Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Interstitial Lung Disease

Adams, Traci N.; Batra, Kiran; Silhan, Leann; Anand, Vikram; Joerns, Elena K.; Moore, Samantha A.; Butt, Yasmeen M.; Torrealba, José; Newton, Chad A.; Glazer, Craig S.

doi:10.1007/s00408-020-00389-4

Cited by 10 publications

(8 citation statements)

References 33 publications

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“…Variables that were significantly associated with change in diagnosis (p-value <0.2) were included in multivariable model to test independent associations. All p-values less than 0.05 were considered significant [ 5 ]. Statistical analyses were performed using MedCalc Statistical Software version 19.2.6 (MedCalc Software bv Ostend, Belgium; https://www.medcalc.org ; 2020).…”

Section: Methodsmentioning

confidence: 99%

“…Bronchoalveolar lavage and transbronchial biopsy can increase diagnostic confidence in the diagnosis of hypersensitivity pneumonitis (HP) [1][2][3]. Bronchoscopy is particularly useful in patients with a high-resolution computed tomography (HRCT) that is not consistent with UIP, in those with identified antigen exposure, and in those who do not meet criteria for connective tissue disease related ILD [4,5]. While sensitivity of transbronchial biopsy (TBBx) is much lower than surgical lung biopsy (SLB) due to smaller sample size, the complication rate of TBBx is less than that of SLB [4,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of a diagnostic bronchoscopy in hypersensitivity pneumonitis

et al. 2023

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Background Bronchoalveolar lavage and transbronchial biopsy can increase diagnostic confidence in the diagnosis of hypersensitivity pneumonitis (HP). Improving the yield of bronchoscopy may help to improve diagnostic confidence while decreasing the risk of potential adverse outcomes associated with more invasive procedures such as surgical lung biopsy. The purpose of this study is to identify factors that were associated with a diagnostic BAL or TBBx in HP. Methods We conducted a retrospective cohort study of HP patients at a single center who underwent bronchoscopy during the diagnostic evaluation. Imaging characteristics, clinical characteristics including use of immunosuppressive medications and presence of active antigen exposure at the time of bronchoscopy, and procedural characteristics were collected. Univariable and multivariable analysis was performed. Results 88 patients were included in the study. 75 patients underwent BAL and 79 patients underwent TBBx. Patients who had an active fibrogenic exposure at the time of bronchoscopy had a higher BAL yield than those who were out of exposure at the time of bronchoscopy. TBBx yield was higher when more than 1 lobe was biopsied, with a trend toward higher yield of TBBx when nonfibrotic lung was biopsied compared to fibrotic lung. Discussion Our study suggests characteristics that may improve yield of BAL and TBBx in patients with HP. We suggest that bronchoscopy be performed when patients are in the antigen exposure and that TBBx samples are taken from more than 1 lobe in order to improve diagnostic yield of the procedure.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Characteristics of a diagnostic bronchoscopy in hypersensitivity pneumonitis

et al. 2023

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“…Bronchoalveolar lavage (BAL) is unlikely to change a clinical and serological diagnosis of CTD-ILD ( 37 ). While BAL fluid cytology has been described in various subtypes of ILD, findings are non-specific, and therefore the role of BAL in ASyS assessment is limited.…”

Section: Assessment Of Lung Diseasementioning

confidence: 99%

A multidisciplinary approach to the diagnosis of antisynthetase syndrome

et al. 2022

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Antisynthetase syndrome is a subtype of idiopathic inflammatory myopathy, strongly associated with the presence of interstitial lung disease. Diagnosis is made by identifying myositis-specific antibodies directed against aminoacyl tRNA synthetase, and relevant clinical and radiologic features. Given the multisystem nature of the disease, diagnosis requires the careful synthesis of subtle clinical and radiological features with the interpretation of specialized autoimmune serological testing. This is provided in a multidisciplinary environment with input from rheumatologists, respiratory physicians, and radiologists. Differentiation from other idiopathic interstitial lung diseases is key; treatment and prognosis differ between patients with antisynthetase syndrome and idiopathic interstitial lung disease. In this review article, we look at the role of the multidisciplinary team and its individual members in the initial diagnosis of the antisynthetase syndrome, including the role of physicians, radiologists, and the wider team.

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“…We suggest evaluating for subclinical myositis by checking aldolase and creatine kinase (CK) at baseline and periodically every 6–12 months, particularly in patients with positive anti-synthetase antibodies, MDA-5 antibody, or anti-PM-Scl antibody. Elevated acute phase markers (erythrocyte sedimentation rate [ESR] or C-reactive protein [CRP]) have been shown to be prognostically relevant in various RD-ILDs [ 39 – 41 ] and in IPAF [ 25 , 26 ].…”

Section: Evaluation and Treatmentmentioning

confidence: 99%

Interstitial Pneumonia with Autoimmune Features: What the Rheumatologist Needs to Know

et al. 2022

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Purpose of Review This narrative review will focus on the role of the rheumatologist in evaluating patients with interstitial lung disease (ILD) without a defined rheumatic disease and will outline the current classification criteria for interstitial pneumonia with autoimmune features (IPAF) and describe what is known regarding IPAF pathobiology, natural history, prognosis, and treatment. Lastly, knowledge gaps and opportunities for future research will be discussed. Recent Findings IPAF is a recently defined classification of ILD patients who have features suggesting an autoimmune-mediated process, but do not fulfill current rheumatic disease criteria. The goal of the IPAF criteria is to provide a uniform case definition for the study of autoimmune ILD patients who do not currently fit within standard ILD diagnostic categories, ultimately improving diagnosis and therapy. Many of these patients are referred for rheumatologic evaluation to aid the diagnostic process. Summary The care of the IPAF patient is complex and is multidisciplinary with pulmonology, rheumatology, pathology, radiology, physical therapy, primary care, pulmonary transplant providers all serving vital roles. The rheumatologist has several roles which include classification, disease monitoring, and management.

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Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Interstitial Lung Disease

Cited by 10 publications

References 33 publications

Characteristics of a diagnostic bronchoscopy in hypersensitivity pneumonitis

Characteristics of a diagnostic bronchoscopy in hypersensitivity pneumonitis

A multidisciplinary approach to the diagnosis of antisynthetase syndrome

Interstitial Pneumonia with Autoimmune Features: What the Rheumatologist Needs to Know

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