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Marcoux V, Lok SD, Mondal P, Assayag D, Fisher JH, Shapera S, Morisset J, Manganas H, Fell CD, Hambly N, Cox PG, Kolb M, Gershon AS, To T, Sadatsafavi M, Khalil N, Wong AW, Wilcox PG, Ryerson CJ, Vu T, Johannson KA. Impact of surgical lung biopsy on lung function and survival in patients with idiopathic pulmonary fibrosis in a multi-centre registry cohort. Respirology 2024. [PMID: 38436522 DOI: 10.1111/resp.14695] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/14/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND OBJECTIVE Establishing an accurate and timely diagnosis of idiopathic pulmonary fibrosis (IPF) is essential for appropriate management and prognostication. In some cases, surgical lung biopsy (SLB) is performed but carries non-negligible risk. The objective of this retrospective study was to determine if SLB is associated with accelerated lung function decline in patients with IPF using the Canadian Registry for Pulmonary Fibrosis. METHODS Linear mixed models and Cox proportional hazards regression models were used to compare decline in forced vital capacity (FVC)%, diffusion capacity of the lung (DLCO%) and risk of death or lung transplantation between SLB and non-SLB patients. Adjustments were made for baseline age, sex, smoking history, antifibrotic use, and lung function. A similar analysis compared lung function changes 12 months pre- and post-SLB. RESULTS A total of 81 SLB patients and 468 non-SLB patients were included. In the SLB group, the post-biopsy annual FVC% decline was 2.0% (±0.8) in unadjusted, and 2.1% (±0.8) in adjusted models. There was no difference in FVC% decline, DLCO% decline, or time to death or lung transplantation between the two groups, in adjusted or unadjusted models (all p-values >0.07). In the pre-post SLB group, no differences were identified in FVC% decline in unadjusted or adjusted models (p = 0.07 for both). CONCLUSION No association between SLB and lung function decline or risk of death or lung transplantation was identified in this multi-centre study of patients with IPF.
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Affiliation(s)
- Veronica Marcoux
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Stacey D Lok
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Prosanta Mondal
- Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Deborah Assayag
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Jolene H Fisher
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shane Shapera
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Julie Morisset
- Department of Medicine, Université de Montreal, Montreal, Quebec, Canada
| | - Hélène Manganas
- Department of Medicine, Université de Montreal, Montreal, Quebec, Canada
| | - Charlene D Fell
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nathan Hambly
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - P Gerard Cox
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Martin Kolb
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Andrea S Gershon
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Teresa To
- The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alyson W Wong
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Pearce G Wilcox
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Thao Vu
- Population Health, Quality and Research, Saskatchewan Cancer Agency, Saskatoon, Saskatchewan, Canada
| | - Kerri A Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
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Yamamoto R, Okagaki N, Sakamoto H, Tanaka Y, Takeda A, Maruguchi N, Nakamura S, Matsumura K, Ueyama M, Ikegami N, Kaji Y, Hashimoto S, Tanaka E, Taguchi Y, Maruyama W, Katsuragawa H, Sumiyoshi S, Hajiro T. Intravascular Large B-cell Lymphoma Presenting as Pulmonary Ground-glass Nodules That Progressed Slowly over Several Months with No Overt Symptoms. Intern Med 2024; 63:559-563. [PMID: 37407462 PMCID: PMC10937140 DOI: 10.2169/internalmedicine.2040-23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/28/2023] [Indexed: 07/07/2023] Open
Abstract
A 74-year-old man with no overt symptoms was referred for a chest computed tomography (CT) that revealed multiple bilaterally pulmonary ground-glass nodules (GGNs) with subtle changes in size over eight months. Surgical lung biopsies were performed in the left upper lobe. A pathologic study confirmed the intravascular large B-cell lymphoma (IVLBCL). This lesion was a nodule-like cluster of atypical cells, meaning that it had been localized for several months. Pulmonary IVLBCL may form focal lesions presenting as GGN on chest CT and progress slowly without apparent symptoms.
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Affiliation(s)
- Ryo Yamamoto
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | | | | | - Yuuma Tanaka
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | - Atsushi Takeda
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | | | | | | | | | - Naoya Ikegami
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | - Yusuke Kaji
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | | | - Eisaku Tanaka
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | - Yoshio Taguchi
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | | | - Hiroyuki Katsuragawa
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Japan
- Department of Clinical Pathology, Tenri Hospital, Japan
| | | | - Takashi Hajiro
- Department of Respiratory Medicine, Tenri Hospital, Japan
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3
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Kaláb J, Lišková E, Dušková J. The importance of lung biopsy in a patient with idiopathic pulmonary fibrosis: a case report. Cas Lek Cesk 2022; 161:242-246. [PMID: 36543579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a severe progressive fibrotic disease of the lung. Its etiology is not yet completely clear. The affected population is exclusively older than 40 years with maximum incidence in the age categories of 60 to 70 years. Its worldwide prevalence varies from 2 to 29/100 000 people (in the Czech Republic 5-6/100 000). Annual incidence is constantly rising, mainly thanks to the ever-improving diagnostic possibilities. Untreated IPF disease causes rapid structural and functional devastation of the lungs with development of respiratory insufficiency and death of the patient within 2 to 3 years after diagnosis, prognosis with IPF is therefore fully (without any exaggeration) comparable to untreated bronchogenic carcinoma. In recent years, the prognosis and quality of life of patients have significantly improved thanks to available specific antifibrotic treatment, which can substantially slow down the disease progression and thus prolong survival. However, a necessary condition for the timely treatment initiation is a quick and accurate diagnosis. The following case report describes a protracted journey to the correct diagnosis in a patient with atypical radiological findings, so that the definitive diagnosis was established only as a result of a surgical lung biopsy.
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Isono T, Shibata S, Matsui Y, Hosoda C, Kawabata Y, Shimizu Y, Takayanagi N. Rheumatoid Arthritis Accompanying Diffuse Panbronchiolitis. Intern Med 2021; 60:3779-3783. [PMID: 34148951 PMCID: PMC8710394 DOI: 10.2169/internalmedicine.6915-20] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 58-year-old woman with rheumatoid arthritis (RA) visited our hospital complaining of a persistent cough and sputum for the past year. She had a high cold hemagglutinin titer and chronic sinusitis. Chest computed tomography revealed bilateral diffuse centrilobular nodules, bronchiectasis, and bronchial wall thickening. A surgical lung biopsy was performed that confirmed diffuse panbronchiolitis (DPB) because of the lymphocytic and plasmacytic infiltrates in the respiratory bronchioles. Her condition improved after the administration of clarithromycin. Several cases of RA complicating DPB have previously been reported, but only in Japan. We need to consider DPB as a bronchiolitis types accompanying RA among Japanese patients.
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Affiliation(s)
- Taisuke Isono
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Shun Shibata
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Yuma Matsui
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Chiaki Hosoda
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Yoshinori Kawabata
- Department of Pathology, Saitama Cardiovascular and Respiratory Center, Japan
| | - Yoshihiko Shimizu
- Department of Pathology, Saitama Cardiovascular and Respiratory Center, Japan
| | - Noboru Takayanagi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
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Pastre J, Khandhar S, Barnett S, Ksovreli I, Mani H, Brown AW, Shlobin OA, Ahmad K, Khangoora V, Aryal S, Morris DL, King CS, Nathan SD. Surgical Lung Biopsy for Interstitial Lung Disease. Safety and Feasibility at a Tertiary Referral Center. Ann Am Thorac Soc 2021; 18:460-7. [PMID: 32970474 DOI: 10.1513/AnnalsATS.202006-759OC] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Rationale: Video-assisted thoracoscopic surgery (VATS) remains the gold standard for interstitial lung disease (ILD) characterization when histology is deemed necessary. There is diminishing use of VATS owing to increased reliance on high-resolution computed tomographic patterns, as well as concerns regarding the potential morbidity and mortality of the procedure.Objectives: The goal of this study was to evaluate the safety and tolerability of VATS among a broad group of patients with ILD referred to a tertiary care center.Methods: Data for all patients with ILD who underwent VATS lung biopsies at Inova Fairfax hospital for the period from December 2012 to September 2019 were collected. Clinical, physiologic, and functional parameters as well as postoperative outcomes including any complications, hospital length of stay, and mortality were collated.Results: There were 268 diagnostic VATS biopsies performed during the period. The mean age of the cohort was 63 ± 13 years, 54% were male, and 25% were ultimately diagnosed with idiopathic pulmonary fibrosis. Two hundred twenty-nine patients were scheduled (85%, Elective VATS group) whereas 39 were inpatients (15%). In the elective group, the 1-month complication rate was 8%, whereas 4% had a severe complication, and there were no deaths. The only mortalities were in the group who were hospitalized before the VATS (4/39 = 10%). Complications were less frequent when VATS was requested by the tertiary referral ILD team. Of the elective group, 87% patients were discharged the same day.Conclusions: This report demonstrates the safety, tolerability, and feasibility of VATS lung biopsy as a same-day procedure in the modern era, especially if patients are first vetted by a team with expertise in the field of ILD. These results support a lower threshold to pursue a VATS biopsy when histology is required for an ILD diagnosis.
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6
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Menezes V, Molina JC, Pollock C, Romeo P, Morisset J, Ferraro P, Lafontaine E, Martin J, Nasir B, Leduc C, Liberman M. Lung Cryobiopsy Outside of the Operating Room: A Safe Alternative to Surgical Biopsy. Innovations (Phila) 2021; 16:463-469. [PMID: 34338070 PMCID: PMC8637350 DOI: 10.1177/15569845211034506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective Transbronchial lung cryobiopsy (TBLC) is a promising technique that can
provide a histologic diagnosis in interstitial lung diseases (ILD) and is an
alternative to surgical lung biopsy. The main concerns with the procedure
are safety and diagnostic accuracy. The technique is applicable in patients
unable to undergo surgical biopsy due to severe comorbidities or when
patient transport to the operating room is dangerous. This study reports the
initial experience with TBLC on a thoracic surgical service as a first
attempt at diagnosis in patients with diffuse parenchymal lung diseases
(DPLD). Methods Between May 2018 and July 2020, 32 patients underwent TBLC using bedside
flexible bronchoscopy for suspected ILD on a thoracic surgical endoscopy
service. Retrospective evaluation of the procedure details, complications,
and diagnostic yield were analyzed and reported. Results A total of 89 pathological samples were obtained (mean 2.8 per patient).
Pneumothorax and minor bleeding occurred in 25% and 16.7% of patients,
respectively. Sixty-seven percent of complications occurred with use of the
2.4 mm cryoprobe (P = 0.036). Concordance between the
histologic diagnosis and final clinical diagnosis was observed in 62.5% of
patients and the pathology guided the final treatment in 71%
(P = 0.027) with Kappa-concordance of 0.60
(P < 0.001). Conclusions Cryobiopsy is becoming part of the diagnostic evaluation in patients with
indeterminate DPLD or hypoxemic respiratory failure. TBLC is easy to perform
and has a favorable safety profile. Thoracic specialists should consider
adding TBLC to their procedural armamentarium as a first option for patients
with indeterminate PLD.
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Affiliation(s)
- Vanessa Menezes
- 5622 Division of Thoracic Surgery, CHUM Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Juan Carlos Molina
- 5622 Division of Thoracic Surgery, CHUM Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Clare Pollock
- 5622 Division of Thoracic Surgery, CHUM Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Philippe Romeo
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Julie Morisset
- Division of Pulmonology, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Pasquale Ferraro
- 5622 Division of Thoracic Surgery, CHUM Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Edwin Lafontaine
- 5622 Division of Thoracic Surgery, CHUM Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Jocelyne Martin
- 5622 Division of Thoracic Surgery, CHUM Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Basil Nasir
- 5622 Division of Thoracic Surgery, CHUM Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Charles Leduc
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Moishe Liberman
- 5622 Division of Thoracic Surgery, CHUM Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Québec, Canada
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7
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Enomoto T, Takimoto T, Kagawa T, Tachibana K, Sugimoto C, Arai T, Sakurai T, Kasai T, Akira M, Hayashi S, Inoue Y. Histologically Proven Dendriform Pulmonary Ossification: A Five-case Series. Intern Med 2021; 60:2261-2268. [PMID: 33518560 PMCID: PMC8355403 DOI: 10.2169/internalmedicine.5906-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Dendriform pulmonary ossification (DPO) is a rare condition characterized by metaplastic bone formation in the lung parenchyma. It has been reported to be often associated with primary lung diseases, such as usual interstitial pneumonia (UIP) or chronic aspiration of gastric acid; however, its clinical features and pathophysiology remain unclear, especially in idiopathic cases. We herein report five DPO cases, including three with an idiopathic origin. In all cases of idiopathic DPO, the pathological and radiological examinations showed localized pulmonary lesions suggesting inflammation or hemorrhaging.
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Affiliation(s)
- Takatoshi Enomoto
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Takayuki Takimoto
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Tomoko Kagawa
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Kazunobu Tachibana
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Chikatoshi Sugimoto
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Toru Arai
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Teiko Sakurai
- Department of General Thoracic Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Takahiko Kasai
- Department of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Masanori Akira
- Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Seiji Hayashi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
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8
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Nagano M, Miyamoto A, Kikunaga S, Suzuki S, Takaya H, Fujii T, Fujimori S. Outcomes of Video-Assisted Thoracic Surgical Lung Biopsy for Interstitial Lung Diseases. Ann Thorac Cardiovasc Surg 2021; 27:290-296. [PMID: 33431760 PMCID: PMC8560540 DOI: 10.5761/atcs.oa.20-00270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Surgical lung biopsy (SLB) is an important diagnostic tool for interstitial lung disease (ILD), yet the risk factors for SLB are still debatable and long-term outcomes remain unknown. Methods: We retrospectively reviewed the records of 85 consecutive patients with ILD who underwent SLB by video-assisted thoracic surgery (VATS) from 2008 to 2019. Risk factors for complications and differences of outcomes between idiopathic pulmonary fibrosis (IPF) and other ILDs were examined. Results: All patients who underwent VATS had no mortality or acute exacerbation of ILD within 90 days of SLB. The rate of complication was 9.4%, and there were no statistically significant risk factors for complications. While the IPF group was not significantly different from the non-IPF group with regard to surgical parameters or complications, patients with IPF had significantly higher rates of mortality (50% vs. 9% in 5 years; p <0.001) and readmission due to acute exacerbation (75% vs. 8% in 5 years; p <0.001). Conclusion: VATS lung biopsy for ILD can be a safe approach regardless of underlying phenotypes. An accurate diagnosis of IPF via SLB may be beneficial for correct patient management.
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Affiliation(s)
- Masaaki Nagano
- Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan
| | - Atsushi Miyamoto
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan
| | - Shinichiro Kikunaga
- Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan
| | - Souichiro Suzuki
- Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan
| | - Hisashi Takaya
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Sakashi Fujimori
- Department of Thoracic Surgery, Respiratory Center, Toranomon Hospital, Tokyo, Japan
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9
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Barata M, Caetano Mota P, Melo N, Novais Bastos H, Guimarães S, Souto Moura C, Pereira JM, Morais A. Transbronchial lung cryobiopsy in smoking-related interstitial lung diseases. Sarcoidosis Vasc Diffuse Lung Dis 2020; 37:e2020013. [PMID: 33597800 PMCID: PMC7883511 DOI: 10.36141/svdld.v37i4.9934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/02/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transbronchial lung cryobiopsy (TBLC) is an emerging technique in the diagnostic approach to diffuse parenchymal lung diseases. However, the role of TBLC in smoking-related Interstitial Lung Diseases (ILDs) is still under discussion. OBJECTIVES The aim of the present study was to describe our experience with TBLC in diagnostic work-up of patients with smoking-related ILDs. METHOD We retrospectively reviewed data of patients evaluated in a tertiary hospital ILDs outpatient clinic, who underwent TBLC, from September 2014 to December 2019. TBLC was performed in accordance with the 2018 expert statement from the Cryobiopsy Working Group. RESULTS Forty-five patients (25 men [55.6%]) with a mean age of 53.9 years [SD, 9.1] were included. The most frequent radiological pattern was ground glass opacity (42 patients). TBLC was performed in different segments of the same lobe in 38 patients and in two lobes in 7 patients. The mean maximal diameter of the samples was 5.2 mm (range, 3-16 mm [SD 2.0]). Pneumothorax occurred in seven patients (15%) and moderate bleeding occurred in one patient. A specific pathological diagnosis was achieved in 43 of 45 patients. The most frequent histopathologic pattern found was desquamative interstitial pneumonia (33 patients), followed by smoking-related interstitial fibrosis (7 patients), respiratory bronchiolitis - ILD (1 patient) and pulmonary Langerhans cell histiocytosis (1 patient). Two patients had alternative diagnosis (Pneumoconiosis and Interstitial Pneumonia with unspecific features) and one patient had normal lung parenchyma. A definitive multidisciplinary team (MDT) diagnosis was reached in 95.5% (43 of 45 cases). Two patients were submitted to additional diagnostic techniques. CONCLUSIONS The results from this series support TBLC as a safe procedure with a meaningful diagnostic value in the context of a MDT approach of smoking-related ILDs. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (4): e2020013).
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Affiliation(s)
- Margarida Barata
- Pulmonology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Patrícia Caetano Mota
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of Porto University, Porto, Portugal
| | - Natália Melo
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Hélder Novais Bastos
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of Porto University, Porto, Portugal
| | - Susana Guimarães
- Faculty of Medicine of Porto University, Porto, Portugal
- Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Conceição Souto Moura
- Faculty of Medicine of Porto University, Porto, Portugal
- Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Miguel Pereira
- Faculty of Medicine of Porto University, Porto, Portugal
- Radiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - António Morais
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of Porto University, Porto, Portugal
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10
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Abstract
Chest computed tomography (CT) findings of minute pulmonary meningothelial-like nodules (MPMNs) usually show tiny nodules (2-5 mm in diameter) of ground-glass attenuation. However, diffuse, thin-walled cavities have rarely been reported. We herein report a 56-year-old woman with MPMNs showing diffuse, thin-walled cystic lesions on a thin-section chest CT scan. Clinicians need to be aware of the imaging characteristics of this conditions to guide appropriate management of lung diseases, as these CT findings may resemble certain metastatic lung neoplasias and primary adenocarcinoma of the lung.
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Affiliation(s)
- Masanori Harada
- Division of Respiratory Medicine, Iwata City Hospital, Japan
| | - Yuya Aono
- Division of Respiratory Medicine, Iwata City Hospital, Japan
| | - Hideki Yasui
- Division of Respiratory Medicine, Iwata City Hospital, Japan
| | - Tomohiro Uto
- Division of Respiratory Medicine, Iwata City Hospital, Japan
| | - Jun Sato
- Division of Respiratory Medicine, Iwata City Hospital, Japan
| | - Shiro Imokawa
- Division of Respiratory Medicine, Iwata City Hospital, Japan
| | | | | | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
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11
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Troy LK, Grainge C, Corte T, Williamson JP, Vallely MP, Cooper W, Mahar AM, Lai S, Mulyadi E, Torzillo PJ, Salamonsen M, Don G, Myers J, Raghu G, Lau EMT. Cryobiopsy versus open lung biopsy in the diagnosis of interstitial lung disease (COLDICE): protocol of a multicentre study. BMJ Open Respir Res 2019; 6:e000443. [PMID: 31321059 PMCID: PMC6606076 DOI: 10.1136/bmjresp-2019-000443] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction Transbronchial lung cryobiopsy (TBLC) is a novel, minimally invasive technique for obtaining lung tissue for histopathological assessment in interstitial lung disease (ILD). Despite its increasing popularity, the diagnostic accuracy of TBLC is not yet known. The COLDICE Study (Cryobiopsy versus Open Lung biopsy in the Diagnosis of Interstitial lung disease allianCE) aims to evaluate the agreement between TBLC and surgical lung biopsy sampled concurrently from the same patients, for both histopathological and multidisciplinary discussion (MDD) diagnoses. Methods and analysis This comparative, multicentre, prospective trial is enrolling patients with ILD requiring surgical lung biopsy to aid with their diagnosis. Participants are consented for both video-assisted thoracoscopic surgical (VATS) biopsy and TBLC within the same anaesthetic episode. Specimens will be blindly assessed by three expert pathologists both individually and by consensus. Each tissue sample will then be considered in conjunction with clinical and radiological data, within a centralised MDD. Each patient will be presented twice in random order, once with TBLC data and once with VATS data. Meeting participants will be blinded to the method of tissue sampling. The accuracy of TBLC will be assessed by agreement with VATS at (1) histopathological analysis and (2) MDD diagnosis. Data will be collected on interobserver agreement between pathologists, interobserver agreement between MDD participants, and detailed clinical and procedural characteristics. Ethics and dissemination The study is being conducted in accordance with the International Conference on Harmonisation Guideline for Good Clinical Practice and Australian legislation for the ethical conduct of research. Trial registration number ACTRN12615000718549.
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Affiliation(s)
- Lauren K Troy
- Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Christopher Grainge
- Faculty of Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,Respiratory Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Tamera Corte
- Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Jonathan P Williamson
- Respiratory Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia.,Respiratory Medicine, Macquarie University Hospital, North Ryde BC, New South Wales, Australia
| | - Michael P Vallely
- Cardiothoracic Surgery, Macquarie University Hospital, North Ryde BC, New South Wales, Australia
| | - Wendy Cooper
- Sydney Medical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Annabelle M Mahar
- Sydney Medical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Simon Lai
- Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Ellie Mulyadi
- Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Paul J Torzillo
- Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Matthew Salamonsen
- Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Garrick Don
- Respiratory Medicine, Royal North Shore Hospital School, Saint Leonards, New South Wales, Australia
| | - Jeffrey Myers
- Pathology, University of Michigan Hospital, Ann Arbor, Michigan, USA
| | - Ganesh Raghu
- Division of Pulmonary, Sleep and Critical Care Medicine, University of Washington, Seattle, Washington, USA
| | - Edmund M T Lau
- Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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12
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Okuda R, Hagiwara E, Katano T, Ikeda S, Sekine A, Kitamura H, Baba T, Okudela K, Ohashi K, Ogura T. Newly defined acute exacerbation of idiopathic pulmonary fibrosis with surgically-proven usual interstitial pneumonia: risk factors and outcome. Sarcoidosis Vasc Diffuse Lung Dis 2019; 36:39-46. [PMID: 32476935 DOI: 10.36141/svdld.v36i1.7117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/19/2018] [Indexed: 11/02/2022]
Abstract
Background In 2016, the diagnostic criteria for the acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) were revised. However, there have been published few clinical reports on AE-IPF published using the new criteria. The aim of this study was to investigate the incidence of, risk factors for, and mortality due to newly defined AE. Moreover, differences between triggered AE and idiopathic AE were investigated. Methods The retrospective study was conducted including all IPF patients diagnosed with surgically-proven usual interstitial pneumonia through multi-disciplinary discussion between January 2006 and December 2015. Data were retrieved from a clinical chart review. Results A total of 107 patients with newly diagnosed 107 IPF patients were included. The cumulative incidence of initial AE were 9.6% at 1 year, 16.8% at 2 years, 23.9% at 3 years, and 37.3% at 4 years after diagnosis. Three risk factors for AE-IPF development were identified: 1) the minimum peripheral ozygen saturation level of ≤88% during the 6-minute walk test at the time of diagnosis; 2) forced vital capacity (FVC) decreasing by ≥10% in 1 year; and 3) diffusion capacity of the lungs for carbon monoxide (DLco) decreasing by ≥15% in 1 year. There were no significant differences in background (excluding C-reactive protein), survival and treatment between patients with triggered AE and those with idiopathic AE. Conclusions The 6-minute walk test and an annual decline in FVC and DLco were predictive factors for AE incidence. The causes of AE-IPF did not affect the prognosis or treatment options in clinical practice.
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Affiliation(s)
- Ryo Okuda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center
| | - Takuma Katano
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center
| | - Hideya Kitamura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center
| | - Koji Okudela
- Department of Pathology, Yokohama City University Graduate School of Medicine
| | - Kenichi Ohashi
- Department of Pathology, Yokohama City University Graduate School of Medicine
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center
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13
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Minomo S, Kitaichi M, Arai T, Matsui H, Akira M, Inoue Y. Pulmonary Veno-occlusive Disease: A Surgical Lung Biopsy-proven and Autopsied Case Radiologically Mimicking Hypersensitivity Pneumonitis at the Time of a Transbronchial Lung Biopsy. Intern Med 2019; 58:955-964. [PMID: 30568112 PMCID: PMC6478985 DOI: 10.2169/internalmedicine.0681-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pulmonary veno-occlusive disease (PVOD) is a rare disease in the subgroup of conditions known as pulmonary arterial hypertension. Although a histological examination is needed for a definitive diagnosis, a non-invasive diagnosis is required for patients with pulmonary hypertension because a lung biopsy is deemed risky. We herein report a 32-year-old woman diagnosed with PVOD via a surgical lung biopsy and autopsy whose disease showed radiological findings mimicking those of hypersensitivity pneumonitis (pneumonia) at the time of the transbronchial lung biopsy, without obvious pulmonary hypertension on admission. When clinicians encounter patients with interstitial lung disease, they should not forget the possibility of PVOD and should be alert for emerging pulmonary hypertension.
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Affiliation(s)
- Shojiro Minomo
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Masanori Kitaichi
- Department of Pathology, National Hospital Organization Minami Wakayama Medical Center, Japan
| | - Toru Arai
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Hideo Matsui
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Masanori Akira
- Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
| | - Yoshikazu Inoue
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan
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14
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Aburto M, Herráez I, Iturbe D, Jiménez-Romero A. Diagnosis of Idiopathic Pulmonary Fibrosis: Differential Diagnosis. Med Sci (Basel) 2018; 6:E73. [PMID: 30181506 DOI: 10.3390/medsci6030073] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 12/18/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and fibrotic interstitial lung disease of unknown origin with a characteristic imaging and histologic pattern called usual interstitial pneumonia (UIP). The diagnosis of IPF is a complex procedure that requires the support of various specialists, who must integrate clinical, radiological, and histological data. The multidisciplinary team (MDT) has become the new gold standard to diagnose and manage the disease, increasing the accuracy and agreement of the diagnosis between different centers. It is mandatory to exclude nonspecific interstitial pneumonia or other diseases that can cause the UIP pattern, particularly drugs or exposure diseases, including chronic hypersensitivity pneumonitis or systemic autoimmune disease. The role of the MDT is also to decide who could need a biopsy or to review patient diagnoses at regular intervals in those with additional information or unexpected evolution. This review provides updated information to achieve a proper IPF diagnosis.
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15
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Abstract
Necrotizing sarcoid granulomatosis (NSG) is a rare disease that is diagnosed based on pathological findings. We herein report the case of a 27-year-old man who had multiple nodular shadows in bilateral lung fields on chest radiography and elevated levels of C-reactive protein (CRP). The pathological evaluation of a lung biopsy specimen showed the infiltration of lymphocytes, granulomas with necrosis and granulomatous angiitis. He was therefore diagnosed with NSG. He has been followed without treatment, as his fever and CRP levels decreased immediately after the surgical lung biopsy. Thereafter, the pulmonary nodular shadows gradually recovered without any treatment within a few months. Our experience suggests the possibility that surgical invasion might trigger an improvement in disease activity.
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Affiliation(s)
- Takayuki Shibata
- Division of Respiratory Medicine, Japan Community Health care Organization Saga Central Hospital, Japan
| | - Koichiro Takahashi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan
| | - Masaru Uchida
- Division of Respiratory Medicine, Japan Community Health care Organization Saga Central Hospital, Japan
| | - Fumio Yamasaki
- Division of Pathology, Japan Community Health care Organization Saga Central Hospital, Japan
| | - Michihiro Kawashima
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan
| | - Naoko Sueoka-Aragane
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Japan
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16
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Miyamoto A, Sharma A, Nishino M, Mino-Kenudson M, Matsubara O, Mark EJ. Expanded acceptance of acute exacerbation of nonspecific interstitial pneumonia, including 7 additional cases with detailed clinical pathologic correlation. Pathol Int 2018; 68:401-408. [PMID: 29726062 DOI: 10.1111/pin.12676] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/28/2018] [Indexed: 12/20/2022]
Abstract
Acute exacerbation is uncommonly diagnosed in patients with nonspecific interstitial pneumonia (NSIP) and its pathologic features have received relatively little attention compared to idiopathic pulmonary fibrosis. We retrospectively studied 14 consecutive cases of histopathologically proven NSIP by surgical lung biopsy. The diagnosis of acute exacerbation was confirmed clinically. We analyzed whether four reported pathologic features, including organizing pneumonia lesion, alveolar hemorrhage, many fibroblastic foci, and focal hyaline membranes were present and suggestive of acute exacerbation of NSIP or not. Acute exacerbation in patients with NSIP was diagnosed in 8 cases, while the remaining 6 cases were diagnosed as clinically stable. Seven cases of organizing pneumonia lesion, 7 of alveolar hemorrhage, 6 of many fibroblastic foci, and 3 of focal hyaline membranes were identified as the main pathologic components in patients with acute exacerbation. Organizing pneumonia lesion and many fibroblastic foci were identified in 2 and 3 stable cases, respectively. Having more than two components was significantly associated with acute exacerbation. Evaluation of lung biopsies with NSIP for organizing pneumonia lesions, alveolar hemorrhage, many fibroblastic foci, and focal hyaline membranes may be useful to predict the possibility of acute exacerbation.
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Affiliation(s)
- Atsushi Miyamoto
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Amita Sharma
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA
| | - Michiya Nishino
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Osamu Matsubara
- Department of Pathology, Hiratsuka Kyosai Hospital, Kanagawa, Japan
| | - Eugene Jerome Mark
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
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17
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Inase N. [DIAGNOSE CHRONIC HYPERSENSITIVITY PNEUMONITIS IN THIS MANNER]. Arerugi 2018; 67:927-930. [PMID: 30146624 DOI: 10.15036/arerugi.67.927] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Naohiko Inase
- Department of Respiratory Medicine, Hiratsuka Kyosai Hospital
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18
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Poletti V, Ravaglia C, Dubini A, Piciucchi S, Rossi G, Kronborg-White S, Tomassetti S. How might transbronchial cryobiopsy improve diagnosis and treatment of diffuse parenchymal lung disease patients? Expert Rev Respir Med 2017; 11:913-917. [PMID: 29050527 DOI: 10.1080/17476348.2017.1395283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Venerino Poletti
- a Azienda USL Romagna. Department of Diseases of the Thorax , Ospedale GB Morgagni , Forlì , Italy.,b Azienda USL Romagna. Department of Anatomic Pathology , Ospedale GB Morgagni , Forlì , Italy.,c Azienda USL Romagna. Department of Radiology , Ospedale GB Morgagni , Forlì , Italy.,d Azienda USL Romagna. Department of Anatomic Pathology , Ospedale Santa Maria delle Croci , Ravenna , Italy.,e Department of Respiratory Diseases and Allergy , Aarhus University Hospital , Aarhus , Denmark
| | - Claudia Ravaglia
- a Azienda USL Romagna. Department of Diseases of the Thorax , Ospedale GB Morgagni , Forlì , Italy
| | - Alessandra Dubini
- b Azienda USL Romagna. Department of Anatomic Pathology , Ospedale GB Morgagni , Forlì , Italy
| | - Sara Piciucchi
- c Azienda USL Romagna. Department of Radiology , Ospedale GB Morgagni , Forlì , Italy
| | - Giulio Rossi
- d Azienda USL Romagna. Department of Anatomic Pathology , Ospedale Santa Maria delle Croci , Ravenna , Italy
| | - Sissel Kronborg-White
- e Department of Respiratory Diseases and Allergy , Aarhus University Hospital , Aarhus , Denmark
| | - Sara Tomassetti
- a Azienda USL Romagna. Department of Diseases of the Thorax , Ospedale GB Morgagni , Forlì , Italy
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19
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Raj R, Raparia K, Lynch DA, Brown KK. Surgical Lung Biopsy for Interstitial Lung Diseases. Chest 2017; 151:1131-40. [PMID: 27471113 DOI: 10.1016/j.chest.2016.06.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/01/2016] [Accepted: 06/21/2016] [Indexed: 11/21/2022] Open
Abstract
This review addresses common questions regarding the role of surgical lung biopsy (SLB) in the diagnosis and treatment of interstitial lung disease (ILD). We specifically address when a SLB can be diagnostic as well as when it may be avoided; for example, when the combination of the clinical context and the imaging pattern seen on high-resolution CT (HRCT) chest scans can provide a confident diagnosis. Existing studies on the diagnostic utility as well as the complications associated with SLB are reviewed; also reviewed are the performance characteristics and reliability of HRCT scans of the chest in predicting the underlying histopathologic findings of the lung. The review is formatted in the form of answers to questions that clinicians regularly ask when considering an SLB in a patient with ILD.
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20
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Hagmeyer L, Theegarten D, Wohlschläger J, Treml M, Matthes S, Priegnitz C, Randerath WJ. The role of transbronchial cryobiopsy and surgical lung biopsy in the diagnostic algorithm of interstitial lung disease. Clin Respir J 2015; 10:589-95. [PMID: 25620578 DOI: 10.1111/crj.12261] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 12/15/2014] [Accepted: 01/20/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS It is not yet known if transbronchial cryobiopsy (TCB) is a reliable and safe diagnostic tool in the investigation of interstitial lung disease (ILD). To date, there have been no studies directly comparing the value of TCB with that of surgical lung biopsy (SLB). The study was initiated to determine whether the samples taken by TCB lead to a reliable diagnosis and whether SLB can be avoided in a relevant percentage of cases. METHODS We analyzed 32 subjects with suspected ILD who underwent a TCB. Subjects' baseline characteristics, pathological findings after TCB and SLB, and complication rates were analyzed. The pathological inter-rater agreement was quantified statistically. RESULTS The overall inter-rater agreement concerning TCB sample evaluation was good with a kappa value of 0.80. In 23/32 cases (72%), the findings from the TCB showed a strong congruence with all other clinical data, thereby enabling a definitive diagnosis. Eight of the remaining nine subjects gave their consent for an SLB, which led to a definitive histological diagnosis in six cases (75%). Following TCB, pneumothorax occurred in 6/32 subjects (19%) and endobronchial bleeding was moderate in 8/32 (25%) and was severe in 17/32 cases (53%). CONCLUSION This is the first study to correlate histological results and complications following TCB and SLB in ILD subjects, some of whom underwent both procedures. TCB is a suitable diagnostic tool in ILD, potentially completely dispensing with the need for an SLB in some cases. In all cases, an interdisciplinary case evaluation is necessary as a final step.
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Affiliation(s)
- Lars Hagmeyer
- Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany.
| | - Dirk Theegarten
- Institute for Pathology and Neuropathology, University Hospital Essen, University Duisburg-Essen, Duisburg-Essen, Germany
| | - Jeremias Wohlschläger
- Institute for Pathology and Neuropathology, University Hospital Essen, University Duisburg-Essen, Duisburg-Essen, Germany
| | - Marcel Treml
- Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany
| | - Sandhya Matthes
- Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany
| | - Christina Priegnitz
- Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany
| | - Winfried J Randerath
- Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany
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21
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Affiliation(s)
- Fabien Maldonado
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
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22
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Abstract
Desquamative interstitial pneumonia (DIP) is characterised by the accumulation of numerous pigmented macrophages within most of the distal airspace of the lung and, sometimes, the presence of giant cells. Diagnosis of DIP is not easy and requires surgical lung biopsy. DIP is usually associated with tobacco smoke. However, the association between smoking and DIP is less robust than that with respiratory bronchiolitis with interstitial lung disease or pulmonary Langerhans' cell histiocytosis; approximately 10-42% of patients with DIP are nonsmokers. DIP can also occur in patients following exposure to certain inhaled toxins (occupational exposure) and drugs, and may occur in the context of certain viral illnesses and autoimmune diseases. In the context of DIP, occupational exposure should be systematically investigated.
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Affiliation(s)
- Benoît Godbert
- CHU de Nancy, Pôle de spécialités médicales, Service de pneumologie, Nancy, France.
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23
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Abstract
Idiopathic pulmonary fibrosis (IPF), the most prevalent of the idiopathic interstitial pneumonias, is associated with a poor prognosis. An accurate diagnosis of IPF is essential for its optimal management. The 2011 American Thoracic Society (ATS)/European Respiratory Society (ERS)/Japanese Respiratory Society (JRS)/Latin American Thoracic Association (ALAT) recommendations on the diagnosis and management of IPF were developed from a systematic review of the published literature. High-resolution computed tomography (HRCT) scanning has a central role in the IPF diagnostic pathway, with formal designation of criteria for an HRCT pattern of usual interstitial pneumonia. In the correct clinical context, a usual interstitial pneumonia pattern on HRCT is indicative of a definite diagnosis of IPF and negates the need for a surgical lung biopsy. However, although the 2011 ATS/ERS/JRS/ALAT statement is a major advance, the application of the guideline recommendations by clinicians has identified limitations that should be addressed in future statements. Key problems include: 1) HRCT misdiagnosis, particularly by less experienced radiologists; 2) lack of management recommendations for the highly prevalent clinical scenarios of "probable" or "possible" IPF; 3) ongoing confusion concerning the diagnostic role of bronchoalveolar lavage; and 4) the lack of integration of clinical data in the designation of the diagnostic likelihood of IPF, including the treated course of disease. These issues become evident as the recommendations are applied and highlight the need for continued guideline adjustments.
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Affiliation(s)
- Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK.
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24
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Handa T, Nakatsue T, Baba M, Takada T, Nakata K, Ishii H. Clinical features of three cases with pulmonary alveolar proteinosis secondary to myelodysplastic syndrome developed during the course of Behçet's disease. Respir Investig 2014; 52:75-9. [PMID: 24388375 DOI: 10.1016/j.resinv.2013.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/16/2013] [Accepted: 05/20/2013] [Indexed: 01/22/2023]
Abstract
We have previously reported that myelodysplastic syndrome (MDS) is the most common underlying disease in cases of secondary pulmonary alveolar proteinosis (PAP). Here, we present 3 MDS cases in which PAP developed during the course of Behçet's disease (BD). All patients carried trisomy 8 in the bone marrow. Chest HRCT scans showed variable distribution of ground glass opacities, but none of the scans showed so called "crazy paving appearance". Two patients with intestinal BD who underwent potent immunosuppressive therapy died of sepsis. These findings demonstrate that PAP secondary to MDS may be occasionally associated with BD.
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