Lung biopsy in interstitial lung disease: balancing the risk of surgery and diagnostic uncertainty

Cottin, Vincent

doi:10.1183/13993003.01633-2016

Cited by 39 publications

(28 citation statements)

References 38 publications

(41 reference statements)

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“…The most important is biopsy, performed depending on the tissue involved. Lung biopsy can be useful to assess the ILD pattern with more precision, but the acquired information should be balanced with the risk of the procedure [2]. It should be taken into account that, although small studies have reported histological differences between the UIP pattern in RA and IPF (fewer fibroblastic foci and more CD4+ cells in RA), no evidences strongly support a confident differential diagnosis between these two conditions [135].…”

Section: Second-line Instrumental Examsmentioning

confidence: 99%

“…The diagnostic assessment of patients with Interstitial Lung Disease (ILD) can be challenging, since this condition is associated with several possible diseases [1]. The utility of invasive exams should be also balanced, between the amount of histological information provided and the risk of side effects, mainly in elderly patients or in subjects with a severe disease [2]. Currently, the gold standard in the diagnosis and management of ILD is the Multidisciplinary Team (MDT), in which physicians of several disciplines discuss doubtful cases to reach a confident diagnosis [3].…”

Section: Introductionmentioning

confidence: 99%

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Patients with Interstitial Lung Disease Secondary to Autoimmune Diseases: How to Recognize Them?

Sambataro

Pignataro³

et al. 2020

Diagnostics

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The diagnostic assessment of patients with Interstitial Lung Disease (ILD) can be challenging due to the large number of possible causes. Moreover, the diagnostic approach can be limited by the severity of the disease, which may not allow invasive exams. To overcome this issue, the referral centers for ILD organized Multidisciplinary Teams (MDTs), including physicians and experts in complementary discipline, to discuss the management of doubtful cases of ILD. MDT is currently considered the gold standard for ILD diagnosis, but it is not often simple to organize and, furthermore, rheumatologists are still not always included. In fact, even if rheumatologic conditions represent a common cause of ILD, they are sometimes difficult to recognize, considering the variegated clinical features and their association with all possible radiographic patterns of ILD. The first objective of this review is to describe the clinical, laboratory, and instrumental tests that can drive a diagnosis toward a possible rheumatic disease. The secondary objective is to propose a set of first-line tests to perform in all patients in order to recognize any possible rheumatic conditions underlying ILD.

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Section: Second-line Instrumental Examsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patients with Interstitial Lung Disease Secondary to Autoimmune Diseases: How to Recognize Them?

Sambataro

Pignataro³

et al. 2020

Diagnostics

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“…If a UIP pattern was not clearly identified ("possible" or "inconsistent with UIP") by HRCT, confirmation of diagnosis via surgical lung biopsy (SLB) was recommended [14]. SLB is associated with an elevated risk of acute exacerbation, pneumothorax and mortality, and may therefore be inappropriate for some patients [15][16][17][18].…”

Section: Diagnosismentioning

confidence: 99%

Ongoing challenges in pulmonary fibrosis and insights from the nintedanib clinical programme

et al. 2020

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The approvals of nintedanib and pirfenidone changed the treatment paradigm in idiopathic pulmonary fibrosis (IPF), and increased our understanding of the underlying disease mechanisms. Nonetheless, many challenges and unmet needs remain in the management of patients with IPF and other progressive fibrosing interstitial lung diseases. This review describes how the nintedanib clinical programme has helped to address some of these challenges. Data from this programme have informed changes to the IPF diagnostic guidelines, the timing of treatment initiation, and the assessment of disease progression. The use of nintedanib to treat patients with advanced lung function impairment, concomitant emphysema, patients awaiting lung transplantation and patients with IPF and lung cancer is discussed. The long-term use of nintedanib and an up-to-date summary of nintedanib in clinical practice are discussed. Directions for future research, namely emerging therapeutic options, precision medicine and other progressive fibrosing interstitial lung diseases, are described. Further developments in these areas should continue to improve patient outcomes.

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“…It was recently estimated that only 5% of clinically suspected IPFs were biopsied [8]. The risk of surgical lung biopsy, which low for patients younger than 65 years and with no significant comorbidity and preserved lung function who are referred for elective surgery, is higher in other situations [9,10], and a biopsy may be impracticable or risky. In addition, physicians often are reluctant to refer patients for lung biopsy even in the absence of any contraindication or comorbidity, and most patients would generally prefer not to undergo surgery.…”

mentioning

confidence: 99%

“…Over recent years, this need to balance diagnostic uncertainty with the risk of biopsy [9] has generated some pressure to develop newer techniques (including genomics, genetics, biomarkers, and new imaging techniques) in order to move away from lung biopsy and also to assess the diagnostic accuracy of less invasive techniques of accessing lung tissue. Recently, transbronchial lung cryobiopsy has been shown to be a valuable tool for the pathological assessment of ILDs [11][12][13][14].…”

mentioning

confidence: 99%

Lung Biopsy in Interstitial Lung Diseases: There Is More than One Way to Cook an Egg

Nasser¹,

Cottin²

2018

Respiration

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Lung biopsy in interstitial lung disease: balancing the risk of surgery and diagnostic uncertainty

Cited by 39 publications

References 38 publications

Patients with Interstitial Lung Disease Secondary to Autoimmune Diseases: How to Recognize Them?

Patients with Interstitial Lung Disease Secondary to Autoimmune Diseases: How to Recognize Them?

Ongoing challenges in pulmonary fibrosis and insights from the nintedanib clinical programme

Lung Biopsy in Interstitial Lung Diseases: There Is More than One Way to Cook an Egg

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