in terms of quality and technique. The main procedures available to obtain such samples are transbronchial lung cryobiopsy (TBLC) and surgical lung biopsy (SLB). Objective The purpose of this paper is to review the evidence for the role of TBLC in the diagnostic-therapeutic process of PF. Methods A comprehensive review was performed to identify articles to date that addressed the role of TBLC in the diagnostic-therapeutic process of PF using the PubMed® database. Results The reasoned search identified 206 papers, including 21 manuscripts (three reviews, one systematic review, two guidelines, two prospective studies, three retrospective studies, one cross-sectional study, one original article, three editorials, three clinical trials, and two unclassifiable studies), which were included in the final review. Conclusions TBLC is gaining increasing efficacy and improving safety profile; however, there are currently no clear data demonstrating its superiority over SLB. Therefore, the two techniques should be considered with careful rationalization on a case-by-case basis. Further research is needed to further optimize and standardize the procedure and to thoroughly study the histological and molecular characteristics of PF.
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Zayed Y, Alzghoul BN, Hyde R, Wadood Z, Banifadel M, Khasawneh M, Maharrey PB, Saker H, Harden C, Barnes G, Gomez-Manjarres D, Patel D, Faruqi I, Mehrad B, Mehta HJ. Role of Transbronchial Lung Cryobiopsy in the Diagnosis of Interstitial Lung Disease: A Meta-analysis of 68 Studies and 6300 Patients. J Bronchology Interv Pulmonol 2023; 30:99-113. [PMID: 35698283 PMCID: PMC10448786 DOI: 10.1097/lbr.0000000000000865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 04/06/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Diagnosis of interstitial lung disease (ILD) is based on multidisciplinary team discussion (MDD) with the incorporation of clinical, radiographical, and histopathologic information if available. We aim to evaluate the diagnostic yield and safety outcomes of transbronchial lung cryobiopsy (TBLC) in the diagnosis of ILD. METHODS We conducted a meta-analysis by comprehensive literature search to include all studies that evaluated the diagnostic yields and/or adverse events with TBLC in patients with ILD. We calculated the pooled event rates and their 95% confidence intervals (CIs) for the diagnostic yield by MDD, histopathologic diagnostic yield, and various clinical adverse events. RESULTS We included 68 articles (44 full texts and 24 abstracts) totaling 6386 patients with a mean age of 60.7±14.1 years and 56% men. The overall diagnostic yield of TBLC to achieve a definite or high-confidence diagnosis based on MDD was 82.3% (95% CI: 78.9%-85.2%) and histopathologic diagnosis of 72.5% (95% CI: 67.7%-76.9%). The overall rate of pneumothorax was 9.6% (95% CI: 7.9%-11%), while the rate of pneumothorax requiring drainage by a thoracostomy tube was 5.3% (95% CI: 4.1%-6.9%). The rate of moderate bleeding was 11.7% (95% CI: 9.1%-14.9%), while the rate of severe bleeding was 1.9% (95% CI: 1.4%-2.6%). The risk of mortality attributed to the procedure was 0.9% (95% CI: 0.7%-1.3%). CONCLUSION Among patients with undiagnosed or unclassified ILD requiring tissue biopsy for diagnosis, transbronchial cryobiopsy represents a reliable alternative to surgical lung biopsy with decreased incidence of various clinical adverse events.
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Affiliation(s)
- Yazan Zayed
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Bashar N. Alzghoul
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Ryan Hyde
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Zerka Wadood
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Momen Banifadel
- Division of Pulmonary and Critical Care, Case Western Reserve University, University Hospitals, Cleveland, Ohio, USA
| | - Majd Khasawneh
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - P. Brandon Maharrey
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Haneen Saker
- Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Christopher Harden
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Gabrielle Barnes
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Diana Gomez-Manjarres
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Divya Patel
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Ibrahim Faruqi
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Borna Mehrad
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Hiren J. Mehta
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, Florida, USA
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Dsouza KG, Surolia R, Kulkarni T, Li FJ, Singh P, Zeng H, Stephens C, Kumar A, Wang Z, Antony VB. Use of a pulmosphere model to evaluate drug antifibrotic responses in interstitial lung diseases. Respir Res 2023; 24:96. [PMID: 36978076 PMCID: PMC10045174 DOI: 10.1186/s12931-023-02404-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Interstitial lung diseases (ILD) encompass a heterogenous group of diffuse parenchymal lung disorders characterized by variable degrees of inflammation and fibrosis. Pretherapeutic clinical testing models for such diseases can serve as a platform to test and develop effective therapeutic strategies. In this study, we developed patient derived 3D organoid model to recapitulate the disease process of ILDs. We characterized the inherent property of invasiveness in this model and tested for antifibrotic responses with an aim to develop a potential platform for personalized medicine in ILDs. METHODS In this prospective study, 23 patients with ILD were recruited and underwent lung biopsy. 3D organoid-based models (pulmospheres) were developed from the lung biopsy tissues. Pulmonary functioning testing and other relevant clinical parameters were collected at the time of enrollment and follow up visits. The patient derived pulmospheres were compared to normal control pulmospheres obtained from 9 explant lung donor samples. These pulmospheres were characterized by their invasive capabilities and responsiveness to the antifibrotic drugs, pirfenidone and nintedanib. RESULTS Invasiveness of the pulmospheres was measured by the zone of invasiveness percentage (ZOI%). The ILD pulmospheres (n = 23) had a higher ZOI% as compared to control pulmospheres (n = 9) (516.2 ± 115.6 versus 54.63 ± 19.6 respectively. ILD pulmospheres were responsive to pirfenidone in 12 of the 23 patients (52%) and responsive to nintedanib in all 23 patients (100%). Pirfenidone was noted to be selectively responsive in patients with connective tissue disease related ILD (CTD-ILD) at low doses. There was no correlation between the basal pulmosphere invasiveness, response to antifibrotics, and FVC change (Δ FVC). CONCLUSIONS The 3D pulmosphere model demonstrates invasiveness which is unique to each individual subject and is greater in ILD pulmospheres as compared to controls. This property can be utilized to test responses to drugs such as antifibrotics. The 3D pulmosphere model could serve as a platform for the development of personalized approaches to therapeutics and drug development in ILDs and potentially other chronic lung diseases.
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Affiliation(s)
- Kevin G Dsouza
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Superfund Research Center at The University of Alabama at Birmingham, 901 19Th St S, BMR2, Rm 404, Birmingham, AL, 35294, USA
| | - Ranu Surolia
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Superfund Research Center at The University of Alabama at Birmingham, 901 19Th St S, BMR2, Rm 404, Birmingham, AL, 35294, USA
| | - Tejaswini Kulkarni
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Superfund Research Center at The University of Alabama at Birmingham, 901 19Th St S, BMR2, Rm 404, Birmingham, AL, 35294, USA
| | - Fu Jun Li
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Superfund Research Center at The University of Alabama at Birmingham, 901 19Th St S, BMR2, Rm 404, Birmingham, AL, 35294, USA
| | - Pooja Singh
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Superfund Research Center at The University of Alabama at Birmingham, 901 19Th St S, BMR2, Rm 404, Birmingham, AL, 35294, USA
| | - Huaxiu Zeng
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Superfund Research Center at The University of Alabama at Birmingham, 901 19Th St S, BMR2, Rm 404, Birmingham, AL, 35294, USA
| | - Crystal Stephens
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Superfund Research Center at The University of Alabama at Birmingham, 901 19Th St S, BMR2, Rm 404, Birmingham, AL, 35294, USA
| | | | - Zheng Wang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Veena B Antony
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Superfund Research Center at The University of Alabama at Birmingham, 901 19Th St S, BMR2, Rm 404, Birmingham, AL, 35294, USA.
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49
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Ishii S, Morishita M, Matsuki R, Izumi S, Hojo M, Sugiyama H. Diagnosis of diffuse panbronchiolitis by transbronchial lung cryobiopsy. Heliyon 2023; 9:e15127. [PMID: 37089367 PMCID: PMC10119591 DOI: 10.1016/j.heliyon.2023.e15127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
A 70-year-old man began to cough. Chest X-ray showed a tumor in the center, pleural effusion on the left side, and diffuse granular shadows on the right side. Chest computed tomography (CT) showed bronchial wall thickening and numerous granular shadows. We suspected diffuse panbronchiolitis. Thus, transbronchial lung biopsy (TBLB) and transbronchial lung cryobiopsy (TBLC) were performed. The tissue size obtained was 1 mm by TBLB and 6 mm at 5 seconds by TBLC. Histological analysis of the TBLB specimen showed lymphocyte infiltration, no fibrosis in Hematoxylin-eosin (HE) staining, and no elastic fibers in Elastica van Gieson (EVG) staining. On the other hand, TBLC specimens showed inflammatory cell infiltration and fibrosis around the bronchioles in HE staining and hypertrophy of elastic fibers in EVG staining. It was diagnosed as diffuse panbronchiolitis (DPB) from clinical and pathological findings. Cryobiopsy is useful in diagnosing DPB as well as interstitial pneumonia and lung cancer.
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50
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Transbronchial needle aspiration combined with cryobiopsy in the diagnosis of mediastinal diseases: a multicentre, open-label, randomised trial. THE LANCET. RESPIRATORY MEDICINE 2023; 11:256-264. [PMID: 36279880 DOI: 10.1016/s2213-2600(22)00392-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Transbronchial mediastinal cryobiopsy is a novel sampling technique for mediastinal disease. Despite the possibility of lung cancer misdiagnosis, the improved diagnostic yield of this approach for non-lung-cancer lesions compared with standard endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) highlights its diagnostic potential as a complementary technique to conventional biopsy. We aimed to evaluate the safety profile and added value of the combined use of transbronchial mediastinal cryobiopsy and standard EBUS-TBNA for the diagnosis of mediastinal diseases. METHODS We conducted an open-label, randomised trial at three hospital sites in Europe and Asia. Eligible patients were aged 15 years or older, with at least one mediastinal lesion of 1 cm or longer in the short axis that required diagnostic bronchoscopy. Participants were randomly assigned (1:1) using a block randomisation scheme generated by a computer (block size of four participants based on a random table from an independent statistician) to the combined use of EBUS-TBNA and transbronchial mediastinal cryobiopsy (combined group) or EBUS-TBNA alone (control group). Because of the nature of the intervention, neither participants nor investigators were masked to group assignment. The coprimary outcomes were differences in procedure-related complications and diagnostic yield (defined as the proportion of participants for whom mediastinal biopsy led to a definitive diagnosis), assessed in the full analysis set, including all the patients who met the eligibility criteria and had a biopsy. A fully paired, intraindividual diagnostic analysis in participants who had both needle aspiration and mediastinal cryobiopsy was conducted, in addition to interindividual comparisons. This trial is now complete and is registered with ClinicalTrials.gov, NCT04572984. FINDINGS Between Oct 12, 2020, and Sept 9, 2021, 297 consecutive patients were assessed for eligibility and 271 were enrolled and randomly assigned to the combined group (n=136) or the control group (n=135). The addition of cryobiopsy to standard sampling significantly increased the overall diagnostic yield for mediastinal lesions, as shown by both interindividual (126 [93%] of 136 participants in the combined group vs 109 [81%] of 135 in the control group; risk ratio [RR] 1·15 [95% CI 1·04-1·26]; p=0·0039) and intraindividual (126 [94%] of 134 vs 110 [82%] of 134; RR 1·15 [95% CI 1·05-1·25]; p=0·0026) analyses. In subgroup analyses in the intraindividual population, diagnostic yields were similar for mediastinal metastasis (68 [99%] of 69 participants in the combined group vs 68 [99%] of 69 in the control group; RR 1·00 [95% CI 0·96-1·04]; p=1·00), whereas the combined approach was more sensitive than standard needle aspiration in benign disorders (45 [94%] of 48 vs 32 [67%] of 48; RR 1·41 [95% CI 1·14-1·74]; p=0·0009). The combined approach also resulted in an improved suitability of tissue samples for molecular and immunological analyses of non-small-cell lung cancer. The incidence of adverse events related to the biopsy procedure did not differ between trial groups, as grade 3-4 airway bleeding occurred in three (2%) patients in the combined group and two (1%) in the control group (RR 0·67 [95% CI 0·11-3·96]; p=1·00). There were no severe complications causing death or disability. INTERPRETATION The addition of mediastinal cryobiopsy to standard EBUS-TBNA resulted in a significant improvement in diagnostic yield for mediastinal lesions, with a good safety profile. These data suggest that this combined approach is a valid first-line diagnostic tool for mediastinal diseases. FUNDING National Natural Science Foundation of China.
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