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Abia-Trujillo D, Folch EE, Yu Lee-Mateus A, Balasubramanian P, Kheir F, Keyes CM, Villalobos R, Chadha RM, Hazelett BN, Fernandez-Bussy S. Mobile cone-beam computed tomography complementing shape-sensing robotic-assisted bronchoscopy in the small pulmonary nodule sampling: A multicentre experience. Respirology 2024; 29:324-332. [PMID: 38016646 DOI: 10.1111/resp.14626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/12/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Shape-sensing robotic-assisted bronchoscopy (ssRAB) has expanded as an important diagnostic tool for peripheral pulmonary nodules (PPNs), with diagnostic yields ranging from 60% to 88%. However, sampling and diagnosing PPN less than 2 cm in size has historically been challenging. Mobile cone-beam computed tomography (mCBCT) has been recently integrated into ssRAB to improve diagnostic accuracy, but its added value remains uncertain. We aim to describe the role of mCBCT and determine if it provides any diagnostic advantage. METHODS A multicentre, retrospective study on the use of ssRAB and mCBCT in two tertiary care institutions: Mayo Clinic Florida and Massachusetts General Hospital. The primary outcome was diagnostic yield and sensitivity for malignancy of ssRAB complemented with mCBCT, compared to ssRAB with the standard 2D fluoroscopy. RESULTS A total of 192 nodules were biopsied from 173 patients. mCBCT was used in 117 (60.9%) nodules. The overall diagnostic yield was 85.4%. Diagnostic yield between subgroups with and without mCBCT was 83.8% and 88% (p = 0.417), respectively. The mCBCT group had fewer solid nodules (65.8% vs. 81.3%, p = 0.020) and a higher number of ground-glass nodules (10.3% vs. 1.3%, p = 0.016). CONCLUSION Overall, diagnostic yield between subgroups with and without mCBCT was similar. The complementary use of mCBCT to ssRAB allows proceduralists to target more complex and subsolid PPNs with a diagnostic yield comparable to simple solid PPNs while maintaining an excellent safety profile.
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Affiliation(s)
- David Abia-Trujillo
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Erik E Folch
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Fayez Kheir
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Colleen M Keyes
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Regina Villalobos
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ryan M Chadha
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Britney N Hazelett
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
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2
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Hariri LP, Sharma A, Nandy S, Berigei SR, Yamamoto S, Raphaely RA, Flashner BM, Muniappan A, Auchincloss HG, Lanuti M, Hallowell RW, Shea BS, Keyes CM. Endobronchial Optical Coherence Tomography as a Novel Method for In Vivo Microscopic Assessment of Interstitial Lung Abnormalities. Am J Respir Crit Care Med 2024. [PMID: 38207094 DOI: 10.1164/rccm.202310-1871le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/10/2024] [Indexed: 01/13/2024] Open
Affiliation(s)
- Lida P Hariri
- Massachusetts General Hospital, Pathology, Boston, Massachusetts, United States;
| | - Amita Sharma
- Massachusetts General Hospital, Radiology, Boston, Massachusetts, United States
| | - Sreyankar Nandy
- Massachusetts General Hospital, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Sarita R Berigei
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States
| | - Satomi Yamamoto
- Massachusetts General Hospital, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Rebecca A Raphaely
- University of Washington, 7284, Division of Pulmonary and Critical Care Medicine, Seattle, Washington, United States
| | - Bess M Flashner
- Beth Israel Deaconess Medical Center, 1859, Internal Medicine, Boston, Massachusetts, United States
| | - Ashok Muniappan
- Massachusetts General Hospital, Thoracic Surgery, Boston, Massachusetts, United States
| | - Hugh G Auchincloss
- Massachusetts General Hospital, Thoracic Surgery, Boston, Massachusetts, United States
| | - Michael Lanuti
- Massachusetts General Hospital, Thoracic Surgery, Boston, Massachusetts, United States
| | - Robert W Hallowell
- Massachusetts General Hospital, 2348, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Barry S Shea
- Massachusetts General Hospital, 2348, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Colleen M Keyes
- Massachusetts General Hospital, Interventional Pulmonology, Boston, Massachusetts, United States
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3
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Dagogo-Jack I, Manoogian A, Jessop N, Georgantas NZ, Fintelmann FJ, Farahani A, Digumarthy SR, Price MC, Folch EE, Keyes CM, Do A, Peterson JL, Mino-Kenudson M, Pitman M, Rivera M, Nardi V, Dias-Santagata D, Le LP, Iafrate AJ, Heist RS, Ritterhouse LR, Lennerz JK. Integrated Radiology, Pathology, and Pharmacy Program to Accelerate Access to Osimertinib. JCO Oncol Pract 2023; 19:786-792. [PMID: 37437226 PMCID: PMC10538938 DOI: 10.1200/op.23.00031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/18/2023] [Accepted: 05/30/2023] [Indexed: 07/14/2023] Open
Abstract
PURPOSE Targeted therapy yields superior outcomes relative to genotype-agnostic therapy for patients with epidermal growth factor receptor (EGFR)-mutant lung cancer. Workflows that facilitate timely detection of EGFR mutations and early dispensation of osimertinib can improve management of this disease. METHODS We developed an Integrated Radiology, Pathology, and Pharmacy Program to minimize delays in initiating osimertinib. The intervention consisted of parallel workflows coupling interventional radiology, surgical pathology, and analysis of nucleic acids from frozen tissue with early pharmacy engagement. We compared time to EGFR testing results and time to treatment for participating patients with those of historical cohorts. RESULTS Between January 2020 and December 2021, 222 patients participated in the intervention. The median turnaround time from biopsy to EGFR results was 1 workday. Forty-nine (22%) tumors harbored EGFR exon 19 deletions or EGFR L858R. Thirty-one (63%) patients were prescribed osimertinib via the intervention. The median interval between osimertinib prescription and osimertinib dispensation was 3 days; dispensation occurred within 48 hours for 42% of patients. The median interval between biopsy and osimertinib dispensation was 5 days. Three patients received osimertinib within 24 hours of EGFR results. Compared with patients with EGFR-mutant non-small-cell lung cancer who were diagnosed through routine workflows, the intervention led to a significant reduction in median time between biopsy and EGFR results (1 v 7 days; P < .01) and median time to treatment initiation (5 v 23 days; P < .01). CONCLUSION Combining radiology and pathology workflows with early parallel pharmacy engagement leads to a significant reduction in time to initiating osimertinib. Multidisciplinary integration programs are essential to maximize clinical utility of rapid testing.
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Affiliation(s)
- Ibiayi Dagogo-Jack
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Nicholas Jessop
- Center for Integrated Diagnostics, Massachusetts General Hospital, Boston, MA
| | - N. Zeke Georgantas
- Center for Integrated Diagnostics, Massachusetts General Hospital, Boston, MA
| | - Florian J. Fintelmann
- Harvard Medical School, Boston, MA
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Alexander Farahani
- Center for Integrated Diagnostics, Massachusetts General Hospital, Boston, MA
| | - Subba R. Digumarthy
- Harvard Medical School, Boston, MA
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Melissa C. Price
- Harvard Medical School, Boston, MA
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Erik E. Folch
- Harvard Medical School, Boston, MA
- Interventional Pulmonology, Massachusetts General Hospital, Boston, MA
| | - Colleen M. Keyes
- Harvard Medical School, Boston, MA
- Interventional Pulmonology, Massachusetts General Hospital, Boston, MA
| | - Andrew Do
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | - Mari Mino-Kenudson
- Harvard Medical School, Boston, MA
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Martha Pitman
- Harvard Medical School, Boston, MA
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Miguel Rivera
- Harvard Medical School, Boston, MA
- Center for Integrated Diagnostics, Massachusetts General Hospital, Boston, MA
| | - Valentina Nardi
- Harvard Medical School, Boston, MA
- Center for Integrated Diagnostics, Massachusetts General Hospital, Boston, MA
| | - Dora Dias-Santagata
- Harvard Medical School, Boston, MA
- Center for Integrated Diagnostics, Massachusetts General Hospital, Boston, MA
| | - Long P. Le
- Center for Integrated Diagnostics, Massachusetts General Hospital, Boston, MA
| | - Anthony John Iafrate
- Harvard Medical School, Boston, MA
- Center for Integrated Diagnostics, Massachusetts General Hospital, Boston, MA
| | - Rebecca S. Heist
- Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Lauren R. Ritterhouse
- Harvard Medical School, Boston, MA
- Center for Integrated Diagnostics, Massachusetts General Hospital, Boston, MA
| | - Jochen K. Lennerz
- Harvard Medical School, Boston, MA
- Center for Integrated Diagnostics, Massachusetts General Hospital, Boston, MA
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4
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Temel JS, Dudzinski DM, Digumarthy SR, Keyes CM, Keane FK, Shepherd D. Case 35-2022: A 60-Year-Old Man with Progressive Dyspnea, Neck Swelling, and a Lung Mass. N Engl J Med 2022; 387:1889-1896. [PMID: 36383716 DOI: 10.1056/nejmcpc2211354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jennifer S Temel
- From the Departments of Medicine (J.S.T., D.M.D., C.M.K.), Radiology (S.R.D.), Radiation Oncology (F.K.K.), and Pathology (D.S.), Massachusetts General Hospital, and the Departments of Medicine (J.S.T., D.M.D., C.M.K.), Radiology (S.R.D.), Radiation Oncology (F.K.K.), and Pathology (D.S.), Harvard Medical School - both in Boston
| | - David M Dudzinski
- From the Departments of Medicine (J.S.T., D.M.D., C.M.K.), Radiology (S.R.D.), Radiation Oncology (F.K.K.), and Pathology (D.S.), Massachusetts General Hospital, and the Departments of Medicine (J.S.T., D.M.D., C.M.K.), Radiology (S.R.D.), Radiation Oncology (F.K.K.), and Pathology (D.S.), Harvard Medical School - both in Boston
| | - Subba R Digumarthy
- From the Departments of Medicine (J.S.T., D.M.D., C.M.K.), Radiology (S.R.D.), Radiation Oncology (F.K.K.), and Pathology (D.S.), Massachusetts General Hospital, and the Departments of Medicine (J.S.T., D.M.D., C.M.K.), Radiology (S.R.D.), Radiation Oncology (F.K.K.), and Pathology (D.S.), Harvard Medical School - both in Boston
| | - Colleen M Keyes
- From the Departments of Medicine (J.S.T., D.M.D., C.M.K.), Radiology (S.R.D.), Radiation Oncology (F.K.K.), and Pathology (D.S.), Massachusetts General Hospital, and the Departments of Medicine (J.S.T., D.M.D., C.M.K.), Radiology (S.R.D.), Radiation Oncology (F.K.K.), and Pathology (D.S.), Harvard Medical School - both in Boston
| | - Florence K Keane
- From the Departments of Medicine (J.S.T., D.M.D., C.M.K.), Radiology (S.R.D.), Radiation Oncology (F.K.K.), and Pathology (D.S.), Massachusetts General Hospital, and the Departments of Medicine (J.S.T., D.M.D., C.M.K.), Radiology (S.R.D.), Radiation Oncology (F.K.K.), and Pathology (D.S.), Harvard Medical School - both in Boston
| | - Daniel Shepherd
- From the Departments of Medicine (J.S.T., D.M.D., C.M.K.), Radiology (S.R.D.), Radiation Oncology (F.K.K.), and Pathology (D.S.), Massachusetts General Hospital, and the Departments of Medicine (J.S.T., D.M.D., C.M.K.), Radiology (S.R.D.), Radiation Oncology (F.K.K.), and Pathology (D.S.), Harvard Medical School - both in Boston
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5
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Nandy S, Berigei SR, Keyes CM, Muniappan A, Auchincloss HG, Lanuti M, Roop BW, Shih AR, Colby TV, Medoff BD, Suter MJ, Villiger M, Hariri LP. Polarization-Sensitive Endobronchial Optical Coherence Tomography for Microscopic Imaging of Fibrosis in Interstitial Lung Disease. Am J Respir Crit Care Med 2022; 206:905-910. [PMID: 35675552 DOI: 10.1164/rccm.202112-2832le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sreyankar Nandy
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | | | - Colleen M Keyes
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Ashok Muniappan
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Hugh G Auchincloss
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Michael Lanuti
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | | | - Angela R Shih
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | | | - Benjamin D Medoff
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Melissa J Suter
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Martin Villiger
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Lida P Hariri
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
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6
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Hariri LP, Flashner BM, Kanarek DJ, O'Donnell WJ, Soskis A, Ziehr DR, Frank A, Nandy S, Berigei SR, Sharma A, Mathisen D, Keyes CM, Lanuti M, Muniappan A, Shepard JAO, Mino-Kenudson M, Ly A, Hung YP, Castelino FV, Ott HC, Medoff BD, Christiani DC. E-Cigarette Use, Small Airway Fibrosis, and Constrictive Bronchiolitis. NEJM Evid 2022; 1:10.1056/evidoa2100051. [PMID: 37122361 PMCID: PMC10137322 DOI: 10.1056/evidoa2100051] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Vaping, including the use of electronic cigarettes (e-cigarettes), has become increasingly prevalent, yet the associated long-term health risks are largely unknown. Given the prevalence of use, particularly among adolescents early in their lifespan, it is vital to understand the potential chronic pathologic sequelae of vaping. METHODS We present the cases of four patients with chronic lung disease associated with e-cigarette use characterized by clinical evaluation, with pulmonary function tests (PFTs), chest high-resolution computed tomography (HRCT), endobronchial optical coherence tomography (EB-OCT) imaging, and histopathologic assessment. RESULTS Each patient presented with shortness of breath and chest pain in association with a 3- to 8-year history of e-cigarette use, with mild progressive airway obstruction on PFTs and/or chest HRCT findings demonstrating evidence of air trapping and bronchial wall thickening. EB-OCT imaging performed in two patients showed small airway–centered fibrosis with bronchiolar narrowing and lumen irregularities. The predominant histopathologic feature on surgical lung biopsy was small airway–centered fibrosis, including constrictive bronchiolitis and MUC5AC overexpression in all patients. Patients who ceased vaping had a partial, but not complete, reversal of disease over 1 to 4 years. CONCLUSIONS After thorough evaluation for other potential etiologies, vaping was considered to be the most likely common causal etiology for all patients due to the temporal association of symptomatic chronic lung disease with e-cigarette use and partial improvement in symptoms after e-cigarette cessation. In this series, we associate the histopathologic pattern of small airway–centered fibrosis, including constrictive bronchiolitis, with vaping, potentially defining a clinical and pathologic entity associated with e-cigarette use. (Funded in part by the National Institutes of Health.)
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Affiliation(s)
- Lida P Hariri
- Department of Pathology, Massachusetts General Hospital, Boston
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Bess M Flashner
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - David J Kanarek
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Walter J O'Donnell
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Alyssa Soskis
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
- Division of Pulmonary and Critical Care Medicine, Duke University Hospital, Durham, NC
| | - David R Ziehr
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Angela Frank
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Sreyankar Nandy
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Sarita R Berigei
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Amita Sharma
- Harvard Medical School, Boston
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Douglas Mathisen
- Harvard Medical School, Boston
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston
| | - Colleen M Keyes
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Michael Lanuti
- Harvard Medical School, Boston
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston
| | - Ashok Muniappan
- Harvard Medical School, Boston
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston
| | | | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Flavia V Castelino
- Harvard Medical School, Boston
- Division of Rheumatology, Massachusetts General Hospital, Boston
| | - Harald C Ott
- Harvard Medical School, Boston
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - David C Christiani
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
- Harvard T.H. Chan School of Public Health, Boston
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7
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Nandy S, Raphaely RA, Muniappan A, Shih A, Roop BW, Sharma A, Keyes CM, Colby TV, Auchincloss HG, Gaissert HA, Lanuti M, Morse CR, Ott HC, Wain JC, Wright CD, Garcia-Moliner ML, Smith ML, VanderLaan PA, Berigei SR, Mino-Kenudson M, Horick NK, Liang LL, Davies DL, Szabari MV, Caravan P, Medoff BD, Tager AM, Suter MJ, Hariri LP. Reply to Kalverda et al.: Endobronchial Optical Coherence Tomography: Shining New Light on Diagnosing Usual Interstitial Pneumonitis? Am J Respir Crit Care Med 2022; 205:968-971. [PMID: 35148493 PMCID: PMC9838623 DOI: 10.1164/rccm.202112-2737le] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Sreyankar Nandy
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Rebecca A. Raphaely
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Ashok Muniappan
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Angela Shih
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | | | - Amita Sharma
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Colleen M. Keyes
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | | | - Hugh G. Auchincloss
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Henning A. Gaissert
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Michael Lanuti
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Christopher R. Morse
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Harald C. Ott
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - John C. Wain
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts,St. Elizabeth’s Medical CenterBoston, Massachusetts
| | - Cameron D. Wright
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | | | | | - Paul A. VanderLaan
- Harvard Medical SchoolBoston, Massachusetts,Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | | | - Mari Mino-Kenudson
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Nora K. Horick
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | | | | | - Margit V. Szabari
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Peter Caravan
- Harvard Medical SchoolBoston, Massachusetts,Athinoula A. Martinos Center for Biomedical ImagingCharlestown, Massachusetts,Massachusetts General HospitalCharlestown, Massachusetts
| | - Benjamin D. Medoff
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Andrew M. Tager
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Melissa J. Suter
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Lida P. Hariri
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts,Corresponding author (e-mail: )
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8
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Nandy S, Raphaely RA, Muniappan A, Shih A, Roop BW, Sharma A, Keyes CM, Colby TV, Auchincloss HG, Gaissert HA, Lanuti M, Morse CR, Ott HC, Wain JC, Wright CD, Garcia-Moliner ML, Smith ML, VanderLaan PA, Berigei SR, Mino-Kenudson M, Horick NK, Liang LL, Davies DL, Szabari MV, Caravan P, Medoff BD, Tager AM, Suter MJ, Hariri LP. Diagnostic Accuracy of Endobronchial Optical Coherence Tomography for the Microscopic Diagnosis of Usual Interstitial Pneumonia. Am J Respir Crit Care Med 2021; 204:1164-1179. [PMID: 34375171 PMCID: PMC8759308 DOI: 10.1164/rccm.202104-0847oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022] Open
Abstract
Rationale: Early, accurate diagnosis of interstitial lung disease (ILD) informs prognosis and therapy, especially in idiopathic pulmonary fibrosis (IPF). Current diagnostic methods are imperfect. High-resolution computed tomography has limited resolution, and surgical lung biopsy (SLB) carries risks of morbidity and mortality. Endobronchial optical coherence tomography (EB-OCT) is a low-risk, bronchoscope-compatible modality that images large lung volumes in vivo with microscopic resolution, including subpleural lung, and has the potential to improve the diagnostic accuracy of bronchoscopy for ILD diagnosis. Objectives: We performed a prospective diagnostic accuracy study of EB-OCT in patients with ILD with a low-confidence diagnosis undergoing SLB. The primary endpoints were EB-OCT sensitivity/specificity for diagnosis of the histopathologic pattern of usual interstitial pneumonia (UIP) and clinical IPF. The secondary endpoint was agreement between EB-OCT and SLB for diagnosis of the ILD fibrosis pattern. Methods: EB-OCT was performed immediately before SLB. The resulting EB-OCT images and histopathology were interpreted by blinded, independent pathologists. Clinical diagnosis was obtained from the treating pulmonologists after SLB, blinded to EB-OCT. Measurements and Main Results: We enrolled 31 patients, and 4 were excluded because of inconclusive histopathology or lack of EB-OCT data. Twenty-seven patients were included in the analysis (16 men, average age: 65.0 yr): 12 were diagnosed with UIP and 15 with non-UIP ILD. Average FVC and DlCO were 75.3% (SD, 18.5) and 53.5% (SD, 16.4), respectively. Sensitivity and specificity of EB-OCT was 100% (95% confidence interval, 75.8-100.0%) and 100% (79.6-100%), respectively, for both histopathologic UIP and clinical diagnosis of IPF. There was high agreement between EB-OCT and histopathology for diagnosis of ILD fibrosis pattern (weighted κ: 0.87 [0.72-1.0]). Conclusions: EB-OCT is a safe, accurate method for microscopic ILD diagnosis, as a complement to high-resolution computed tomography and an alternative to SLB.
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Affiliation(s)
- Sreyankar Nandy
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Rebecca A. Raphaely
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Ashok Muniappan
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Angela Shih
- Department of Pathology
- Harvard Medical School, Boston, Massachusetts
| | - Benjamin W. Roop
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
| | - Amita Sharma
- Department of Radiology, and
- Harvard Medical School, Boston, Massachusetts
| | - Colleen M. Keyes
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Thomas V. Colby
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | | | - Michael Lanuti
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | | | - Harald C. Ott
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - John C. Wain
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
- St. Elizabeth’s Medical Center, Boston, Massachusetts
| | - Cameron D. Wright
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Maria L. Garcia-Moliner
- Department of Pathology, Rhode Island Hospital and Alpert Medical School, Providence, Rhode Island
| | - Maxwell L. Smith
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Paul A. VanderLaan
- Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sarita R. Berigei
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
| | | | - Nora K. Horick
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | - Margit V. Szabari
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Peter Caravan
- Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts; and
- Institute for Innovation in Imaging (i), Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Benjamin D. Medoff
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Andrew M. Tager
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Melissa J. Suter
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Lida P. Hariri
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Department of Pathology
- Harvard Medical School, Boston, Massachusetts
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Fintelmann FJ, Braun P, Mirzan SH, Huang AJ, Best TD, Keyes CM, Choy E, Leppelmann KS, Muniappan A, Soto DE, Som A, Uppot RN. Percutaneous Cryoablation: Safety and Efficacy for Pain Palliation of Metastases to Pleura and Chest Wall. J Vasc Interv Radiol 2019; 31:294-300. [PMID: 31899108 DOI: 10.1016/j.jvir.2019.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/21/2019] [Accepted: 09/17/2019] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To assess safety and efficacy of percutaneous cryoablation for pain palliation of metastases to pleura and chest wall. MATERIALS AND METHODS This retrospective single-center cohort study included 22 patients (27% female, mean age 63 y ± 11.4) who underwent 25 cryoablation procedures for pain palliation of 39 symptomatic metastases measuring 5.1 cm ± 1.9 (range, 2.0-8.0 cm) in pleura and chest wall between June 2012 and December 2017. Pain intensity was assessed using a numerical scale (0-10 points). Statistical tests t test, χ2, and Wilcoxon signed rank were performed. RESULTS Patients were followed for a median of 4.1 months (interquartile range [IQR], 2.3-10.1; range, 0.1-36.7 mo) before death or loss to follow-up. Following cryoablation, pain intensity decreased significantly by a median of 4.5 points (IQR, 2.8-6; range, 0-10 points; P = .0002 points, Wilcoxon signed rank). Pain relief of at least 3 points was documented following 18 of 20 procedures. Pain relief occurred within a median of 1 day following cryoablation (IQR, 1-2; range, 1-4 d) and lasted for a median of 5 weeks (IQR, 3-17; range, 1-34 wk). Systemic opioid requirements decreased in 11 of 22 patients (50%) by an average of 56% ± 34. Difference in morphine milligram equivalents was not significant (P = .73, Wilcoxon signed rank). No procedure-related complications occurred despite previous radiation of 7 tumors. Of 25 procedures, 22 (88%) were performed on an outpatient basis. CONCLUSIONS Percutaneous cryoablation for metastases to pleura and chest wall can safely provide significant pain relief within days following a single session.
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Affiliation(s)
- Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.
| | - Platon Braun
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Syed Hamad Mirzan
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Ambrose J Huang
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Till D Best
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114; Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Colleen M Keyes
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Edwin Choy
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | | | - Ashok Muniappan
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Daniel E Soto
- Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Avik Som
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Raul N Uppot
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
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Abstract
BACKGROUND Autopsy identifies lung involvement in 58-92% of patients with the most prevalent forms of systemic amyloidoses. In the absence of lung biopsies, amyloid lung disease often goes unrecognized. Report of a death following transbronchial biopsies in a patient with systemic amyloidosis cautioned against the procedure in this patient cohort. We reviewed our experience with transbronchial biopsies in patients with amyloidosis to determine the safety and utility of bronchoscopic lung biopsies. METHODS We identified patients referred to the Amyloidosis Center at Boston Medical Center with lung amyloidosis diagnosed by transbronchial lung biopsies (TBBX). Amyloid typing was determined by immunohistochemistry or mass spectrometry. Standard end organ assessments, including pulmonary function test (PFT) and chest tomography (CT) imaging, and extra-thoracic biopsies established the extent of disease. RESULTS Twenty-five (21.7%) of 115 patients with lung amyloidosis were diagnosed by TBBX. PFT classified 33.3% with restrictive physiology, 28.6% with obstructive disease, and 9.5% mixed physiology; 9.5% exhibited isolated diffusion defects while 19% had normal pulmonary testing. Two view chest or CT imaging identified focal opacities in 52% of cases and diffuse interstitial disease in 48%. Amyloid type and disease extent included 68% systemic AL disease, 16% localized (lung limited) AL disease, 12% ATTR disease, and 4% AA amyloidosis. Fluoroscopy was not used during biopsy. No procedure complications were reported. CONCLUSIONS Our case series of 25 patients supports the use of bronchoscopic transbronchial biopsies for diagnosis of parenchymal lung amyloidosis. Normal PFTs do not rule out the histologic presence of amyloid lung disease.
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Affiliation(s)
- Praveen Govender
- a Pulmonary Center, Boston Medical Center , Boston , MA , USA.,b Department of Medicine , Boston Medical Center , Boston , MA , USA
| | | | | | - Carl J O'Hara
- e Amyloidosis Center, Boston Medical Center , Boston , MA , USA.,f Department of Pathology , Boston Medical Center , Boston , MA , USA
| | - Vaishali Sanchorawala
- b Department of Medicine , Boston Medical Center , Boston , MA , USA.,e Amyloidosis Center, Boston Medical Center , Boston , MA , USA
| | - John L Berk
- a Pulmonary Center, Boston Medical Center , Boston , MA , USA.,b Department of Medicine , Boston Medical Center , Boston , MA , USA.,e Amyloidosis Center, Boston Medical Center , Boston , MA , USA
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