BACKGROUND: Histology is a key element for the multidisciplinary diagnosis of fibrotic diffuse parenchymal lung diseases (f-DPLD) when the clinical-radiological picture is nondiagnostic. Transbronchial lung cryobiopsy (TBLC) have been shown to be useful for obtaining large and well-preserved biopsies of lung parenchyma, but experience with TBLC in f-DPLD is limited. OBJECTIVES: To evaluate safety, feasibility and diagnostic yield of TBLC in f-DPLD. METHOD: Prospective study of 69 cases of TBLC using flexible cryoprobe in the clinical-radiological setting of f-DPLD with nondiagnostic high resolution computed tomography (HRCT) features. RESULTS: SAFETY: pneumothorax occurred in 19 patients (28%). One patient (1.4%) died of acute exacerbation. Feasibility: adequate cryobiopsies were obtained in 68 cases (99%). The median size of cryobiopsies was 43.11 mm(2) (range, 11.94-76.25). Diagnostic yield: among adequate TBLC the pathologists were confident ("high confidence") that histopathologic criteria sufficient to define a specific pattern in 52 patients (76%), including 36 of 47 with UIP (77%) and 9 nonspecific interstitial pneumonia (6 fibrosing and 3 cellular), 2 desquamative interstitial pneumonia/respiratory bronchiolitis-interstitial lung disease, 1 organizing pneumonia, 1 eosinophilic pneumonia, 1 diffuse alveolar damage, 1 hypersensitivity pneumonitis and 1 follicular bronchiolitis. In 11 diagnoses of UIP the pathologists were less confident ("low confidence"). Agreement between pathologists in the detection of UIP was very good with a Kappa coefficient of 0.83 (95% CI, 0.69-0.97). Using the current consensus guidelines for clinical-radiologic-pathologic correlation 32% (20/63) of cases were classified as Idiopathic Pulmonary Fibrosis (IPF), 30% (19/63) as possible IPF, 25% (16/63) as other f-DPLDs and 13% (8/63) were unclassifiable. CONCLUSIONS: TBLC in the diagnosis of f-DPLD appears safe and feasible. TBLC has a good diagnostic yield in the clinical-radiological setting of f-DPLD without diagnostic HRCT features of usual interstitial pneumonia. Future studies should consider TBLC as a potential alternative to SLBx in f-DPLD.

Transbronchial Lung Cryobiopsy in the Diagnosis of Fibrotic Interstitial Lung Diseases / Martin R. J. Kolb;Gian Luca Casoni;Sara Tomassetti;Alberto Cavazza;Thomas V. Colby;Alessandra Dubini;Jay H. Ryu;Elisa Carretta;Paola Tantalocco;Sara Piciucchi;Claudia Ravaglia;Christian Gurioli;Micaela Romagnoli;Carlo Gurioli;Marco Chilosi;Venerino Poletti. - In: PLOS ONE. - ISSN 1932-6203. - ELETTRONICO. - 9:(2014), pp. 1-7. [10.1371/journal.pone.0086716]

Transbronchial Lung Cryobiopsy in the Diagnosis of Fibrotic Interstitial Lung Diseases

CARRETTA, ELISA;Claudia Ravaglia;
2014

Abstract

BACKGROUND: Histology is a key element for the multidisciplinary diagnosis of fibrotic diffuse parenchymal lung diseases (f-DPLD) when the clinical-radiological picture is nondiagnostic. Transbronchial lung cryobiopsy (TBLC) have been shown to be useful for obtaining large and well-preserved biopsies of lung parenchyma, but experience with TBLC in f-DPLD is limited. OBJECTIVES: To evaluate safety, feasibility and diagnostic yield of TBLC in f-DPLD. METHOD: Prospective study of 69 cases of TBLC using flexible cryoprobe in the clinical-radiological setting of f-DPLD with nondiagnostic high resolution computed tomography (HRCT) features. RESULTS: SAFETY: pneumothorax occurred in 19 patients (28%). One patient (1.4%) died of acute exacerbation. Feasibility: adequate cryobiopsies were obtained in 68 cases (99%). The median size of cryobiopsies was 43.11 mm(2) (range, 11.94-76.25). Diagnostic yield: among adequate TBLC the pathologists were confident ("high confidence") that histopathologic criteria sufficient to define a specific pattern in 52 patients (76%), including 36 of 47 with UIP (77%) and 9 nonspecific interstitial pneumonia (6 fibrosing and 3 cellular), 2 desquamative interstitial pneumonia/respiratory bronchiolitis-interstitial lung disease, 1 organizing pneumonia, 1 eosinophilic pneumonia, 1 diffuse alveolar damage, 1 hypersensitivity pneumonitis and 1 follicular bronchiolitis. In 11 diagnoses of UIP the pathologists were less confident ("low confidence"). Agreement between pathologists in the detection of UIP was very good with a Kappa coefficient of 0.83 (95% CI, 0.69-0.97). Using the current consensus guidelines for clinical-radiologic-pathologic correlation 32% (20/63) of cases were classified as Idiopathic Pulmonary Fibrosis (IPF), 30% (19/63) as possible IPF, 25% (16/63) as other f-DPLDs and 13% (8/63) were unclassifiable. CONCLUSIONS: TBLC in the diagnosis of f-DPLD appears safe and feasible. TBLC has a good diagnostic yield in the clinical-radiological setting of f-DPLD without diagnostic HRCT features of usual interstitial pneumonia. Future studies should consider TBLC as a potential alternative to SLBx in f-DPLD.
2014
Transbronchial Lung Cryobiopsy in the Diagnosis of Fibrotic Interstitial Lung Diseases / Martin R. J. Kolb;Gian Luca Casoni;Sara Tomassetti;Alberto Cavazza;Thomas V. Colby;Alessandra Dubini;Jay H. Ryu;Elisa Carretta;Paola Tantalocco;Sara Piciucchi;Claudia Ravaglia;Christian Gurioli;Micaela Romagnoli;Carlo Gurioli;Marco Chilosi;Venerino Poletti. - In: PLOS ONE. - ISSN 1932-6203. - ELETTRONICO. - 9:(2014), pp. 1-7. [10.1371/journal.pone.0086716]
Martin R. J. Kolb;Gian Luca Casoni;Sara Tomassetti;Alberto Cavazza;Thomas V. Colby;Alessandra Dubini;Jay H. Ryu;Elisa Carretta;Paola Tantalocco;Sara Piciucchi;Claudia Ravaglia;Christian Gurioli;Micaela Romagnoli;Carlo Gurioli;Marco Chilosi;Venerino Poletti
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/396603
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