Chest CT Diagnosis and Clinical Management of Drug-related Pneumonitis in Patients Receiving Molecular Targeting Agents and Immune Checkpoint Inhibitors: A Position Paper from the Fleischner Society
“…They often showed interval progression [2,15,17,25,49,57]. However, ILA is derived from subclinical radiologic findings on CT, whereas NSIP is being diagnosed with MDD approach because of the possibility of secondary NSIP related to connective tissue disease, hypersensitivity pneumonitis, infection, and drug-related pneumonitis [2,3,18,40,62,63].…”
Section: An Overlap Of Ct Findings Between Ila and Nsipmentioning
confidence: 99%
“…The first step in management of ILD is the identification of underlying diseases or conditions such as CTD or environmental/occupational exposures, since treatment and prognosis of ILD varies greatly depending on the associated etiologies [62,63,79,80]. The NSIP is the most frequently associated ILD in CTD, although there are certain predilections of specific ILD patterns for different CTDs [81][82][83].…”
This review article aims to address mysteries existing between Interstitial Lung Abnormality (ILA) and Nonspecific Interstitial Pneumonia (NSIP). The concept and definition of ILA are based upon CT scans from multiple large-scale cohort studies, whereas the concept and definition of NSIP originally derived from pathology with evolution to multidisciplinary diagnosis. NSIP is the diagnosis as Interstitial Lung Disease (ILD) with clinical significance, whereas only a part of subjects with ILA have clinically significant ILD. Eventually, both ILA and NSIP must be understood in the context of chronic fibrosing ILD and progressive ILD, which remains to be further investigated.
“…They often showed interval progression [2,15,17,25,49,57]. However, ILA is derived from subclinical radiologic findings on CT, whereas NSIP is being diagnosed with MDD approach because of the possibility of secondary NSIP related to connective tissue disease, hypersensitivity pneumonitis, infection, and drug-related pneumonitis [2,3,18,40,62,63].…”
Section: An Overlap Of Ct Findings Between Ila and Nsipmentioning
confidence: 99%
“…The first step in management of ILD is the identification of underlying diseases or conditions such as CTD or environmental/occupational exposures, since treatment and prognosis of ILD varies greatly depending on the associated etiologies [62,63,79,80]. The NSIP is the most frequently associated ILD in CTD, although there are certain predilections of specific ILD patterns for different CTDs [81][82][83].…”
This review article aims to address mysteries existing between Interstitial Lung Abnormality (ILA) and Nonspecific Interstitial Pneumonia (NSIP). The concept and definition of ILA are based upon CT scans from multiple large-scale cohort studies, whereas the concept and definition of NSIP originally derived from pathology with evolution to multidisciplinary diagnosis. NSIP is the diagnosis as Interstitial Lung Disease (ILD) with clinical significance, whereas only a part of subjects with ILA have clinically significant ILD. Eventually, both ILA and NSIP must be understood in the context of chronic fibrosing ILD and progressive ILD, which remains to be further investigated.
“…Letztlich können alle zielgerichteten Therapien Reaktionen in der Lunge auslösen, die dem Krankheitsbild der DILD („drug-induced lung disease“) DILD („drug-induced lung disease“) zugerechnet werden. CT-morphologisch lässt sich die DILD in ihren verschiedenen Ausprägungsformen gut abbilden [ 9 ].…”
Section: Pulmonale Veränderungen Infolge Von Molekularer Therapie – Dildunclassified
Die Strahlentherapie und in jüngerer Zeit insbesondere die medikamentöse molekulare Therapie sind zentrale Bestandteile der modernen Onkologie. Beide Therapieformen eignen sich dazu, Tumoren bei vergleichsweise geringen systemischen Nebenwirkungen effektiv zu behandeln. Dennoch haben auch diese Behandlungsansätze Nebenwirkungen, die zum einen durch die Toxizität der Strahlung, zum anderen durch immunmodulatorische Effekte der verabreichten Medikamente ausgelöst werden. Das pneumotoxische Potenzial dieser Therapieformen spiegelt sich unter anderem in der Entstehung von interstitiellen Pneumonitiden wider, die in fibrotische Lungengerüstveränderungen übergehen können. Erschwert wird die klinische Diagnose der Erkrankung durch die unspezifischen Symptome. Die Computertomographie (CT) stellt ein ausgezeichnetes Mittel dar, um korrespondierende Verdichtungen zu diagnostizieren und im zeitlichen Verlauf zu monitoren. Damit wird dem Radiologen im interdisziplinären Kontext eine wichtige Rolle bei der Diagnostik dieses Krankheitsbildes zuteil.
“…In the clinical setting, we frequently encounter drug-related pneumonitis (DRP), which is reported at rates of 2.6–5% in interstitial lung disease (ILD) cohorts [ 1 ] and the prevalence is 19.4 per 100,000 per year [ 2 ]. Computed tomography (CT) patterns of DRP are classified based on the American Thoracic Society (ATS)/European Respiratory Society international multidisciplinary classification of interstitial pneumonia (IP), as acute interstitial pneumonia/diffuse alveolar damage (DAD) pattern, hypersensitivity pneumonitis (HP) pattern, cryptogenic organizing pneumonia pattern, nonspecific interstitial pneumonia (NSIP) pattern, or others [ 3 , 4 ]. These categories are useful when considering differential diagnosis, response to treatment, and prognosis.…”
Section: Introductionmentioning
confidence: 99%
“…We queried our hospital's electronic medical record to retrospectively identify all adult patients with “drug-related pneumonitis”, between October 2013 and October 2019. Of the 133 patients with “definite or suspected drug related pneumonitis”, three patients (2.3%) were classified as having an HP pattern by a radiologist, according to the consensus criterion for the diagnosis [ 3 , 4 ]: small, poorly defined centrilobular nodules with or without widespread areas of ground-glass opacity (GGO).…”
Novel therapies have recently emerged for various diseases, and the management of drug-related pneumonitis (DRP) has become increasingly important. In particular, the hypersensitivity pneumonitis (HP) pattern of DRP has been increasingly recognized due to development of new therapeutic strategies, such as immunotherapy. However, literature describing detailed clinical cases is still lacking.
Herein, we report three cases of DRP with typical HP radiographic pattern. These patients were treated with different drugs, namely nano albumin-bound (nab)-paclitaxel, everolimus, or nivolumab, but had common clinical features, including a good prognosis.
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