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Lin YT, Lin CH, Wang SC, Huang YJ, Wu RC, Lee CS, Chang CH. Mucinous Adenocarcinoma of the Lung Diagnosed by Radial Endobronchial Ultrasound-guided Bronchoscopic Cryobiopsy and Presenting as Interstitial Lung Disease in a Patient with Systemic Sclerosis. J Med Ultrasound 2023; 31:314-317. [PMID: 38264591 PMCID: PMC10802878 DOI: 10.4103/jmu.jmu_56_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/10/2022] [Accepted: 08/09/2022] [Indexed: 01/25/2024] Open
Abstract
We report a patient with systemic sclerosis who was diagnosed with advanced-stage mucinous adenocarcinoma of the lungs. The clinical presentation, imaging findings, pathological results, and molecular diagnoses are presented. A 64-year-old woman with systemic sclerosis was administered prednisolone and hydroxychloroquine sulfate to control her disease. High-resolution computed tomography (HRCT) revealed an interstitial pattern in both lungs during annual imaging. Connective tissue disease-associated interstitial lung disease (CTD-ILD) was diagnosed using blood tests, pulmonary function tests, and imaging findings. One year later, the patient underwent follow-up chest HRCT, which showed progressive lung disease. The patient underwent endobronchial ultrasound (EBUS)-guided transbronchial lung cryobiopsy and computed tomography-guided biopsy for a pathological diagnosis. The pathology reports of bilateral lungs disclosed mucinous adenocarcinoma. After tumor staging and mutation testing, the patient received chemotherapy with pemetrexed and cisplatin. The bilateral lung lesions subsided after four cycles of first-line chemotherapy. Patients with CTD and lung involvement may be diagnosed with CTD-ILD. Although histopathological results are not mandatory for ILD diagnosis, EBUS-guided transbronchial lung biopsy or lung cryobiopsy should be considered when ILD has atypical or unexplained features.
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Affiliation(s)
- Yan-Ting Lin
- Department of Internal Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan
| | - Chiung-Hung Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan
| | - Shao-Chung Wang
- Department of Medical Imaging and Intervention, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Ju Huang
- Department of Allergy, Immunology, Rheumatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Department of Anatomic Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Shu Lee
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan
- Department of Pulmonary and Critical Care Medicine, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan
| | - Chih-Hao Chang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan
- Department of Pulmonary and Critical Care Medicine, New Taipei Municipal Tucheng Hospital, New Taipei, Taiwan
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Ruaro B, Tavano S, Confalonieri P, Pozzan R, Hughes M, Braga L, Volpe MC, Ligresti G, Andrisano AG, Lerda S, Geri P, Biolo M, Baratella E, Confalonieri M, Salton F. Transbronchial lung cryobiopsy and pulmonary fibrosis: A never-ending story? Heliyon 2023; 9:e14768. [PMID: 37025914 PMCID: PMC10070648 DOI: 10.1016/j.heliyon.2023.e14768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Background The diagnostic process of pulmonary fibrosis (PF) is often challenging, requires a collaborative effort of several experts, and often requires bioptic material, which can be difficult to obtain, both in terms of quality and technique. The main procedures available to obtain such samples are transbronchial lung cryobiopsy (TBLC) and surgical lung biopsy (SLB). Objective The purpose of this paper is to review the evidence for the role of TBLC in the diagnostic-therapeutic process of PF. Methods A comprehensive review was performed to identify articles to date that addressed the role of TBLC in the diagnostic-therapeutic process of PF using the PubMed® database. Results The reasoned search identified 206 papers, including 21 manuscripts (three reviews, one systematic review, two guidelines, two prospective studies, three retrospective studies, one cross-sectional study, one original article, three editorials, three clinical trials, and two unclassifiable studies), which were included in the final review. Conclusions TBLC is gaining increasing efficacy and improving safety profile; however, there are currently no clear data demonstrating its superiority over SLB. Therefore, the two techniques should be considered with careful rationalization on a case-by-case basis. Further research is needed to further optimize and standardize the procedure and to thoroughly study the histological and molecular characteristics of PF.
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Berger K, Kaner RJ. Diagnosis and Pharmacologic Management of Fibrotic Interstitial Lung Disease. Life (Basel) 2023; 13:life13030599. [PMID: 36983755 PMCID: PMC10055741 DOI: 10.3390/life13030599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023] Open
Abstract
Interstitial lung disease is an umbrella term that encompasses a spectrum of parenchymal lung pathologies affecting the gas exchanging part of the lung. While many of these disease entities are not fibrotic in nature, a number can lead to pulmonary fibrosis which may or may not progress over time. Idiopathic pulmonary fibrosis is the prototypical, progressive fibrotic interstitial lung disease, which can lead to worsening hypoxemic respiratory failure and mortality within a number of years from the time of diagnosis. The importance of an accurate and timely diagnosis of interstitial lung diseases, which is needed to inform prognosis and guide clinical management, cannot be overemphasized. Developing a consensus diagnosis requires the incorporation of a variety of factors by a multidisciplinary team, which then may or may not determine a need for tissue sampling. Clinical management can be challenging given the heterogeneity of disease behavior and the paucity of controlled trials to guide decision making. This review addresses current paradigms and recent updates in the diagnosis and pharmacologic management of these fibrotic interstitial lung diseases.
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Affiliation(s)
- Kristin Berger
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
| | - Robert J. Kaner
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY 10021, USA
- Department of Genetic Medicine, Weill Cornell Medicine, New York, NY 10021, USA
- Correspondence:
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Reichenberger F, Dechant C, Ley S, Gschwendtner A, Benedikter J, Späthling-Mestekemper S, Kneidinger N, Powitz F, Krüger K, Wahle M, Schwaiblmair M. [Diagnostics of Interstitial Lung Diseases - Practical Instructions with a Focus on Rheumatologic Systemic Diseases]. Dtsch Med Wochenschr 2022; 147:1371-1383. [PMID: 36279863 DOI: 10.1055/a-1877-0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Interstitial lung diseases (ILD) are etiologically heterogeneous with unknown and known causes like rheumatologic systemic diseases differing in their therapeutic and prognostic consequences. In consensus between pulmonologists, rheumatologists, radiologists, and pathologists, we developed practical instructions for ILD diagnosis in rheumatologic systemic diseases, in particular because ILD can present in early stages of rheumatic systemic diseases. ILD diagnosis is based on clinical assessment results including a detailed medical history, physical examination, focused laboratory tests, radiology with a high-resolution computed tomography, lung function, and histopathology also to differentiate it from cardiac and infection associated lung diseases. The ILD diagnosis is made in a multidisciplinary discussion leading to therapeutic and prognostic consequences. The occurrence of acute exacerbations is especially critical. They are often the causes for ILD progression and are associated with considerable mortality.
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Oki M, Saka H, Kogure Y, Niwa H, Ishida A, Yamada A, Torii A, Kitagawa C. Thin bronchoscopic cryobiopsy using a nasobronchial tube. BMC Pulm Med 2022; 22:361. [PMID: 36153576 PMCID: PMC9508729 DOI: 10.1186/s12890-022-02166-w] [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: 06/06/2022] [Accepted: 09/19/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Transbronchial lung cryobiopsy is useful when diagnosing lung lesions. However, prevention of associated bleeding complications is essential. This study aimed to evaluate the safety and efficacy of our novel bronchoscopic cryobiopsy technique, which uses a long nasobronchial tube to prevent blood flooding the central airway. METHODS Patients with localized or diffuse lung lesions were prospectively enrolled and underwent cryobiopsy using a 1.9 mm diameter cryoprobe and a 4.0 mm diameter thin bronchoscope under conscious sedation. For cryobiopsy, a long silicone tube (inner diameter, 5.0 mm) was advanced through the nose to the target bronchus, then wedged to drain blood under thin-tube bronchoscopic control. The primary endpoint was the frequency of bleeding complications. RESULTS Of the 80 patients initially enrolled, 73 that underwent at least one cryobiopsy were ultimately included. Mild bleeding during cryobiopsy occurred in 58 patients (79.5%), but there was no moderate or severe bleeding. Other complications occurred in four patients (two pneumothorax, one pneumomediastinum, and one pneumonia). Tube dislocation was noted in eight patients (11%). Cryobiopsy specimens were significantly larger than forceps biopsy specimens (9.0 mm2 vs. 2.7 mm2, P < .001) and allowed specific diagnoses in 50 patients (68.5%). CONCLUSIONS Thin bronchoscopic cryobiopsy using a nasobronchial tube in consciously sedated patients is safe and effective. Trial registration Date of registration: 24/06/2019. UMIN-Clinical Trials Registry; Identifier: UMIN000037156 https://www.umin.ac.jp/ctr/index.htm.
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Affiliation(s)
- Masahide Oki
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Hideo Saka
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan ,grid.416589.70000 0004 0640 6976Department of Respiratory Medicine, Matsunami General Hospital, Gifu, Japan
| | - Yoshihito Kogure
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Hideyuki Niwa
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Akane Ishida
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Arisa Yamada
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Atsushi Torii
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Chiyoe Kitagawa
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
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Pulmonary amyloidosis diagnosed via transbronchial lung cryobiopsy without surgical lung biopsy: A case series. Respir Med Case Rep 2022; 38:101688. [PMID: 35769635 PMCID: PMC9234253 DOI: 10.1016/j.rmcr.2022.101688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/23/2022] [Accepted: 06/14/2022] [Indexed: 11/21/2022] Open
Abstract
Pulmonary amyloidosis is a rare disease characterized by abnormal extracellular deposition of amyloid fibril in the lung tissue, and the identification of amyloid deposits is essential for its diagnosis. Surgical lung biopsy (SLB) is a standard diagnostic method for pulmonary amyloidosis. However, it has a relatively high post-procedural mortality rate. Recently, transbronchial lung cryobiopsy (TBLC) has been gradually used for diagnosing interstitial lung disease. However, its diagnostic efficacy for pulmonary amyloidosis has not yet been validated. Here, we describe two cases of pulmonary amyloidosis with deposition of amyloid light chain detected via TBLC. Since SLB is a high-risk procedure for the patients due to age and complications, TBLC was performed. Both patients presented with Congo red-positive amyloid deposits. One patient with localized pulmonary amyloidosis had a good clinical course without therapeutic intervention and was followed up. The other with systemic amyloidosis received chemotherapy and presented with a stable clinical course. TBLC can collect a larger pulmonary specimen for pulmonary amyloidosis than forceps biopsy and has fewer complications and a lower mortality rate than SLB. Thus, it can be a diagnostic method for pulmonary amyloidosis.
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Sawal N, Mukhopadhyay S, Rayancha S, Moore A, Garcha P, Kumar A, Kaul V. A narrative review of interstitial lung disease in anti-synthetase syndrome: a clinical approach. J Thorac Dis 2021; 13:5556-5571. [PMID: 34659821 PMCID: PMC8482343 DOI: 10.21037/jtd-20-3328] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 07/23/2021] [Indexed: 12/17/2022]
Abstract
Anti-synthetase syndrome (AS) is a rare autoimmune disorder characterized by the presence of aminoacyl-transfer RNA synthetase antibodies in conjunction with clinical features such as interstitial lung disease (ILD), Raynaud's phenomenon, nonerosive arthritis, and myopathy. AS distinguishes itself from other inflammatory myopathies by its significant lung involvement and rapidly progressive interstitial lung disease (AS-ILD), therefore the management of AS-ILD requires careful clinical, serologic and radiologic assessment. Glucocorticoids are considered the mainstay of therapy; however, additional immunosuppressive agents are often required to achieve disease control. Patient prognosis is highly dependent on early diagnosis and symptom recognition as the antibody profile is thought to influence therapy response. Since progressive ILD is the leading cause of morbidity and mortality, this review will discuss the clinical approach to patient with suspected AS, with particular emphasis on diagnosis and management of AS-ILD.
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Affiliation(s)
- Naina Sawal
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Sheetal Rayancha
- Department of Rheumatology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alastair Moore
- Department of Radiology, Baylor Scott and White Health, Dallas, TX, USA
| | - Puneet Garcha
- Department of Pulmonary Critical-Care, Baylor College of Medicine, Houston, TX, USA
| | - Anupam Kumar
- Department of Pulmonary Critical-Care, Baylor College of Medicine, Houston, TX, USA
| | - Viren Kaul
- Department of Pulmonary Critical-Care, Crouse Health/SUNY Upstate Medical University, Syracuse, NY, USA
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Olive G, Yung R, Marshall H, Fong KM. Alternative methods for local ablation-interventional pulmonology: a narrative review. Transl Lung Cancer Res 2021; 10:3432-3445. [PMID: 34430378 PMCID: PMC8350102 DOI: 10.21037/tlcr-20-1185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/22/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To discuss and summarise the background and recent advances in the approach to bronchoscopic ablative therapies for lung cancer, focusing on focal parenchymal lesions. BACKGROUND This series focusses on the challenges highlighted by increasing recognition of the prognostically more favourable oligometastatic disease rather than the more frequent, but prognostically poor, high tumour burden metastatic disease. While surgery, stereotactic body radiation therapy (SBRT), and trans-thoracic percutaneous ablative techniques such as microwave (MWA) and radiofrequency ablation (RFA) are well recognised options for selected cases of pulmonary oligometastasis, bronchoscopic approaches to pulmonary tumour ablation are becoming realistic alternatives. An underlying tenet driving research and implementation in this domain is that percutaneous ablative techniques are obliged to traverse the pleura leading to a high rate of pneumothorax, and risks also goes up for peri-vascular lesions. Historically low yield bronchoscopic targeting of isolated peripheral tumors have significantly improved by incorporating multi-modality high resolution imaging and processing, including navigation planning and real-time image guidances (ultrasound, electromagnetic navigation, cone-beam CT). Combining advanced image guidance with ablative technology adaptations for bronchoscopic delivery opens up the options for high dose local ablative therapies that may reduce transthoracic complications and provide palliative to curative options for limited stage primary and oligometastatic diseases. METHODS We conduct a narrative review of the literature summarizing the history of bronchoscopic tumor ablation approaches, technical details including biologic rational for their uses, and current evidence for each modality, as well as investigations into future applications. Because of the relative paucity of prospective studies, we have been very inclusive in our inclusion of experiences from the published clinical databases. CONCLUSIONS Whilst surgical resection and SBRT remain the current mainstay of curative therapies for peripheral cancers, in the foreseeable future, developments and further research will see bronchoscopic ablative therapies become viable lung sparing alternatives in those deemed suitable. The future is bright.
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Affiliation(s)
- Gerard Olive
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
- University of Queensland Thoracic Research Centre, Queensland, Australia
| | - Rex Yung
- Chief Medical Officer – IONIQ (ProLung) Inc., Salt Lake City, UT, USA
| | - Henry Marshall
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
- University of Queensland Thoracic Research Centre, Queensland, Australia
| | - Kwun M. Fong
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
- University of Queensland Thoracic Research Centre, Queensland, Australia
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Krauss E, El-Guelai M, Pons-Kuehnemann J, Dartsch RC, Tello S, Korfei M, Mahavadi P, Breithecker A, Fink L, Stoehr M, Majeed RW, Seeger W, Crestani B, Guenther A. Clinical and Functional Characteristics of Patients with Unclassifiable Interstitial Lung Disease (uILD): Long-Term Follow-Up Data from European IPF Registry (eurIPFreg). J Clin Med 2020; 9:jcm9082499. [PMID: 32756496 PMCID: PMC7464480 DOI: 10.3390/jcm9082499] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/26/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022] Open
Abstract
(1) Aim of the study: In spite of extensive research, up to 20% of interstitial lung diseases (ILD) patients cannot be safely classified. We analyzed clinical features, progression factors, and outcomes of unclassifiable ILD (uILD). (2) Methods: A total of 140 uILD subjects from the University of Giessen and Marburg Lung Center (UGMLC) were recruited between 11/2009 and 01/2019 into the European Registry for idiopathic pulmonary fibrosis (eurIPFreg) and followed until 01/2020. The diagnosis of uILD was applied only when a conclusive diagnosis could not be reached with certainty. (3) Results: In 46.4% of the patients, the uILD diagnosis was due to conflicting clinical, radiological, and pathological data. By applying the diagnostic criteria of usual interstitial pneumonia (UIP) based on computed tomography (CT), published by the Fleischner Society, 22.2% of the patients displayed a typical UIP pattern. We also showed that forced vital capacity (FVC) at baseline (p = 0.008), annual FVC decline ≥10% (p < 0.0001), smoking (p = 0.033), and a diffusing capacity of the lung for carbon monoxide (DLco) ≤55% of predicted value at baseline (p < 0.0001) were significantly associated with progressive disease. (4) Conclusions: The most important prognostic factors in uILD are baseline level and decline in lung function and smoking. The use of Fleischner diagnostic criteria allows further differentiation and accurate diagnosis.
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Affiliation(s)
- Ekaterina Krauss
- European IPF Registry & Biobank (eurIPFreg/bank), 35392 Giessen, Germany; (E.K.); (M.E.-G.); (R.C.D.); (S.T.); (M.K.); (P.M.); (M.S.); (R.W.M.); (W.S.); (B.C.)
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), 35392 Giessen, Germany; (A.B.); (L.F.)
| | - Mustapha El-Guelai
- European IPF Registry & Biobank (eurIPFreg/bank), 35392 Giessen, Germany; (E.K.); (M.E.-G.); (R.C.D.); (S.T.); (M.K.); (P.M.); (M.S.); (R.W.M.); (W.S.); (B.C.)
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), 35392 Giessen, Germany; (A.B.); (L.F.)
| | - Joern Pons-Kuehnemann
- Medical Statistics, Institute of Medical Informatics, Justus-Liebig University of Giessen; 35392 Giessen, Germany;
| | - Ruth C. Dartsch
- European IPF Registry & Biobank (eurIPFreg/bank), 35392 Giessen, Germany; (E.K.); (M.E.-G.); (R.C.D.); (S.T.); (M.K.); (P.M.); (M.S.); (R.W.M.); (W.S.); (B.C.)
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), 35392 Giessen, Germany; (A.B.); (L.F.)
| | - Silke Tello
- European IPF Registry & Biobank (eurIPFreg/bank), 35392 Giessen, Germany; (E.K.); (M.E.-G.); (R.C.D.); (S.T.); (M.K.); (P.M.); (M.S.); (R.W.M.); (W.S.); (B.C.)
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), 35392 Giessen, Germany; (A.B.); (L.F.)
| | - Martina Korfei
- European IPF Registry & Biobank (eurIPFreg/bank), 35392 Giessen, Germany; (E.K.); (M.E.-G.); (R.C.D.); (S.T.); (M.K.); (P.M.); (M.S.); (R.W.M.); (W.S.); (B.C.)
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), 35392 Giessen, Germany; (A.B.); (L.F.)
| | - Poornima Mahavadi
- European IPF Registry & Biobank (eurIPFreg/bank), 35392 Giessen, Germany; (E.K.); (M.E.-G.); (R.C.D.); (S.T.); (M.K.); (P.M.); (M.S.); (R.W.M.); (W.S.); (B.C.)
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), 35392 Giessen, Germany; (A.B.); (L.F.)
| | - Andreas Breithecker
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), 35392 Giessen, Germany; (A.B.); (L.F.)
- Gesundheitszentrum Wetterau, 61231 Bad Nauheim, Germany
| | - Ludger Fink
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), 35392 Giessen, Germany; (A.B.); (L.F.)
- Gesundheitszentrum Wetterau, 61231 Bad Nauheim, Germany
- Institute of Pathology, Cytology, and Molecular Pathology, 35578 Wetzlar, Germany
| | - Mark Stoehr
- European IPF Registry & Biobank (eurIPFreg/bank), 35392 Giessen, Germany; (E.K.); (M.E.-G.); (R.C.D.); (S.T.); (M.K.); (P.M.); (M.S.); (R.W.M.); (W.S.); (B.C.)
| | - Raphael W. Majeed
- European IPF Registry & Biobank (eurIPFreg/bank), 35392 Giessen, Germany; (E.K.); (M.E.-G.); (R.C.D.); (S.T.); (M.K.); (P.M.); (M.S.); (R.W.M.); (W.S.); (B.C.)
| | - Werner Seeger
- European IPF Registry & Biobank (eurIPFreg/bank), 35392 Giessen, Germany; (E.K.); (M.E.-G.); (R.C.D.); (S.T.); (M.K.); (P.M.); (M.S.); (R.W.M.); (W.S.); (B.C.)
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), 35392 Giessen, Germany; (A.B.); (L.F.)
- Cardio-Pulmonary Institute (CPI) 35392 Giessen, Germany
| | - Bruno Crestani
- European IPF Registry & Biobank (eurIPFreg/bank), 35392 Giessen, Germany; (E.K.); (M.E.-G.); (R.C.D.); (S.T.); (M.K.); (P.M.); (M.S.); (R.W.M.); (W.S.); (B.C.)
- Institute National de la Sainté et de la Recherche Médicale, Hopital Bichat, Service de Pneumologie, 75018 Paris, France
| | - Andreas Guenther
- European IPF Registry & Biobank (eurIPFreg/bank), 35392 Giessen, Germany; (E.K.); (M.E.-G.); (R.C.D.); (S.T.); (M.K.); (P.M.); (M.S.); (R.W.M.); (W.S.); (B.C.)
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), 35392 Giessen, Germany; (A.B.); (L.F.)
- Cardio-Pulmonary Institute (CPI) 35392 Giessen, Germany
- Agaplesion Lung Clinic Waldhof-Elgershausen, 35753 Greifenstein, Germany
- Correspondence: ; Tel.: +49-641-985-42514; Fax: +49-641-985-42508
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