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European Respiratory Review : An... Mar 2023Childhood interstitial lung diseases (chILDs) are rare and heterogeneous diseases with significant morbidity and mortality. An accurate and quick aetiological diagnosis... (Review)
Review
Childhood interstitial lung diseases (chILDs) are rare and heterogeneous diseases with significant morbidity and mortality. An accurate and quick aetiological diagnosis may contribute to better management and personalised treatment. On behalf of the European Respiratory Society Clinical Research Collaboration for chILD (ERS CRC chILD-EU), this review summarises the roles of the general paediatrician, paediatric pulmonologists and expert centres in the complex diagnostic workup. Each patient's aetiological chILD diagnosis must be reached without prolonged delays in a stepwise approach from medical history, signs, symptoms, clinical tests and imaging, to advanced genetic analysis and specialised procedures including bronchoalveolar lavage and biopsy, if necessary. Finally, as medical progress is fast, the need to revisit a diagnosis of "undefined chILD" is stressed.
Topics: Child; Humans; Lung Diseases, Interstitial; Diagnostic Imaging; Morbidity; Bronchoalveolar Lavage; Biopsy; Lung
PubMed: 36813289
DOI: 10.1183/16000617.0188-2022 -
Advances in Respiratory Medicine Jul 2022Limited epidemiological data are available on changes in management, benefits, complications, and outcomes after open lung biopsy in patients with ARDS. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Limited epidemiological data are available on changes in management, benefits, complications, and outcomes after open lung biopsy in patients with ARDS.
METHODS
We performed a literature search of PubMed, Ovid, and Cochrane databases for articles from the inception of each database till November 2020 that provided outcomes of lung biopsy in ARDS patients. The primary outcome was the proportion of patients that had a change in management with alteration of treatment plan, after lung biopsy. Secondary outcomes included pathological diagnoses and complications related to the lung biopsy. Pooled proportions with a 95% confidence interval (CI) were calculated for the prevalence of outcomes.
RESULTS
After analysis of 22 articles from 1994 to 2018, a total of 851 ARDS patients (mean age 59.28 ± 7.41, males 56.4%) that were admitted to the ICU who underwent surgical lung biopsy for ARDS were included. Biopsy changed the management in 539 patients (pooled proportion 75%: 95% CI 64-84%). There were 394 deaths (pooled proportion 49%: 95% CI 41-58%). The most common pathologic diagnosis was diffuse alveolar damage that occurred in 30% (95% CI 19-41%), followed by interstitial lung disease in 10% (95% CI 3-19%), and viral infection in 9% (95% CI 4-16%). Complications occurred among 201 patients (pooled proportion 24%, 95% CI 17-31%). The most common type of complication was persistent air-leak among 115 patients (pooled estimate 13%, 95% CI 9-17%).
CONCLUSION
Despite the high mortality risk associated with ARDS, lung biopsy changed management in about 3/4 of the patients. However, 1/4 of the patients had a complication due to lung biopsy. The risks from the procedure should be carefully weighed before proceeding with lung biopsy.
Topics: Aged; Biopsy; Humans; Lung; Male; Middle Aged; Prevalence; Respiratory Distress Syndrome; Thorax
PubMed: 36004956
DOI: 10.3390/arm90040036 -
Journal of Cancer Research and... Jul 2021The aim of the study was to compare the relative diagnostic utility of low-dose computed tomography (LDCT) and standard-dose computed tomography (SDCT)-guided lung... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVES
The aim of the study was to compare the relative diagnostic utility of low-dose computed tomography (LDCT) and standard-dose computed tomography (SDCT)-guided lung biopsy approaches.
MATERIALS AND METHODS
The PubMed, Embase, and Cochrane Library databases were searched for relevant studies published through August 2020. Data pertaining to endpoints including technical success, diagnostic performance, operative time, radiation dose, and complications, were extracted, and meta-analysis was performed using RevMan v5.3.
RESULTS
Three retrospective analyses and three randomized controlled trials, were included. The studies included 1977 lung lesions across 1927 patients who underwent LDCT-guided lung biopsy, and 887 lung lesions across 879 patients who underwent SDCT-guided lung biopsy. No significant differences were observed between these LDCT and SDCT groups with respect to the rates of technical success (99.0% vs. 99.5%, odds ratio [OR]: 1.82, P = 0.35,), diagnostic yield (79.6% vs. 76.2%, OR: 0.93, P = 0.47), diagnostic accuracy (96.1% vs. 96.1%, OR: 0.93, P = 0.69), operative time (mean difference [MD]: 1.04, P = 0.30), pneumothorax (19.9% vs. 21.3%, OR: 0.92, P = 0.43) or hemoptysis (4.6% vs. 5.8%, OR: 1.14, P = 0.54). Patients in the LDCT group received a significantly lower radiation dose (MD: ‒209.87, P < 0.00001) than patients in the SDCT group. Significant heterogeneity was observed with respect to the operative duration and radiation dose endpoints (I = 84% and 100%, respectively).
CONCLUSIONS
Relative to SDCT-guided lung biopsy, an LDCT-guided approach is equally safe and can achieve comparable diagnostic efficacy while exposing patients to lower doses of radiation.
Topics: Humans; Image-Guided Biopsy; Lung; Lung Neoplasms; Radiation Dosage; Randomized Controlled Trials as Topic; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 34269301
DOI: 10.4103/jcrt.JCRT_1274_20 -
Surgical Lung Biopsy for Interstitial Lung Disease: A Two Center Propensity Score Matching Analysis.Respiration; International Review of... 2022Surgical lung biopsy (SLB) is recommended for patients with nonclassified interstitial lung disease (nILD) if high resolution computed tomography and/or transbronchial...
BACKGROUND
Surgical lung biopsy (SLB) is recommended for patients with nonclassified interstitial lung disease (nILD) if high resolution computed tomography and/or transbronchial lung biopsy did not achieve a definitive diagnosis. Current literature suggests better patient tolerability and less postoperative complications if surgery is performed under spontaneous ventilation.
OBJECTIVES
We conducted a propensity score matching (PSM) analysis of our nILD patients undergoing SLB under spontaneous ventilation or general anesthesia to investigate postprocedural AE-ILD, 30-/90-day mortality and perioperative variables in two academic high-volume centers (Hannover, Heidelberg).
METHODS
All patients undergoing SLB for nILD under general anesthesia (GAVATS) and spontaneous ventilation (NIVATS) at both centers from February 2013 until April 2021 were analyzed retrospectively. Data of 132 patients were used for PSM resulting in 40 pairs.
RESULTS
There was one death in the NIVATS group 60 days after SLB and one AE-ILD in each cohort. Chest tube indwelling time, chest tube total effusion, length of hospital stay, and operative time were all in favor of NIVATS.
CONCLUSIONS
In our PSM analysis, NIVATS is associated with faster postprocedural recovery. However, a reduction in postoperative AE-ILD or 30-/90-day mortality was not observed.
Topics: Biopsy; Humans; Lung; Lung Diseases, Interstitial; Propensity Score; Retrospective Studies; Thoracic Surgery, Video-Assisted
PubMed: 36007492
DOI: 10.1159/000525903 -
Respiratory Research Mar 2024The prognostic and theragnostic role of histopathological subsets in systemic sclerosis interstitial lung disease (SSc-ILD) have been largely neglected due to the... (Review)
Review
BACKGROUND
The prognostic and theragnostic role of histopathological subsets in systemic sclerosis interstitial lung disease (SSc-ILD) have been largely neglected due to the paucity of treatment options and the risks associated with surgical lung biopsy. The novel drugs for the treatment of ILDs and the availability of transbronchial cryobiopsy provide a new clinical scenario making lung biopsy more feasible and a pivotal guide for treatment. The aim of our study was to investigate the usefulness of lung biopsy in SSc ILD with a systematic literature review (SLR).
METHODS
PubMed, Embase and Cochrane databases were searched up to June 30, 2023. Search terms included both database-specific controlled vocabulary terms and free-text terms relating to lung biopsy and SSc-ILD diagnostic and prognosis. The SLR was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Studies were selected according to the PEO (population, exposure, and outcomes) framework and Quality assessment of diagnostic accuracy studies (QUADAS) were reported.
RESULTS
We selected 14 articles (comprising 364 SSc-ILD patients). The paucity and heterogeneity of the studies prevented a systematic analysis. Diffuse cutaneous SSc was present in 30-100% of cases. Female predominance was observed in all studies (ranging from 64 to 100%). Mean age ranged from 42 to 64 years. Mean FVC was 73.98 (+/-17.3), mean DLCO was 59.49 (+/-16.1). Anti-Scl70 antibodies positivity was detected in 33% of cases (range: 0-69.6). All patients underwent surgical lung biopsies, and multiple lobes were biopsied in a minority of studies (4/14). Poor HRCT-pathologic correlation was reported with HRCT-NSIP showing histopathologic UIP in up to 1/3 of cases. Limited data suggest that SSc-UIP patients may have a worse prognosis and response to immunosuppressive treatment compared to other histopathologic patterns.
CONCLUSIONS
The data from this SLR clearly show the paucity and heterogeneity of the studies reporting lung biopsy in SSc ILD. Moreover, they highlight the need for further research to address whether the lung biopsy can be helpful to refine prognostic prediction and guide therapeutic choices.
Topics: Humans; Female; Adult; Middle Aged; Male; Lung Diseases, Interstitial; Lung; Scleroderma, Systemic; Biopsy; Prognosis
PubMed: 38521926
DOI: 10.1186/s12931-024-02725-1 -
Annals of the American Thoracic Society May 2022
Topics: Biopsy; Humans; Lung; Lung Diseases, Interstitial; Thorax
PubMed: 35486083
DOI: 10.1513/AnnalsATS.202111-1315ED -
Medicine Mar 2022This meta-analysis was conducted to compare the safety and diagnostic performance between computed tomography (CT)-guided core needle biopsy (CNB) and fine-needle... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This meta-analysis was conducted to compare the safety and diagnostic performance between computed tomography (CT)-guided core needle biopsy (CNB) and fine-needle aspiration biopsy (FNAB) in lung nodules/masses patients.
METHODS
All relevant studies in the Pubmed, Embase, and Cochrane Library databases that were published as of June 2020 were identified. RevMan version 5.3 was used for all data analyses.
RESULTS
In total, 9 relevant studies were included in the present meta-analysis. These studies were all retrospective and analyzed outcomes associated with 2175 procedures, including both CT-guided CNB (n = 819) and FNAB (n = 1356) procedures. CNB was associated with significantly higher sample adequacy rates than was FNAB (95.7% vs 85.8%, OR: 0.26; P < .00001), while diagnostic accuracy rates did not differ between these groups (90.1% vs 87.6%, OR: 0.8; P = .46). In addition, no differences in rates of pneumothorax (28.6% vs 23.0%, OR: 1.15; P = .71), hemorrhage (17.3% vs 20.1%, OR: 0.91; P = .62), and chest tube insertion (5.9% vs 4.9%, OR: 1.01; P = .97) were detected between these groups. Significant heterogeneity among included studies was detected for the diagnostic accuracy (I2 = 57%) and pneumothorax (I2 = 77%) endpoints. There were no significant differences between CNB and FNAB with respect to diagnostic accuracy rates for lung nodules (P = .90). In addition, we detected no evidence of significant publication bias.
CONCLUSIONS
CT-guided CNB could achieve better sample adequacy than FNAB did during the lung biopsy procedure. However, the CNB did not show any superiorities in items of diagnostic accuracy and safety.
Topics: Biopsy, Fine-Needle; Biopsy, Large-Core Needle; Humans; Image-Guided Biopsy; Lung; Pneumothorax; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 35244081
DOI: 10.1097/MD.0000000000029016 -
Archives of Pathology & Laboratory... Jul 2017- Transbronchial cryobiopsy has recently been proposed as an alternative to surgical biopsy in the diagnosis of diffuse lung disease. (Review)
Review
CONTEXT
- Transbronchial cryobiopsy has recently been proposed as an alternative to surgical biopsy in the diagnosis of diffuse lung disease.
OBJECTIVE
- To familiarize pathologists with transbronchial cryobiopsy, including what it is, how it is performed, how it compares to other techniques of lung biopsy in diffuse lung disease, what are the technical issues relating to it, what the complications are, how cryobiopsies should be interpreted, and the clinical usefulness of cryobiopsy.
DATA SOURCES
- All the available literature on cryobiopsy in diffuse lung disease through May 2016, primarily in the last 5 years, was reviewed, and some unpublished data known to the authors were included.
CONCLUSIONS
- Cryobiopsies are considerably larger than forceps biopsies and allow pattern recognition approaching that of a surgical lung biopsy in many cases. Artifacts associated with cryobiopsy are minimal. In comparison with surgical lung biopsies, the diagnosis rate with cryobiopsies is lower, in the neighborhood of 80%, versus higher than 90% for surgical lung biopsies. Cryobiopsy is proposed as an alternative to surgical lung biopsy and a technique that may appreciably decrease the number of patients who require surgical lung biopsy for diagnosis. This is important because the mortality from cryobiopsy is very small (0.1% to date) compared with surgical lung biopsy (1.7% for elective procedures and considerably higher for nonelective procedures).
Topics: Biopsy; Cryosurgery; Humans; Lung; Lung Diseases; Pathologists
PubMed: 27588334
DOI: 10.5858/arpa.2016-0233-RA -
Respiration; International Review of... 2018The lung biopsy in interstitial lung disease (ILD) represents an important diagnostic step when the clinical and radiological data are insufficient for a firm diagnosis.... (Review)
Review
The lung biopsy in interstitial lung disease (ILD) represents an important diagnostic step when the clinical and radiological data are insufficient for a firm diagnosis. A growing body of evidence suggests the utility of transbronchial lung cryobiopsy (TBLC) in the diagnostic algorithm of ILD as it allows, compared to transbronchial lung biopsy with conventional forceps, a better identification of complex histological patterns - such as usual interstitial pneumonia - and can provide information which has a clinical impact on the multidisciplinary discussion similar to that provided by surgical lung biopsy. Performed correctly, it appears to have a better safety profile than surgery. The decision to perform a lung biopsy should be a multidisciplinary decision process where it is felt that there is sufficient diagnostic doubt after a careful clinical evaluation including review of the computed tomograms of the thorax. The presence of severe pulmonary hypertension (> 50 mm Hg), poor lung function (FVC < 50%), or dismissed gas transfer (DLCO of < 35%) are considered relative contraindications for TBLC. Anticoagulants and antiplatelet drugs should be discontinued for the minimum period required for the specific drugs. The greatest consideration should be given to ensure the biopsy is performed safely and we recommend the use of either an endotracheal tube or rigid bronchoscopy. Deep sedation or general anesthesia allow better control of the procedure and a better patient experience. Prophylactic balloon blockers should be used to tamponade any bleeding and also to prevent overspill of blood from the segment that is being sampled. The procedure should be performed under fluoroscopy to ensure that samples are ideally obtained about 10 mm from the pleural edge. The cryoprobe is activated for about 5 s for the first biopsy and then adjusted according to the sample size obtained. With a careful standardized approach it is possible to obtain good-quality lung specimens for diagnosis in a safe manner.
Topics: Cryosurgery; Humans; Image-Guided Biopsy; Lung; Lung Diseases, Interstitial
PubMed: 29894993
DOI: 10.1159/000488910 -
Biomedical Papers of the Medical... Nov 2021With the increasing number of detected lung nodules and the need for morphological verification, the number of CT- controlled biopsies is increasing. The aim of this... (Observational Study)
Observational Study
OBJECTIVES
With the increasing number of detected lung nodules and the need for morphological verification, the number of CT- controlled biopsies is increasing. The aim of this study was to assess the risks and benefits of these biopsies.
METHODS
This is a prospective and observational study. We evaluated 101 punctures performed on a group of 90 consecutive patients in the Department of Radiology.
RESULTS
In patients with a mean age of 66 years, with mostly accidentally detected lung nodules, we observed complications 38 times. The most common were minor pneumothoraxes or insignificant bleedings. In 6 patients, the complications were more serious, 5 times the pneumothoraxes required chest drainage, once massive hemoptysis was recorded. The lesions were successfully biopsied 78 times, the target was missed 23 times. The diagnosis of lung cancer (LC) was confirmed in 60 patients, 49 LCs were verified by puncture under CT control. 42% (25/60) of patients with LC were diagnosed in TNM stages I and II. 23% (14/60) of patients with LC were treated surgically. The remaining 30 patients most often suffered from lung metastazes (13/30), in 8 of them an inflammatory lung disease was diagnosed. 69 patients underwent bronchoscopy, in only 19% (13/69) it contributed to the diagnosis. In a model "screening like" group of 49 patients with only randomly detected lung deposits, we diagnosed LC in 76% (37/49). 49% (18/37) were in TNM stage I and II, 11 were treated surgically.
CONCLUSIONS
CT-controlled biopsy of lung lesions is an effective and safe diagnostic method.
Topics: Aged; Biopsy; Humans; Lung; Lung Neoplasms; Prospective Studies; Tomography, X-Ray Computed
PubMed: 32955039
DOI: 10.5507/bp.2020.040