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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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [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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Zuo C, Xue K, Yang H, Huang R, Yong Z, Zhang M, Lin Y, Tian X, Gu Y, Ke M. Clinical Application of Confocal Laser Endomircoscopy Combined with Cryobiopsy in the Diagnosis of Interstitial Lung Disease. Respiration 2023; 102:891-898. [PMID: 37757757 DOI: 10.1159/000533868] [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: 02/05/2023] [Accepted: 08/15/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Confocal laser endomicroscopy (CLE) has the characteristics of high resolution, real-time imaging, and no radiation, which is helpful for the precise and effective implementation of transbronchial cryobiopsy (TBCB). The study aimed to compare the efficacy and safety of TBCB combined with CLE (CLE group) or fluoroscopy (fluoroscopy group) in the diagnosis of interstitial lung disease (ILD). METHODS From a prospective randomized controlled trial, 80 patients with undiagnosed ILD or ILD requiring biopsy between January 2022 and November 2022 were randomly assigned to CLE group and fluoroscopy group. The rate to reach an etiological diagnosis of ILD, maximum cross-sectional area of specimens, operation time, and complications were compared between the two groups. RESULTS The rate to reach an etiological diagnosis in the CLE group was significantly higher than that in the fluoroscopy group (95.0% vs. 80.0%, p < 0.05), but there was no difference in the maximum cross-sectional area of the specimens (42.1 ± 10.1 mm2 vs. 41.5 ± 10.3 mm2, p > 0.05). In terms of operation time, the CLE group was significantly shorter than the fluoroscopy group (37.6 ± 10.6 min vs. 54.8 ± 24.9 min, p < 0.05). The bleeding volume in the CLE group was significantly lower than that in the fluoroscopy group (4.9 ± 3.6 mL/case vs. 9.0 ± 9.2 mL/case, p < 0.05). Further analysis showed that the incidence of moderate bleeding was also lower in the CLE group (20.0% vs. 75.0%, p < 0.001). In addition, the incidence of pneumothorax in the CLE group was significantly lower than that in the fluoroscopy group (0 vs. 25.0%, p < 0.001). CONCLUSIONS Compared with simple fluoroscopy, the combination of CLE significantly improves the rate of etiological diagnosis, shortens the operation time, and reduces complications such as bleeding and pneumothorax.
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Affiliation(s)
- Cuiyun Zuo
- Respiratory Center of the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Keying Xue
- Respiratory Center of the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Hui Yang
- Respiratory Center of the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Rui Huang
- Respiratory Center of the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Zhiya Yong
- Respiratory Center of the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Meihua Zhang
- Respiratory Center of the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Yanli Lin
- Department of Pathology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Xiaoqin Tian
- Department of Pathology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Yingying Gu
- Respiratory Pathology Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mingyao Ke
- Respiratory Center of the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
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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: 0] [Impact Index Per Article: 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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Motokura Y, Ito A, Yokoe S, Iri O, Nishimura K, Kamiyama S, Ishida T. Pulmonary Cryptococcosis Diagnosed by a Transbronchial Lung Cryobiopsy in a Patient with Rheumatoid Arthritis. Intern Med 2023; 62:583-587. [PMID: 35908974 PMCID: PMC10017238 DOI: 10.2169/internalmedicine.9764-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
A 77-year-old woman with seronegative rheumatoid arthritis who was being treated with prednisolone (8 mg/day) and methotrexate (12 mg/week) visited our hospital with an 11-day history of a fever and dyspnea. Chest computed tomography showed infiltration in the right lower lobe. A transbronchial lung cryobiopsy (TBLC) showed cryptococcal cells, and bronchoalveolar lavage fluid later showed growth of Cryptococcus neoformans. She was treated with amphotericin B and flucytosine for about four weeks, and the pulmonary shadows improved. The treatment was then changed to fluconazole as outpatient consolidation and maintenance therapy. A rare case of pulmonary cryptococcosis diagnosed by a TBLC is reported.
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Affiliation(s)
- Yumi Motokura
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
| | - Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
| | - Shinya Yokoe
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
| | - Osamu Iri
- Department of Endocrinology and Rheumatology, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
| | - Keisuke Nishimura
- Department of Endocrinology and Rheumatology, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Japan
| | - Shinya Kamiyama
- Department of Laboratory Medicine and Infectious Diseases, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
- Department of General Medicine and Infection Diseases, Tsuyama Chuo Hospital, Japan
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Japan
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Giri M, Huang G, Puri A, Zhuang R, Li Y, Guo S. Efficacy and Safety of Cryobiopsy vs. Forceps Biopsy for Interstitial Lung Diseases, Lung Tumors, and Peripheral Pulmonary Lesions: An Updated Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:840702. [PMID: 35372452 PMCID: PMC8965605 DOI: 10.3389/fmed.2022.840702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background Cryobiopsy has emerged as a novel alternative to conventional forceps biopsy for the diagnosis of interstitial lung diseases (ILDs), lung tumors, and peripheral pulmonary lesions (PPLs). This study aims to compare cryobiopsy and forceps biopsy for the diagnosis of these lung pathologies with respect to efficacy and safety by performing a meta-analysis of updated evidence. Methods A number of databases, such as PubMed, Embase, Web of Science, the Cochrane Library, OVID, CNKI, and Wanfang database, were searched for eligible studies. Randomized and non-randomized comparative studies investigating the efficacy and safety of cryobiopsy vs. forceps biopsy for lung pathologies were included. Pooled results were calculated as an odds ratio (OR) or standardized mean difference (SMD) with 95% CI. Results A total of 39 studies, such as 9 RCTs with 3,586 biopsies (1,759 cryobiopsies and 1,827 flexible forceps biopsies) were analyzed. Cryobiopsy was associated with a significant increase in the diagnostic rates of ILDs (OR, 4.29; 95% CI, 1.85–9.93; p < 0.01), lung tumors (OR, 3.58; 95% CI, 2.60–4.93; p < 0.01), and PPLs (OR, 1.70; 95% CI, 1.23–2.34; p < 0.01). Cryobiopsy yielded significantly larger specimens compared with flexible forceps biopsy (SMD, 3.06; 95% CI, 2.37–3.74; p < 0.01). The cryobiopsy group had a significantly higher (moderate to severe) bleeding risk than the forceps group (OR, 2.17; 95% CI, 1.48–3.19; p < 0.01). No significant difference was observed in the incidence of pneumothorax between the groups (OR, 0.90; 95% CI, 0.44–1.85; p = 0.78). Conclusion Our results demonstrate that cryobiopsy is a safe and efficacious alternative to conventional forceps biopsy.
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Affiliation(s)
- Mohan Giri
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guichuan Huang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Zunyi, China
| | - Anju Puri
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rongjuan Zhuang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yishi Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuliang Guo
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Shuliang Guo
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Castellani C, Castellani H, Benn BS. Transbronchial Lung Cryobiopsy is Safe and Effective for Diagnosing Acutely Ill Hospitalized Patients with New Diffuse Parenchymal Lung Disease. Lung 2022; 200:153-159. [PMID: 35103841 PMCID: PMC8805131 DOI: 10.1007/s00408-022-00513-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/08/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Transbronchial lung cryobiopsy (TBLC) is an accepted alternative to surgical lung biopsy (SLB) for diagnosing diffuse parenchymal lung disease (DPLD) that is less invasive and results in comparable diagnostic yields. Performing lung biopsies on hospitalized patients, however, has increased risk due to the patient's underlying disease severity. Data evaluating the safety and efficacy of TBLC in hospitalized patients are limited. We present a comparison of TBLC for hospitalized and outpatients and provide the safety and diagnostic yields in these populations. METHODS Demographic data, pulmonary function values, chest imaging pattern, procedural information, and diagnosis were recorded from enrolled patients. Complications from the procedure were the primary outcomes and diagnostic yield was the secondary outcome. RESULTS 77 patients (n = 22 hospitalized vs n = 55 outpatient) underwent TBLC during the study period. Comparing adverse events between hospitalized and outpatients revealed no statistically significant differences in pneumothorax (9%, n = 2 vs 5%,n = 3), tube thoracostomy placement (5%, n = 1 vs 2%, n = 1), grade 2 bleeding (9%, n = 2 vs 0%, n = 0), escalation in level of care (5%, n = 1 vs 0%, n = 0), 30-day mortality (9%, n = 2 vs 2%, n = 1), and 60-day mortality (9%, n = 2 vs 4%, n = 2) (p > 0.05 for all). No deaths were attributed to the procedure. 95% of cases received a multidisciplinary conference diagnosis (hospitalized 100%, n = 22 vs outpatients 93%, n = 51, p = 0.32). CONCLUSION Our experience supports that TBLC may be a safe and effective modality for acutely ill-hospitalized patients with DPLD. Further efforts to enhance procedural safety and to determine the impact of an expedited tissue diagnosis on patient outcomes are needed.
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Affiliation(s)
- 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, 8701 W Watertown Plank, Milwaukee, WI, 53226, USA.
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Luo L, Li YX. Pulmonary Langerhans cell histiocytosis and multiple system involvement: A case report. World J Clin Cases 2021; 9:11029-11035. [PMID: 35047614 PMCID: PMC8678860 DOI: 10.12998/wjcc.v9.i35.11029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/18/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary Langerhans cell histiocytosis (PLCH) is a relatively rare type of lung disease, common in middle-aged smoking men. It is characterized by proliferation and infiltration of Langerhans cells, and the formation of multiple parabronchial mesenchymal nodules in lung tissue, and may lead to organ dysfunction. There are no typical symptoms and signs, and it is easily misdiagnosed or missed, and therefore deserves clinical attention and further discussion.
CASE SUMMARY We describe the case of a nonsmoking 46-year-old man with PLCH diagnosed based on clinical manifestations of fever and dry cough, with a history of hypothyroidism and diabetes insipidus for 9 years. Computed tomography (CT)- and CT-guided puncture examinations revealed no abnormalities, and he ultimately underwent thoracoscopic biopsy to confirm the diagnosis. The pathological diagnosis was PLCH. Thyroid function was maintained by medication. Pituitary magnetic resonance imaging showed that the pituitary stalk had become thinner.
CONCLUSION LCH often involves multiple systems. Moreover, the pathogenesis is not clear, clinical manifestations lack specificity, and diagnosis requires special attention. Diagnosis of PLCH can significantly benefit from comprehensive multidisciplinary analysis.
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Affiliation(s)
- Lin Luo
- Department of Critical Care Medicine, The Second Hospital of Dalian Medical University, Dalian 116023, Liaoning Province, China
| | - Yan-Xia Li
- Department of Respiratory and Critical Care Medicine, Institute of Respiratory Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
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Tomassetti S, Colby TV, Wells AU, Poletti V, Costabel U, Matucci-Cerinic M. Bronchoalveolar lavage and lung biopsy in connective tissue diseases, to do or not to do? Ther Adv Musculoskelet Dis 2021; 13:1759720X211059605. [PMID: 34900002 PMCID: PMC8664307 DOI: 10.1177/1759720x211059605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/26/2021] [Indexed: 12/25/2022] Open
Abstract
Bronchoalveolar lavage and lung biopsy (LBx) are helpful in patients with connective tissue diseases (CTD) and interstitial lung diseases (ILD) regardless of cause, including infectious, noninfectious, immunologic, or malignant. The decision whether to perform only bronchoalveolar lavage (BAL), and eventually a subsequent LBx in case of a nondiagnostic lavage, or one single bronchoscopy combining both sampling methods depends on the clinical suspicion, on patient’s characteristics (e.g. increased biopsy risk) and preferences, and on the resources and biopsy techniques available locally (e.g. regular forceps versus cryobiopsy). In CTD-ILD, BAL has major clinical utility in excluding infections and in the diagnosis of specific patterns of acute lung damage (e.g. alveolar hemorrhage, diffuse alveolar damage, and organizing pneumonia). LBx is indicated to exclude neoplasm or diagnose lymphoproliferative lung disorders that in CTD patients are more common than in the general population. Defining BAL cellularity and characterizing the CTD-ILD histopathologic pattern by LBx can be helpful in the differential diagnosis of cases without established CTD [e.g. ILD preceding full-blown CTD, interstitial pneumonia with autoimmune features (IPAF)], but the prognostic and theragnostic role of those findings remains unclear. Few studies in the pretranscriptomics era have investigated the diagnostic and prognostic role of BAL and LBx in CTD-ILD, and it is reasonable to hypothesize that future studies conducted applying innovative techniques on BAL and LBx might open new and unexpected avenues in pathogenesis, diagnosis, and treatment approach to CTD-ILD. This is particularly desirable now that a new drug treatment era is emerging, in which we have more than one therapeutic choice (immunosuppressive agents, antifibrotic drugs, and biological agents). We hope that future research will pave the path toward precision medicine providing data for a more accurate ILD-CTD endotyping that will guide the physicians through targeted therapeutic choices, rather than to the approximative approach ‘one drug fits them all’.
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Affiliation(s)
- Sara Tomassetti
- Department of Experimental and Clinical Medicine, Careggi University Hospital and University of Florence, 50121 Florence, Italy
| | - Thomas V Colby
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | - Athol U Wells
- ILD Unit, Pulmonary Medicine, Royal Brompton Hospital, London, UK
| | - Venerino Poletti
- Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, ItalyUnit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
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Babu PS S, Marwah V, Katoch CDS, Garg Y, Kumar TA, Sharma M, Choudhary R, Peter DK, Chopra M, Bhati G. Diagnostic Yield and Safety of Bronchoscopic Lung Cryobiopsy in Evaluation of Lung Mass. Cureus 2021; 13:e19940. [PMID: 34984115 PMCID: PMC8714048 DOI: 10.7759/cureus.19940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2021] [Indexed: 12/25/2022] Open
Abstract
Background A mass lesion in the lung is a common finding seen on chest radiology. The prognosis of patients with mass lesions in the lung is capricious as malignancy is a consideration. It is essential to diagnose the underlying aetiology at the earliest with minimally invasive procedures for prompt treatment of the case. Bronchoscopic lung cryobiopsy (BLC) is a newer interventional technique in pulmonary medicine for the diagnosis of mass lesions in the lung. Materials and methods This is a retrospective study of patients reporting to a tertiary care centre who were radiologically (by computed tomography scan of the chest) diagnosed with a mass lesion of the lung and who underwent BLC during the period from January 2018 to January 2021. We analysed the diagnostic yield of the technique defined as a positive tissue diagnosis after the histopathological examination (HPE) along with the safety of the procedure. Results During the above period, we evaluated 70 patients who were diagnosed radiologically with mass lesions of the lung and underwent BLC. We obtained tissue diagnoses for 66 cases and the result of four cases was inconclusive. The diagnostic yield of the BLC procedure was 94.29%. There was no mortality and complications were minimal bleeding and small pneumothorax. Conclusion BLC is a newer technique for obtaining lung tissue via a flexible bronchoscope obviating the need for open lung biopsy. The main advantage of the technique is providing larger tissue samples with minimal or no side effects without undergoing multiple procedures as compared to other bronchoscopic or surgical methods for obtaining a diagnosis from lung tissue. BLC is a safer and promising technique in diagnosing mass lesions of the lung with better yield.
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Scala R, Guidelli L. Clinical Value of Bronchoscopy in Acute Respiratory Failure. Diagnostics (Basel) 2021; 11:diagnostics11101755. [PMID: 34679452 PMCID: PMC8534926 DOI: 10.3390/diagnostics11101755] [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: 09/06/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
Bronchoscopy may be considered the “added value” in the diagnostic and therapeutic pathway of different clinical scenarios occurring in acute respiratory critically ill patients. Rigid bronchoscopy is mainly employed in emergent clinical situations due to central airways obstruction, haemoptysis, and inhaled foreign body. Flexible bronchoscopy (FBO) has larger fields of acute applications. In intensive care settings, FBO is useful to facilitate intubation in difficult airways, guide percutaneous dilatational tracheostomy, and mucous plugs causing lobar/lung atelectasis. FBO plays a central diagnostic role in acute respiratory failure caused by intra-thoracic tumors, interstitial lung diseases, and suspected severe pneumonia. “Bronchoscopic” sampling has to be considered when “non-invasive” techniques are not diagnostic in suspected ventilator-associated pneumonia and in non-ventilated immunosuppressed patients. The combined use of either noninvasive ventilation (NIV) or High-flow nasal cannula (HFNC) with bronchoscopy is useful in different scenarios; the largest body of proven successful evidence has been found for NIV-supported diagnostic FBO in non-ventilated high risk patients to prevent and avoid intubation. The expected diagnostic/therapeutic goals of acute bronchoscopy should be balanced against the potential severe risks (i.e., cardio-pulmonary complications, bleeding, and pneumothorax). Expertise of the team is fundamental to achieve the best rate of success with the lowest rate of complications of diagnostic and therapeutic bronchoscopic procedures in acute clinical circumstances.
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Bondue B, Schlossmacher P, Allou N, Gazaille V, Taton O, Gevenois PA, Vandergheynst F, Remmelink M, Leduc D. Trans-bronchial lung cryobiopsy in patients at high-risk of complications. BMC Pulm Med 2021; 21:135. [PMID: 33902504 PMCID: PMC8074461 DOI: 10.1186/s12890-021-01503-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 04/16/2021] [Indexed: 12/23/2022] Open
Abstract
Background The surgical lung biopsy (SLB) is the recommended sampling technique when the pathological analysis of the lung is required in the work-up of an interstitial lung disease (ILD) but trans-bronchial lung cryobiopsy (TBLC) is increasingly recognized as an alternative approach. As TBLCs have lower mortality and morbidity risks than SLB, this study aimed to investigate the safety of TBLCs in patients at higher risk of complications and for whom SLB was not considered as an alternative. Method This prospective study was conducted in two hospitals in which TBLCs were performed in patients with body mass index (BMI) > 35, and/or older than 75 years, and/or with severely impaired lung function (FVC < 50% or DLCO < 30%), and/or systolic pulmonary artery pressure > 45 mmHg, and/or a clinically significant cardiac disease. Patients with any of these risk factors constituted the high-risk group. Clinical outcomes were compared with those obtained in patients without these risk factors (low-risk group). Results Ninety-six patients were included between April 2015 and April 2020, respectively 38 and 58 in the high-risk or the low-risk group. No statistically significant difference was observed between both groups in terms of severity and rate of bleeding, pneumothorax, or duration of hospital stay (p value ranging from 0.419 to 0.914). Conclusion This preliminary study on a limited number of patients suggests that TBLC appears safe in those in whom lung biopsy is at high-risk of complications according to their age, BMI, lung impairment, and cardiac comorbidities. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01503-9.
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Affiliation(s)
- Benjamin Bondue
- Department of Pneumology, Hôpital Erasme, Université libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium.
| | - Pascal Schlossmacher
- Department of Pneumology, University Hospital of La Reunion, Saint Denis, France
| | - Nathalie Allou
- Department of Pneumology, University Hospital of La Reunion, Saint Denis, France
| | - Virgile Gazaille
- Department of Pneumology, University Hospital of La Reunion, Saint Denis, France
| | - Olivier Taton
- Department of Pneumology, Hôpital Erasme, Université libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium
| | - Pierre Alain Gevenois
- Department of Radiology, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Frederic Vandergheynst
- Department of Internal Medicine, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Myriam Remmelink
- Department of Pathology, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Dimitri Leduc
- Department of Pneumology, Hôpital Erasme, Université libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium
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12
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Turan D, Uğur Chousein EG, Koç AS, Çörtük M, Yıldırım Z, Demirkol B, Özgül MA, Çınarka H, Akalın N, Yardımcı AH, Çetinkaya E. Transbronchial cryobiopsy for diagnosing parenchymal lung diseases: real-life experience from a tertiary referral center. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2021; 38:e2021004. [PMID: 33867791 PMCID: PMC8050620 DOI: 10.36141/svdld.v38i1.11029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/23/2021] [Indexed: 11/21/2022]
Abstract
Background and Objectives: Transbronchial cryobiopsy (cryo-TBB) is increasingly being used in the diagnosis of diffuse parenchymal lung diseases (DPLD). Varying diagnostic success and complication rates have been reported. Herein we report our experience with cryo-TBB, focusing on diagnostic yield, factors affecting diagnosis, and safety. Methods: This retrospective study was conducted in a tertiary referral chest diseases hospital. Data regarding the patients, procedures, complication rates, diagnostic yield, and the final diagnosis made by a multidisciplinary committee at all diagnosis stages were evaluated. Results: We recruited 147 patients with suspected DPLD. The definitive diagnosis was made pathologically in 98 of 147 patients (66.6%) and using a multidisciplinary approach in 109 of 147 (74.1%) cases. The number of samples had a significant effect on diagnostic success. Histopathologic diagnostic yield and diagnostic yield with a multidisciplinary committee after a single biopsy were 50%, and histopathological diagnostic yield and diagnostic yield with multidisciplinary committee increased to 71.4% and 85.7%, respectively, with a second biopsy (p = 0.034). The incidence of mild-to-moderate hemorrhage was 31.9%; no severe hemorrhage occurred. Pneumothorax rate was 15.6%, and the mortality rate was 0.68%. Conclusions: Cryo-TBB has sufficient diagnostic yield in the context of a multidisciplinary diagnosis with acceptable complication rates. Performing at least 2 biopsies and from at least 2 segments increases diagnostic success.
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Affiliation(s)
- Demet Turan
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Efsun Gonca Uğur Chousein
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Aysu Sinem Koç
- Ministry of Health, Dr. Yaşar Eryilmaz Dogubayazit State Hospital, Clinic of Chest Diseases, Agri, Turkey
| | - Mustafa Çörtük
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Zeynep Yıldırım
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Bariş Demirkol
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Mehmet Akif Özgül
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Halit Çınarka
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Neslihan Akalın
- University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Department of Pathology, Istanbul, Turkey
| | - Aytül Hande Yardımcı
- University of Health Sciences Turkey, Basaksehir Cam and Sakura City Hospital, Department of Radiology, Istanbul, Turkey
| | - Erdoğan Çetinkaya
- University of Health Sciences Turkey, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
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13
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Davidsen JR, Skov IR, Louw IG, Laursen CB. Implementation of transbronchial lung cryobiopsy in a tertiary referral center for interstitial lung diseases: a cohort study on diagnostic yield, complications, and learning curves. BMC Pulm Med 2021; 21:67. [PMID: 33632180 PMCID: PMC7908747 DOI: 10.1186/s12890-021-01438-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/12/2021] [Indexed: 02/07/2023] Open
Abstract
Background Transbronchial lung cryobiopsy (TBLC) has been introduced as an alternative to surgical lung biopsy (SLB) in the diagnostics of interstitial lung diseases (ILD). Despite controversy on safety, TBLC is increasingly implemented in ILD centers with an apparent diagnostic yield comparable to SLB. The aim of this study was to assess TBLC implementation experiences from a tertiary Danish ILD center regarding diagnosis, complications, and learning curves for TBLC performance. Methods TBLC was prospectively performed in a cohort of patients with unclassifiable ILD based on a preceding multidisciplinary clinical and radiological revision. TBLC was performed as an outpatient procedure with the patients in general anesthesia using a flexible bronchoscope with 1.9 or 2.4 mm cryoprobes. Learning curves for TBLC performance were calculated using cumulated sum (CUSUM) scores for diagnostic yield, pneumothorax, and bleeding. Results From February 2017 to March 2020 141 patients (86 (61%) men, median age 69 years [IQR, 60–74 years]) had TBLC performed. A histological and confirmative diagnosis was made in 101 patients (75.2%) and 124 patients (87.9%, i.e. clinical diagnostic yield), respectively, in whom idiopathic interstitial pneumonias constituted the majority (67.3%) of the clinical diagnoses. We observed 2 deaths (1.4%) within 30 days of TBLC, but no procedure-related mortality or severe bleeding. Moderate bleeding occurred in 23 patients (16.3%), pneumothorax in 21 patients (14.9%) with only 14 patients (9.9%) requiring a pleural drain. Based on the CUSUM score analysis, the diagnostic yield obtained was satisfactory throughout the period. Conclusion This study reports experiences of outpatient TBLC implementation in a tertiary referral ILD center from the largest investigated TBLC cohort in Scandinavia The diagnostic yield and prevalence of complications obtained by TBLC from this single center study on unclassifiable ILD support outpatient TBLC as a valuable and safe alternative to SLB to diagnose ILD in well-selected patients. The learning curves for TBLC were acceptable in the hands of experienced bronchoscopists.
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Affiliation(s)
- Jesper Rømhild Davidsen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark. .,Department of Respiratory Medicine, South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Kloevervaenget 2, 5000, Odense C, Denmark. .,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Inge Raadal Skov
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ida Guldbæk Louw
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Department of Respiratory Medicine, South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Kloevervaenget 2, 5000, Odense C, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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14
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Behr J, Günther A, Bonella F, Dinkel J, Fink L, Geiser T, Geissler K, Gläser S, Handzhiev S, Jonigk D, Koschel D, Kreuter M, Leuschner G, Markart P, Prasse A, Schönfeld N, Schupp JC, Sitter H, Müller-Quernheim J, Costabel U. S2K Guideline for Diagnosis of Idiopathic Pulmonary Fibrosis. Respiration 2021; 100:238-271. [PMID: 33486500 DOI: 10.1159/000512315] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 11/19/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a severe and often fatal disease. Diagnosis of IPF requires considerable expertise and experience. Since the publication of the international IPF guideline in the year 2011 and the update 2018 several studies and technical advances have occurred, which made a new assessment of the diagnostic process mandatory. The goal of this guideline is to foster early, confident, and effective diagnosis of IPF. The guideline focusses on the typical clinical context of an IPF patient and provides tools to exclude known causes of interstitial lung disease including standardized questionnaires, serologic testing, and cellular analysis of bronchoalveolar lavage. High-resolution computed tomography remains crucial in the diagnostic workup. If it is necessary to obtain specimens for histology, transbronchial lung cryobiopsy is the primary approach, while surgical lung biopsy is reserved for patients who are fit for it and in whom a bronchoscopic diagnosis did not provide the information needed. After all, IPF is a diagnosis of exclusion and multidisciplinary discussion remains the golden standard of diagnosis.
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Affiliation(s)
- Jürgen Behr
- Department of Internal Medicine V, Ludwig-Maximilians-University (LMU) of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Munich, Germany,
| | - Andreas Günther
- Section of Fibrotic Lung Diseases, University Hospital Giessen and Marburg, Giessen Campus, Justus Liebig University Giessen, Agaplesion Pneumological Clinic Waldhof-Elgershausen, University of Giessen Marburg Lung Center, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Giessen, Germany
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik - University Hospital, University Duisburg-Essen, Essen, Germany
| | - Julien Dinkel
- Department of Radiology, University Hospital, LMU, and Asklepios Specialty Hospitals Munich Gauting, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Munich, Germany
| | - Ludger Fink
- Institute of Pathology and Cytology, Supraregional Joint Practice for Pathology (Überregionale Gemeinschaftspraxis für Pathologie, ÜGP), Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Wetzlar, Germany
| | - Thomas Geiser
- Clinic of Pneumology of the University Hospital of Bern, Bern, Switzerland
| | - Klaus Geissler
- Pulmonary Fibrosis (IPF) Patient Advocacy Group, Essen, Germany
| | - Sven Gläser
- Vivantes Neukölln and Spandau Hospitals Berlin, Department of Internal Medicine - Pneumology and Infectiology as well as Greifswald Medical School, University of Greifswald, Greifswald, Germany
| | - Sabin Handzhiev
- Clinical Department of Pneumology, University Hospital Krems, Krems, Austria
| | - Danny Jonigk
- Institute of Pathology, Hanover Medical School, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hanover, Germany
| | - Dirk Koschel
- Department of Internal Medicine/Pneumology, Coswig Specialist Hospital, Center for Pneumology, Allergology, Respiratory Medicine, Thoracic Surgery and Medical Clinic 1, Pneumology Department, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Medicine, Thorax Clinic, University Hospital Heidelberg, Member of German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Heidelberg, Germany
| | - Gabriela Leuschner
- Department of Internal Medicine V, Ludwig-Maximilians-University (LMU) of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Munich, Germany
| | - Philipp Markart
- Section of Fibrotic Lung Diseases, University Hospital Giessen and Marburg, Giessen Campus, Justus Liebig University Giessen, University of Giessen Marburg Lung Center, as well as the Fulda Campus of the Medical University of Marburg, Med. Clinic V, Member of German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Giessen, Germany
| | - Antje Prasse
- Department of Pneumology, Hanover Medical School and Clinical Research Center Fraunhofer Institute ITEM, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hanover, Germany
| | - Nicolas Schönfeld
- Pneumology Clinic, Part of the Heckeshorn Lung Clinic, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Jonas Christian Schupp
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Helmut Sitter
- Institute for Surgical Research, Philipps-University Marburg, Marburg, Germany
| | - Joachim Müller-Quernheim
- Department of Pneumology, Medical Center - University of Freiburg, Faculty of Medicine - University of Freiburg, Freiburg, Germany
| | - Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik - University Hospital, University Duisburg-Essen, Essen, Germany
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15
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O'Mahony AM, Burke L, Cavazza A, Maher MM, Kennedy MP, Henry MT. Transbronchial lung cryobiopsy (TBLC) in the diagnosis of interstitial lung disease: experience of first 100 cases performed under conscious sedation with flexible bronchoscope. Ir J Med Sci 2021; 190:1509-1517. [PMID: 33471301 DOI: 10.1007/s11845-020-02453-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diagnosing the aetiology of interstitial lung disease (ILD) may require histology via a surgical lung biopsy (SLB). SLB is associated with significant complications. Transbronchial lung cryobiopsy (TBLC) can provide large, adequate biopsies with fewer complications offering a potential alternative to SLB. AIMS This study evaluated the safety, diagnostic yield and impact of TBLC on diagnostic certainty in the multidisciplinary diagnosis (MDD) of ILD within routine clinical practice. METHODS A retrospective study of all TBLC performed in a tertiary institute from March 2014 to December 2016 was performed. Procedures were performed using a flexible bronchoscope and cryoprobe without fluoroscopic guidance. RESULTS One hundred procedures were performed on 85 patients. A total of 272 cryobiopsies were obtained with a mean biopsy diameter of 5.9 ± 3.2 mm. Ninety-seven percent contained alveolated lung tissue. Diagnosis based against MDD gold standard was confirmed using TBLC in 67.1% of patients and in 72/100 procedures. Three patients proceeded to SLB. The addition of histological information changed the clinic-radiological diagnosis in twelve patients. The most common diagnosis based on clinical-radiologic-pathologic correlation at MDD was idiopathic pulmonary fibrosis (IPF) (51.2%) and hypersensitivity pneumonitis (15.9%). Moderate bleeding occurred in 18% of cases and five patients (5%) developed pneumothorax requiring intervention. Eleven patients required admission, with a mean length of stay of 1.3 ± 0.9 days. CONCLUSION TBLC aids the diagnosis of ILD in the appropriate patient and may be an acceptable alternative to SLB with fewer complications. Further work on standardizing the procedure is required.
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Affiliation(s)
- Anne M O'Mahony
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland.
| | - Louise Burke
- Department of Histopathology, Cork University Hospital, Cork, Ireland
| | - Alberto Cavazza
- Department of Pathology, Arcispedale S Maria Nuova, Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Marcus P Kennedy
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland
| | - Michael T Henry
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland
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16
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Pajares V, Núñez-Delgado M, Bonet G, Pérez-Pallarés J, Martínez R, Cubero N, Zabala T, Cordovilla R, Flandes J, Disdier C, Torrego A. Transbronchial biopsy results according to diffuse interstitial lung disease classification. Cryobiopsy versus forceps: MULTICRIO study. PLoS One 2020; 15:e0239114. [PMID: 32956379 PMCID: PMC7505587 DOI: 10.1371/journal.pone.0239114] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In recent years, transbronchial cryobiopsy (TBCB) has come to be increasingly used in interventional pulmonology units as it obtains larger and better-quality samples than conventional transbronchial lung biopsy (TBLB) with forceps. No multicenter studies have been performed, however, that analyse and compare TBCB and TBLB safety and yield according to the interstitial lung disease (ILD) classification. OBJECTIVES We compared the diagnostic yield and safety of TBCB with cryoprobe sampling versus conventional TBLB forceps sampling in the same patient. METHOD Prospective multicenter clinical study of patients with ILD indicated for lung biopsy. Airway management with orotracheal tube, laryngeal mask and rigid bronchoscope was according to the protocol of each centre. All procedures were performed using fluoroscopy and an occlusion balloon. TBLB was followed by TBCB. Complications were recorded after both TBLB and TBCB. RESULTS Included were 124 patients from 10 hospitals. Airway management was orotracheal intubation in 74% of cases. Diagnostic yield according to multidisciplinary committee results for TBCB was 47.6% and for TBLB was 19.4% (p<0.0001). Diagnostic yield was higher for TBCB compared to TBLB for two groups: idiopathic interstitial pneumonias (IIPs) and ILD of known cause or association (OR 2.5; 95% CI: 1.4-4.2 and OR 5.8; 95% CI: 2.3-14.3, respectively). Grade 3 (moderate) bleeding after TBCB occurred in 6.5% of patients compared to 0.8% after conventional TBLB. CONCLUSIONS Diagnostic yield for TBCB was higher than for TBLB, especially for two disease groups: IIPs and ILD of known cause or association. The increased risk of bleeding associated with TBCB confirms the need for safe airway management and prophylactic occlusion-balloon use. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT02464592.
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Affiliation(s)
- Virginia Pajares
- Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | | | - Gloria Bonet
- Respiratory Medicine, Hospital Universitario de Germans Trias i Pujol, Barcelona, Spain
| | - Javier Pérez-Pallarés
- Respiratory Medicine, Hospital Universitario de Santa Lucía, Cartagena, Murcia, Spain
| | - Raquel Martínez
- Respiratory Medicine, Hospital Universitario La Fé, Valencia, Spain
| | - Noelia Cubero
- Respiratory Medicine, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Txomin Zabala
- Respiratory Medicine, Hospital Galdakao-Usansolo, Vizcaya, Bizkaia, Spain
| | - Rosa Cordovilla
- Respiratory Medicine, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Javier Flandes
- Respiratory Medicine, Fundación Jiménez Díaz, Madrid, Spain
| | - Carlos Disdier
- Respiratory Medicine, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Alfons Torrego
- Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
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17
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Leone PM, Richeldi L. Current Diagnosis and Management of Hypersensitivity Pneumonitis. Tuberc Respir Dis (Seoul) 2020; 83:122-131. [PMID: 32185914 PMCID: PMC7105432 DOI: 10.4046/trd.2020.0012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/21/2022] Open
Abstract
Hypersensitivity Pneumonitis (HP) one of the most common interstitial lung diseases (ILDs) is characterized by exposure to an inhaled inciting antigen that leads to a host immunologic reaction determining interstitial inflammation and architectural distortion. The underlying pathogenetic mechanisms are unclear. The absence of international shared diagnostic guidelines and the lack of a "gold-standard" test for HP combined with the presence of several clinical and radiologic overlapping features makes it particularly challenging to differentiate HP from other ILDs, also in expert contests. Radiology is playing a more crucial role in this process; recently the headcheese sign was recognized as a more specific for chronic-HP than the extensive mosaic attenuation. Several classification proposals and diagnostic models have been advanced by different groups, with no prospective validation. Therapeutic options for HP have been limited to antigen avoidance and immunosuppressant drugs over the last decades. Several questions about this condition remain unanswered and there is a need for more studies.
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Affiliation(s)
- Paolo Maria Leone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Luca Richeldi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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18
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Avdeev SN, Chikina SY, Nagatkina OV. Idiopathic pulmonary fibrosis: a new international clinical guideline. ACTA ACUST UNITED AC 2019. [DOI: 10.18093/0869-0189-2019-29-5-525-552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- S. N. Avdeev
- I.M.Sechenov First Moscow State Medical University, Healthcare Ministry of Russia (Sechenov University); Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia
| | - S. Yu. Chikina
- I.M.Sechenov First Moscow State Medical University, Healthcare Ministry of Russia (Sechenov University)
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19
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Zaizen Y, Kohashi Y, Kuroda K, Tabata K, Kitamura Y, Hebisawa A, Saito Y, Fukuoka J. Concordance between sequential transbronchial lung cryobiopsy and surgical lung biopsy in patients with diffuse interstitial lung disease. Diagn Pathol 2019; 14:131. [PMID: 31801596 PMCID: PMC6892217 DOI: 10.1186/s13000-019-0908-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/07/2019] [Indexed: 12/12/2022] Open
Abstract
Background Increasing evidence indicates the utility of transbronchial lung cryobiopsy (TBLC) for the diagnosis of interstitial lung disease (ILD). However, only one study has compared TBLC and surgical lung biopsy (SLB) performed on the same patients. Methods We identified seven patients with ILD with TBLC and SLB. We evaluated the clinical characteristics and made a pathological diagnosis based on the official ATS/ERS/JRS/ALAT clinical practice guideline of idiopathic pulmonary fibrosis with both TBLC and SLB. Results Six cases were diagnosed as Usual interstitial pneumonia (UIP) in both TBLC and SLB. One case was diagnosed as indeterminate for UIP with TBLC and probable UIP with SLB. Etiological diagnosis with TBLC and SLB were concordant in 2 cases of idiopathic pulmonary fibrosis (IPF) but discordant for other diagnoses. Major histological findings of UIP including dense fibrosis, peripheral distribution, and fibroblastic foci showed high concordance between TBLC and SLB, which implies that TBLC can reliably detect these features. In contrast, loose fibrosis, cellular infiltration, and airway disease showed poor concordance between the two methods. Conclusion Our study showed that TBLC is useful for UIP diagnosis but not for other ILD. With a multidisciplinary approach, diagnosis of IPF may be determined by TBLC, whereas ILD other than IPF may require SLB.
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Affiliation(s)
- Yoshiaki Zaizen
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Yasuo Kohashi
- Department of Respirology, HARUHI Respiratory Medical Hospital, Kiyosu, Japan
| | - Kishio Kuroda
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kazuhiro Tabata
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Yuka Kitamura
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.,Department of Respirology, HARUHI Respiratory Medical Hospital, Kiyosu, Japan
| | - Akira Hebisawa
- Department of Clinical Pathology, Asahi Central Hospital, Asahi, Japan
| | - Yuji Saito
- Department of Respirology, HARUHI Respiratory Medical Hospital, Kiyosu, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
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Guo S, Li Q, Jiang J, Luo F, Li Y, Jin F, Liu X, Wang H, Chen P, Bai C, Dai H, Huang H, Ye X, Yi X, Zhang J, Wang C, Ke M, Sun J, Feng J, Zhou H, Wu Y, Wang Z, Ma Y, Li J, Lv L, Xie B, Hohenforst-Schmidt W, Ding W, Wang X, Yang J, Cai Q, Sun P, Luo Z, Giri M. Chinese expert consensus on the standardized procedure and technique of transbronchial cryobiopsy. J Thorac Dis 2019; 11:4909-4917. [PMID: 32030207 DOI: 10.21037/jtd.2019.12.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Shuliang Guo
- The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qiang Li
- Shanghai East Hospital, Tong Ji University, Shanghai 200120, China
| | - Jinyue Jiang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Fengming Luo
- West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yishi Li
- The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Faguang Jin
- Tangdu Hospital Affiliated to Air Force Medical University, Xi'an 710038, China
| | - Xinzhu Liu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Hongwu Wang
- Emergency General Hospital, Beijing 100028, China
| | - Ping Chen
- The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Chong Bai
- Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Haiyun Dai
- The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Haidong Huang
- Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Xianwei Ye
- Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Xianghua Yi
- Tongji Hospital of Tongji University, Shanghai 200065, China
| | - Jie Zhang
- Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Changhui Wang
- Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Mingyao Ke
- The Second Affiliated Hospital of Xiamen Medical College, Xiamen 361021, China
| | - Jiayuan Sun
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jing Feng
- General Hospital, Tianjin Medical University, Tianjin 300052, China
| | - Hongmei Zhou
- Zhongshan Hospital Affiliated to Guangdong Medical University, Zhongshan 528415, China
| | - Youru Wu
- Mianyang Central Hospital, Mianyang 621000, China
| | - Zhen Wang
- Beijing Chao-yang Hospital, Capital Medical University, Beijing 100069, China
| | - Yun Ma
- Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Jing Li
- Guangdong Provincial People's Hospital, Guangzhou 510030, China
| | - Liping Lv
- Anhui Chest Hospital, Hefei 230022, China
| | - Baosong Xie
- Fujian Provincial Hospital, Fuzhou 350001, China
| | | | - Weimin Ding
- Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Xiaoping Wang
- Shandong Provincial Chest Hospital, Jinan 250000, China
| | | | - Qingshan Cai
- Hangzhou Red Cross Hospital, Hangzhou 310003, China
| | - Peng Sun
- Jilin Tuberculosis Hospital, Changchun 212006, China
| | - Zhuang Luo
- First Affiliated Hospital of Kunming Medical University, Kunming 650031, China
| | - Mohan Giri
- The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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21
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Lodhi T, Hughes G, Stanel S, Chaudhuri N, Hayton C. Transbronchial Lung Cryobiopsy in Idiopathic Pulmonary Fibrosis: A State of the Art Review. Adv Ther 2019; 36:2193-2204. [PMID: 31363997 PMCID: PMC6822843 DOI: 10.1007/s12325-019-01036-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Indexed: 12/17/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease associated with significant morbidity and mortality. The diagnosis of IPF involves a combination of clinical history, radiological imaging and examination of histopathological samples in appropriate cases. Historically, transbronchial biopsy (TBB) has been used to obtain histological samples; however this lacks diagnostic accuracy. At present, surgical lung biopsy (SLB) is the gold standard technique for obtaining specimen samples; however this carries a significant mortality risk. Transbronchial lung cryobiopsy (TBLC) is a new technique that has been pioneered in the management of lung malignancy and offers a potential alternative to SLB. The technique employs a freezing probe, which is used to obtain lung tissue samples that are larger and better quality than traditional TBB samples. This affords TBLC an estimated diagnostic yield of 80% in interstitial lung disease. However, with limited evidence directly comparing TBLC to SLB, the diagnostic accuracy of the procedure has been uncertain. Common complications of TBLC include pneumothorax and bleeding. Mortality in TBLC is low compared with SLB, with exacerbation of IPF frequently reported as the cause. TBLC represents an exciting potential option in the diagnostic pathway in IPF; however its true value has yet to be determined.
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Affiliation(s)
- Taha Lodhi
- North West Interstitial Lung Disease Unit, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Gareth Hughes
- Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Department of Thoracic Medicine, Royal Bolton Hospital, Minerva Road, Farnworth, Bolton, BL4 0JR, UK
| | - Stefan Stanel
- North West Interstitial Lung Disease Unit, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
- Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Nazia Chaudhuri
- North West Interstitial Lung Disease Unit, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
- Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Conal Hayton
- North West Interstitial Lung Disease Unit, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.
- Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
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22
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Kania A, Misiaszek M, Vašáková M, Szlubowski A, Bugalho A, Pankowski J, Szołkowska M, Roden AC, Celejewska-Wójcik N, Nastałek P, Gnass M, Sładek K. Cryobiopsy in the diagnosis of idiopathic pulmonary hemosiderosis: a case report. J Thorac Dis 2019; 11:3195-3201. [PMID: 31463151 DOI: 10.21037/jtd.2019.07.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Aleksander Kania
- Department of Pulmonology, II Chair of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Misiaszek
- Department of Pulmonology, II Chair of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Martina Vašáková
- Department of Respiratory Medicine, Thomayer Hospital and 1st Medical Faculty of Charles University, Prague, Czech Republic
| | - Artur Szlubowski
- Bronchoscopy Unit, Pulmonary Hospital Zakopane, Zakopane, Poland
| | - Antonio Bugalho
- Hospital CUF Infante Santo e CUF Descobertas, Instituto CUF Oncologia (I.C.O.), NOVA Medical School, Lisbon, Portugal
| | | | - Małgorzata Szołkowska
- Pathology Department, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Natalia Celejewska-Wójcik
- Department of Pulmonology, II Chair of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Nastałek
- Department of Pulmonology, II Chair of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Maciej Gnass
- Bronchoscopy Unit, Pulmonary Hospital Zakopane, Zakopane, Poland
| | - Krzysztof Sładek
- Department of Pulmonology, II Chair of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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23
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Diagnostic yield and risk/benefit analysis of trans-bronchial lung cryobiopsy in diffuse parenchymal lung diseases: a large cohort of 699 patients. BMC Pulm Med 2019; 19:16. [PMID: 30651103 PMCID: PMC6335717 DOI: 10.1186/s12890-019-0780-3] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/07/2019] [Indexed: 12/02/2022] Open
Abstract
Background Standardization of trans-bronchial lung cryobiopsy in diffuse parenchymal lung diseases is imminent; however, the majority of published series on cryobiopsy include a limited number of patients and are characterized by several differences in procedural technical details. Methods This is an observational, retrospective cohort study. Aim of the study was to suggest some sampling strategies related to transbronchial cryobiopsy in the diagnostic work-up of patients with diffuse parenchymal lung diseases. Results Six hundred ninety-nine patients with suspected diffuse parenchymal lung disease were recruited. A specific pathological diagnosis was achieved in 614/699 cases (87.8%) and a multidisciplinary diagnosis was obtained in 630/699 cases (90.1%). Diagnostic yield was significantly influenced by the number of samples taken (1 vs ≥ 2 biopsies, p < 0.005). In 60.4% of patients, biopsies were taken from one site and in 39.6% from different sites (in the same lobe or in two different lobes), with a significant increase in diagnostic yield, specifically in patients with fibrotic lung diseases (65.5% vs 93.4%, p < 0.0001). The 2.4 mm or 1.9 mm probes were used, with no differences in terms of diagnostic yield. Regarding safety, pneumothorax occurred in 19.2% and was influenced by baseline lung function; in all patients Fogarty balloon has been used and severe haemorrhage occurred in 0.7% of cases. Three patients (0.4% of cases) died within 30 days after the procedure. Conclusions We propose some sampling strategies of cryobiopsy which seem to be associated with a higher diagnostic yield and a favorable risk/benefit ratio: sampling at least two samples in different sites, using either the 2.4 mm or the 1.9 mm probe, intubating the patients and using bronchial blockers/catheters.
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24
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Wijmans L, Bonta PI, Rocha-Pinto R, de Bruin DM, Brinkman P, Jonkers RE, Roelofs JJTH, Poletti V, Hetzel J, Annema JT. Confocal Laser Endomicroscopy as a Guidance Tool for Transbronchial Lung Cryobiopsies in Interstitial Lung Disorder. Respiration 2018; 97:259-263. [PMID: 30428462 DOI: 10.1159/000493271] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Transbronchial cryobiopsy (TBCB) of the lung parenchyma is a minimally invasive alternative for surgical lung biopsy in interstitial lung disease (ILD) patients. Drawbacks are the nondiagnostic rate and complication risk of pneumothorax and bleeding. Fluoroscopy is the current guidance tool for TBCB, which is limited by 2D imaging and a radiation dose for the patient. Confocal laser endomicroscopy (CLE) is a high-resolution imaging technique that provides immediate feedback during bronchoscopy about the elastin fiber network of peripheral lung areas. Both the visceral pleura and fibrotic lung areas consist of elastin fibers and are therefore potentially detectable with CLE. OBJECTIVES To investigate whether CLE is capable of (1) distinguishing fibrotic from normal alveolar areas and (2) identifying the pleura. METHODS In and ex vivo CLE imaging obtained during bronchoscopy was compared with histology of lung biopsies in 14 ILD patients. RESULTS CLE imaging of the alveolar compartment was feasible in all patients without adverse events. Based on CLE imaging, key characteristics that influence both diagnostic yield (dense fibrotic areas) and complication rate (pleura and subpleural space) were visualized. CONCLUSIONS CLE seems a promising alternative to fluoroscopy as a guidance tool for TBCB procedures.
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Affiliation(s)
- Lizzy Wijmans
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Rita Rocha-Pinto
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Daniel M de Bruin
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Paul Brinkman
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - René E Jonkers
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Joris J T H Roelofs
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Venerino Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forli, Italy.,Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Jürgen Hetzel
- Department of Internal Medicine II, University Clinic of Tübingen, Tübingen, Germany
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands,
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25
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Silvestri GA, Pastis NJ. Response. Chest 2018; 151:514. [PMID: 28183491 DOI: 10.1016/j.chest.2016.11.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Gerard A Silvestri
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC.
| | - Nicholas James Pastis
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC
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26
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Ryerson CJ, Corte TJ, Lee JS, Richeldi L, Walsh SLF, Myers JL, Behr J, Cottin V, Danoff SK, Flaherty KR, Lederer DJ, Lynch DA, Martinez FJ, Raghu G, Travis WD, Udwadia Z, Wells AU, Collard HR. A Standardized Diagnostic Ontology for Fibrotic Interstitial Lung Disease. An International Working Group Perspective. Am J Respir Crit Care Med 2017; 196:1249-1254. [PMID: 28414524 DOI: 10.1164/rccm.201702-0400pp] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Christopher J Ryerson
- 1 Department of Medicine and Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,2 St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Tamera J Corte
- 3 Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,4 University of Sydney, Sydney, Australia
| | - Joyce S Lee
- 5 Department of Medicine, University of Colorado Denver, Aurora, Colorado
| | - Luca Richeldi
- 6 Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Simon L F Walsh
- 7 Department of Radiology, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | | | - Jürgen Behr
- 9 Department of Internal Medicine V, Ludwig Maximilians University, Munich, Germany.,10 Asklepios Clinics, Gauting, Germany.,11 Comprehensive Pneumology Center Munich, Member of the German Center for Lung Research, Munich, Germany
| | - Vincent Cottin
- 12 Department of Medicine, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, University of Lyon, Lyon, France
| | - Sonye K Danoff
- 13 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kevin R Flaherty
- 14 Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - David J Lederer
- 15 Department of Medicine, Columbia University, New York, New York
| | - David A Lynch
- 16 Department of Radiology, National Jewish Health, Denver, Colorado
| | | | - Ganesh Raghu
- 18 Department of Medicine, University of Washington, Seattle, Washington
| | - William D Travis
- 19 Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zarir Udwadia
- 20 Hinduja Hospital and Research Centre, Mumbai, India.,21 Breach Candy Hospital, Mumbai, India
| | - Athol U Wells
- 22 Interstitial Lung Disease Unit, Royal Brompton Hospital, London, United Kingdom; and
| | - Harold R Collard
- 23 Department of Medicine, University of California San Francisco, San Francisco, California
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27
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Youness HA, Keddissi J, Berim I, Awab A. Management of oral antiplatelet agents and anticoagulation therapy before bronchoscopy. J Thorac Dis 2017; 9:S1022-S1033. [PMID: 29214062 DOI: 10.21037/jtd.2017.05.45] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Although, bronchoscopy is a relatively safe procedure, small amount of bleeding in the airway can have serious consequences. Careful consideration of the risks of diagnostic and therapeutic bronchoscopic intervention can help minimize potential complications. With increasing number of patients using antiplatelet and anticoagulation therapies, strategies for minimizing thromboembolic and operative bleeding events need to be included in the risk and benefit analyses. Growing evidence suggests that aspirin is safe and does not increase bleeding during bronchoscopy. In addition, despite small studies reporting that it may be safe to perform bronchoscopic procedures that have low risk for bleeding such as endobronchial ultrasound with transbronchial needle aspiration on clopidogrel, it is still recommended to hold it for 7 days prior to performing elective bronchoscopy. It is recommended to hold vitamin K antagonist, as well as new oral anticoagulation agents prior to bronchoscopy. The timing for pre-procedural discontinuation of anticoagulation therapy and the decision to bridge depend on the agent used, the renal function and the thromboembolic risk. In this review article, we will discuss available data regarding management of anticoagulation and antiplatelet therapy as it applies to bronchoscopic procedures.
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Affiliation(s)
- Houssein A Youness
- Department of Medicine, Section of Pulmonary Diseases, Critical Care and Sleep Medicine, University of Oklahoma Health Sciences Center, OK, USA
| | - Jean Keddissi
- Department of Medicine, Section of Pulmonary Diseases, Critical Care and Sleep Medicine, University of Oklahoma Health Sciences Center, OK, USA
| | - Ilya Berim
- Department of Medicine, Section of Pulmonary Diseases, Critical Care and Sleep Medicine, Creighton University, NE, USA
| | - Ahmed Awab
- Department of Medicine, Section of Pulmonary Diseases, Critical Care and Sleep Medicine, University of Oklahoma Health Sciences Center, OK, USA
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28
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Abstract
Interstitial lung diseases (ILDs) form one of the most fascinating fields in pulmonary medicine. They also pose one of the greatest challenges for accurate diagnosis and proper treatment. Even within the recommended and warranted multidisciplinary approach, differentiating between one disease and another may lead to frustration, especially when proper lung tissue is not available for adequate pathological review. A surgical lung biopsy (SLB) might render enough tissue for histopathology, but this could come at the expense of high morbidity and even mortality, as in the case of usual interstitial pneumonia (UIP). Could bronchoscopy and its various techniques offer a safer and higher yield alternative? Since the very late 19th century, efforts have been made to better examine the airways, obtain tissue and treat various conditions. This resulted in the successive emergence of bronchoalveolar lavage (BAL), endobronchial and transbronchial forceps biopsies, until recently when transbronchial cryobiopsy surfaced as a nascent technique with much promise. The use of endobronchial ultrasound revolutionized the diagnosis and staging of lung cancer, while adding to the yield of other conditions such as sarcoidosis. Ongoing research, efforts and studies have continuously scrutinized the roles of various techniques in the approach to ILDs. For example, BAL seems to serve mostly to eliminate infection as an etiology or a complicating factor in the acute worsening of a fibrotic lung disease, while a predominant cellular component might be diagnostic, such as eosinophilia in eosinophilic lung disease, or lymphocytosis in hypersensitivity pneumonitis (HP). On the other hand, endobronchial biopsy's (EBB) role appears limited to sarcoidosis. As for transbronchial biopsy by forceps, the small sample size and related artifact appear to be limiting factors in making an accurate diagnosis. Recently, however, the use of cryotherapy via employing a cryoprobe in obtaining transbronchial lung biopsies is unfolding into a refined interventional method which might transform indefinitely our approach to the pathological diagnosis of the various ILDs.
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Affiliation(s)
- Jad Kebbe
- Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, University of Oklahoma Health Sciences Center and Oklahoma City VA Medical Center, Oklahoma, USA
| | - Tony Abdo
- Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, University of Oklahoma Health Sciences Center and Oklahoma City VA Medical Center, Oklahoma, USA
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29
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Role of Transbronchial Lung Cryobiopsies in Diffuse Parenchymal Lung Diseases: Interest of a Sequential Approach. Pulm Med 2017; 2017:6794343. [PMID: 28512583 PMCID: PMC5415669 DOI: 10.1155/2017/6794343] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/23/2017] [Accepted: 04/02/2017] [Indexed: 12/18/2022] Open
Abstract
Background. Transbronchial lung cryobiopsies (TBLCs) are a promising diagnostic tool in the setting of diffuse parenchymal lung diseases (DPLDs). However, no comparison with surgical lung biopsy (SLB) in the same patient is available. Methods. The diagnostic yield and safety data of TBLCs, as well as the result of SLB performed after TBLCs, were analysed in a multicentric Belgian study. A SLB was performed after TBLCs in absence of a definite pathological diagnosis or if a NSIP pattern was observed without related condition identified following multidisciplinary discussion. Results. Between April 2015 and November 2016, 30 patients were included. Frequent complications included pneumothorax (20%) and bleeding (severe 7%, moderate 33%, and mild 53%). There was no mortality. The overall diagnostic yield was 80%. A SLB was performed in six patients (three without definite histological pattern and three with an NSIP). The surgical biopsy changed the pathological diagnosis into a UIP pattern in five patients and confirmed a NSIP pattern in one patient. Conclusion. TBLCs are useful in the diagnostic work-up of DPLDs avoiding a SLB in 80% of the patients. However, surgical biopsies, performed as a second step after TBLCs because of an indefinite diagnosis or a NSIP pattern, provide additional information supporting the interest of a sequential approach in these patients.
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30
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Kahn N, Fregonese L, Barrecheguren M, Franssen FM, Grgic A, Gompelmann D, Bibaki E, Antoniou KM, Kocks JW, Pinnock H, Herth F. Clinical highlights from the 2016 European Respiratory Society International Congress. ERJ Open Res 2017; 3:00147-2016. [PMID: 28462234 PMCID: PMC5406227 DOI: 10.1183/23120541.00147-2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/05/2017] [Indexed: 12/13/2022] Open
Abstract
This article contains highlights and a selection of the scientific advances from the European Respiratory Society (ERS) Clinical Assembly (Assembly 1) and its six respective groups (Groups 1.1-1.6) that were presented at the 2016 ERS International Congress in London, UK. The most relevant topics for clinicians will be discussed, covering a wide range of areas including clinical problems, rehabilitation and chronic care, thoracic imaging, interventional pulmonology, diffuse and parenchymal lung diseases, and general practice and primary care. In this comprehensive review, the newest research and actual data will be discussed and put into perspective.
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Affiliation(s)
- Nicolas Kahn
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany
| | - Laura Fregonese
- Product Development Scientific Support Dept, European Medicines Agency, London, UK
| | | | | | - Aleksandar Grgic
- Dept of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Daniela Gompelmann
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany
| | - Eleni Bibaki
- Dept of Thoracic Medicine, Interstitial Lung Disease Unit, University Hospital of Heraklion, Heraklion, Greece
| | - Katerina M. Antoniou
- Dept of Thoracic Medicine, Interstitial Lung Disease Unit, University Hospital of Heraklion, Heraklion, Greece
| | - Janwillem W.H. Kocks
- University of Groningen, University Medical Center Groningen, Dept of General Practice and Elderly Care Medicine, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - Hillary Pinnock
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Felix Herth
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany
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31
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Sharp C, Adamali H, Medford A. Developments in Cryobiopsy for Interstitial Lung Disease May Be Cost Saving. Chest 2017; 151:512-513. [PMID: 28183489 DOI: 10.1016/j.chest.2016.10.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/14/2016] [Indexed: 02/07/2023] Open
Affiliation(s)
- Charles Sharp
- Academic Respiratory Unit, North Bristol NHS Trust, Bristol, South Gloucestershire.
| | - Huzaifa Adamali
- Bristol ILD Service, North Bristol NHS Trust, Bristol, South Gloucestershire
| | - Andrew Medford
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, South Gloucestershire; Academic Respiratory Unit, University of Bristol, Bristol, South Gloucestershire
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32
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Martinez FJ, Chisholm A, Collard HR, Flaherty KR, Myers J, Raghu G, Walsh SLF, White ES, Richeldi L. The diagnosis of idiopathic pulmonary fibrosis: current and future approaches. THE LANCET RESPIRATORY MEDICINE 2016; 5:61-71. [PMID: 27932290 DOI: 10.1016/s2213-2600(16)30325-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 12/13/2022]
Abstract
With the recent development of two effective treatments for patients with idiopathic pulmonary fibrosis, an accurate diagnosis is crucial. The traditional approach to diagnosis emphasises the importance of thorough clinical and laboratory evaluations to exclude secondary causes of disease. High-resolution CT is a critical initial diagnostic test and acts as a tool to identify patients who should undergo surgical lung biopsy to secure a definitive histological diagnosis of usual interstitial pneumonia pattern. This diagnostic approach faces several challenges. Many patients with suspected idiopathic pulmonary fibrosis present with atypical high-resolution CT characteristics but are unfit for surgical lung biopsy, therefore preventing a confident diagnosis. The state of the art suggests an iterative, multidisciplinary process that incorporates available clinical, laboratory, imaging, and histological features. Recent research has explored genomic techniques to molecularly phenotype patients with interstitial lung disease. In the future, clinicians will probably use blood-specific or lung-specific molecular markers in combination with other clinical, physiological, and imaging features to enhance diagnostic efforts, refine prognostic recommendations, and influence the initial or subsequent treatment options. There is an urgent and increasing need for well designed, large, prospective studies measuring the effect of different diagnostic approaches. Ultimately, this will help to inform the development of guidelines and tailor clinical practice for the benefit of patients.
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Affiliation(s)
- Fernando J Martinez
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA.
| | | | - Harold R Collard
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kevin R Flaherty
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey Myers
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Ganesh Raghu
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Simon L F Walsh
- Department of Radiology, Royal Brompton Hospital, London, UK
| | - Eric S White
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Luca Richeldi
- Catholic University of the Sacred Heart, A. Gemelli University Hospital, Rome, Italy; Academic Unit of Clinical and Experimental Sciences, NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
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