Does lung biopsy help patients with interstitial lung disease?

Qureshi, Rizwan; Ahmed, Tanveer; Grayson, Antony D.; Soorae, A S; Drakeley, M.J.; Page, Richard

doi:10.1016/s1010-7940(02)00021-0

Cited by 67 publications

(47 citation statements)

References 18 publications

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“…Whether the procedure alters the clinical management represents an important outcome. Several retrospective studies addressing these issues in series of patients with a variety of diffuse parenchymal diseases are available (74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85). In selected reports, the results have been very heterogeneous: the diagnostic yield ranged from 34% to 100%; therapy was altered in 46% to 75% of the cases.…”

Section: Transbronchial Biopsy Haematoxylin-eosin-stained Transbroncmentioning

confidence: 99%

Hypersensitivity pneumonitis

Girard

and

Cormier

2009

Allergy

114

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The first few cases of hypersensitivity pneumonitis (HP) were described in the early 20th century in farmers exposed to moldy hay or straw. As then, HP has been ascribed to multiple inhaled antigens found in a large variety of environmental settings. Hypersensitivity pneumonitis results from an exaggerated immune response, which gives rise to acute infection‐like symptoms or to progressive, sometimes irreversible lung damage. The diagnosis is based on a combination of clinical characteristics of the disease. Clinical diagnostic criteria have recently been published. The immune mechanisms leading to HP are still incompletely understood. Initially, believed to be a classes III and IV immune response, we now have a clearer understanding of the complex inflammatory events involved. These include the release of pro inflammatory cytokines and a decrease in the immune control mechanisms via surfactant, dendritic and T‐regulatory cells. Despite the improved understanding, the treatment and outcome of HP have not changed. Oral corticosteroids remain the only effective drugs and contact withdrawal constitutes the ideal solution. If unchecked, HP can lead to irreversible lung damage in the form of fibrosis or emphysema, respiratory insufficiency and even death.

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Section: Transbronchial Biopsy Haematoxylin-eosin-stained Transbroncmentioning

confidence: 99%

Hypersensitivity pneumonitis

Girard

and

Cormier

2009

Allergy

114

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“…However, various studies have demonstrated that biopsy samples obtained from the lingula or from the middle lobe have the same diagnostic yield as do those obtained from other lung segments. (14,17,18) The samples obtained from the middle lobe were sufficient for the diagnosis, except for that obtained in 1 case, in which there was pronounced honeycombing. It is likely that, in that case, the lung presented an advanced degree of diffuse fibrosis, since multiple biopsies…”

Section: Resultsmentioning

confidence: 91%

“…This is in agreement with the findings of another study, (13) in which it was concluded that a single sample obtained from a region pre-selected using radiology is sufficient for the diagnosis. Yet another study, (14) although not demonstrating greater diagnostic efficacy with the use of multiple biopsies, recommended that such biopsies be performed whenever possible. Various authors have stated that multiple biopsies increase the probability of establishing the definitive diagnosis.…”

Section: Resultsmentioning

confidence: 99%

A videotoracoscopia no diagnóstico das doenças difusas do parênquima pulmonar

et al. 2009

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Objective: To evaluate the role of video-assisted thoracoscopy in the diagnosis of diffuse parenchymal lung diseases. Methods: The medical charts of patients suspected of having diffuse parenchymal lung disease were retrospectively reviewed, as were the results of the anatomopathological examination of lung biopsy specimens collected through video-assisted thoracoscopy. Results: Of the 48 patients included in the study, 25 (52.08%) were female and 23 (47.92%) were male. The mean age was 58.77 years (range, 20-76 years). A total of 54 biopsy fragments were submitted to anatomopathological examination: 24 (44.44%) from the lingula; 10 (18.52%) from the left lower lobe; 7 (12.96%) from the right middle lobe; 6 (11.11%) from the right lower lobe; 5 (9.26%) from the left upper lobe; and 2 (3.71%) from the right upper lobe. The mean duration of thoracic drainage was 2.2 days. Adverse events included conversion to thoracotomy, in 2 patients (4.17%), and residual pneumothorax, in 1 (2.08%). The definitive diagnosis was made in 46 patients (95.83%), and idiopathic interstitial pneumonia was the predominant diagnosis (in 54.18%). The most common diagnoses were usual interstitial pneumonia (in 29.27%), nonspecific interstitial pneumonia (in 16.67%) and hypersensitivity pneumonia (in 12.50%). Conclusions: Lung biopsy through video-assisted thoracoscopy is a safe, effective and viable procedure for the diagnosis of diffuse parenchymal lung diseases.Keywords: Lung diseases, interstitial; Thoracoscopy; Diagnosis. ResumoObjetivo: Analisar o papel da videotoracoscopia no diagnóstico das doenças difusas do parênquima pulmonar. Métodos: Os prontuários de pacientes com suspeita de doenças difusas do parênquima pulmonar e os resultados do exame anatomopatológico das amostras de biópsia pulmonar por videotoracoscopia foram analisados retrospectivamente. Resultados: Dos 48 pacientes incluídos no estudo, 25 (52,08%) eram do sexo feminino, e 23 (47,92%) eram do sexo masculino. A idade média foi de 58,77 anos, variando entre 20 e 76 anos. Foi realizado o exame anatomopatológico de 54 fragmentos de biópsia pulmonar: 24 (44,44%) da língula; 10 (18,52%) do lobo inferior esquerdo; 7 (12,96%) do lobo médio; 6 (11,11%) do lobo inferior direito; 5 (9,26%) do lobo superior esquerdo; e 2 (3,71%) do lobo superior direito. O tempo médio de drenagem torácica foi de 2,2 dias. Como eventos adversos, houve conversão para toracotomia em 2 pacientes (4,17%) e pneumotórax residual em 1 (2,08%). O diagnóstico definitivo foi obtido em 46 (95,83%) casos, com predomínio das pneumonias intersticiais idiopáticas (54,18%). Os diagnósticos mais frequentes foram pneumonia intersticial usual (29,27%), pneumonia intersticial não-específica (16,67%) e pneumonia por hipersensibilidade (12,50%). Conclusões: A videotoracoscopia com biópsia pulmonar é um procedimento eficaz, seguro e viável para o diagnóstico das doenças difusas do parênquima pulmonar.

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“…52 Two studies reported yields below 70%, although these outliers were limited by the lack of SLBx review in a MDD. 53,54 The yield of SLBx can be optimized through several means. 3 Biopsies should have a depth 2 cm and maximum diameter 4 cm when gently inflated post-resection.…”

Section: Surgical Lung Biopsymentioning

confidence: 99%