Diffuse parenchymal lung disease

Tomassetti, Sara; Ravaglia, Claudia; Poletti, Venerino

doi:10.1183/16000617.0004-2017

Cited by 17 publications

(12 citation statements)

References 46 publications

(76 reference statements)

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“…LUS is very useful to explore the pleura and peripheral lung regions adjacent to the pleura, the areas in which the interstitial abnormalities related to SSc are earlier detectable. [27] The interstitial abnormalities early detectable under SSc-ILD are represented by B-lines. B-lines consist of discrete laser-like vertical hyperechoic reverberation artifacts, which are generated by the pleural line and extending to the bottom of the screen.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound B-lines in the evaluation of interstitial lung disease in patients with systemic sclerosis

et al. 2018

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The aim of this study was to establish the cut-off point of ultrasound (US) B-lines number for detecting the presence of significant interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) (SSc-ILD) in relation to high-resolution computed tomography (HRCT) findings. Consecutive SSc-ILD patients underwent chest HRCT, lung US (LUS), pulmonary function test, and clinical assessment. Exclusion criteria were represented by the presence of a coexisting congestive heart failure and a clinical history suggestive of lung or pleural diseases. HRCT images were scored for the presence of ILD by 2 readers, in accordance with the Warrick scoring system. US assessment was performed by a US skilled rheumatologist, blinded to HRCT results and clinical data, and included the bilateral evaluation of 14 lung intercostal spaces (LIS). In each LIS, the number of B-lines was recorded and summed. To test discriminant validity, we used the receiver operating characteristic (ROC) curve analysis applying a Warrick score of 7 as external criterion for the presence of SSc-ILD. Forty patients completed the study. The US B-lines number and the Warrick score confirmed excellent correlation (Spearman rho: 0.958, P = .0001). The ROC curve analysis revealed that the presence of 10 US B-lines is the cut-off point with the greatest positive likelihood ratio (12.52) for the presence of significant SSc-ILD. The detection of 10 B-lines is highly predictive for the HRCT presence of significant SSc-ILD. In SSc patients, the LUS assessment as first imaging tool may represent an effective model to improve the correct timing of chest HRCT.

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Section: Discussionmentioning

confidence: 99%

Ultrasound B-lines in the evaluation of interstitial lung disease in patients with systemic sclerosis

et al. 2018

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“…1) In particular, accurate diagnosis of IPF and distinguishing the disease from other ILDs are crucial in clinical practice with the development of antifibrotic drugs. 2,3) The American Thoracic Society/European Respiratory Society recommends SLB for most patients with ILD, who do not show a typical imaging pattern of idiopathic pulmonary fibrosis (IPF)/usual interstitial pneumonia (UIP) on high-resolution computed tomography (HRCT), for accurate estimates of prognoses, cessation of additional diagnostic testing, and the initiation of specific treatment. 4) However, the risks of SLB should be carefully considered due to postoperative complications, especially acute exacerbation of ILD.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Video-Assisted Thoracic Surgical Lung Biopsy for Interstitial Lung Diseases

Nagano

Miyamoto

Kikunaga

et al. 2021

ATCS

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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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“…Studies suggest that diagnostic performance may be comparable to surgical lung biopsy [1,15,16], with significantly favorable morbidity/mortality [17,18]. Isolated reports have expressed concerns regarding the safety of transbronchial cryobiopsy [19], and diagnostic performance remains variable [1,17]. Notwithstanding significant methodological limitations in the study by DiBardino et al [5,20,21], certainly, refinement of technique may achieve further improvements in diagnostic performance and complication rates.…”

Section: Discussionmentioning

confidence: 96%

“…Transbronchial cryobiopsy continues to gain acceptance as an important technique for the evaluation of patients with DPLD. Studies suggest that diagnostic performance may be comparable to surgical lung biopsy [1,15,16], with significantly favorable morbidity/mortality [17,18]. Isolated reports have expressed concerns regarding the safety of transbronchial cryobiopsy [19], and diagnostic performance remains variable [1,17].…”

Section: Discussionmentioning

confidence: 99%

CT-Fluoroscopic Guidance for Performance of Targeted Transbronchial Cryobiopsy: A Preliminary Report

et al. 2018

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Background: Bronchoscopic transbronchial cryobiopsy is increasingly used for the histological assessment of diffuse parenchymal lung disease. Diagnostic performance may be improved by more accurate targeting of biopsy to radiologic abnormalities, and complication rates may be reduced by avoiding biopsy of pleura or larger vessels. Objectives: To report the preliminary experience of using CT-fluoroscopic guidance for accurate targeting of bronchoscopic transbronchial cryobiopsy. Methods: Bronchoscopic cryobiopsy was performed in a hybrid CT theatre. 3D CT images were acquired following positioning of the cryoprobe in a distal airway segment. Where cryoprobe position was observed to be too close to the chest wall/diaphragm pleura, or not within the region of interest within the lung parenchyma, re-positioning of probe was undertaken and repeat 3D images were acquired to confirm positioning prior to cryobiopsy. Results: CT-fluoroscopic transbronchial cryobiopsy was successfully performed in 4 patients: 3 patients with interstitial lung infiltrates, and one with an enlarging left upper lobe mass. Images were reviewed following each acquisition to accurately assess the probe position within the lung parenchyma, and relative to other thoracic structures. Intra-procedural imaging was of sufficient quality to allow the accurate positioning of the cryoprobe tip with respect to both the parenchymal region of interest and pleural surfaces. No complications were experienced, and all procedures yielded diagnostic specimens. Conclusions: Our preliminary experience confirms the feasibility of performing transbronchial cryobiopsy under CT-fluoroscopic guidance. Accurate targeting of transbronchial cryobiopsy may be achieved using CT-fluoroscopic guidance. Positioning of the probe tip, both with respect to parenchymal region of interest and to pleural surfaces, can be established with high accuracy.

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Diffuse parenchymal lung disease

Cited by 17 publications

References 46 publications

Ultrasound B-lines in the evaluation of interstitial lung disease in patients with systemic sclerosis

Ultrasound B-lines in the evaluation of interstitial lung disease in patients with systemic sclerosis

Outcomes of Video-Assisted Thoracic Surgical Lung Biopsy for Interstitial Lung Diseases

CT-Fluoroscopic Guidance for Performance of Targeted Transbronchial Cryobiopsy: A Preliminary Report

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