scholarly journals RP EBUS as a guide for transbronchial pulmonary biopsy in the diagnosis of organizing pneumonia

2020 ◽  
Vol 15 ◽  
Author(s):  
Gaetano Cicchitto ◽  
Mario Polverino ◽  
Antonio Capuozzo ◽  
Luigi Cacace ◽  
Antonietta Cavallera ◽  
...  
Keyword(s):  
Lung Diseases ◽  
Small Airways ◽  
Organizing Pneumonia ◽  
Tissue Samples ◽  
Pulmonary Biopsy ◽  
Radiological Data ◽  
Diffuse Parenchymal Lung Diseases ◽  
Endobronchial Ultrasonography ◽  
Diagnostic Management ◽  
Peripheral Pulmonary Lesions

Diffuse parenchymal lung diseases (DPLDs) include a wide variety of manifestations characterized by different degrees of inflammation and fibrosis with various patterns of secondary lobule alterations, such that the diagnosis often requires histopathological confirmation in addition to clinical and radiological data. Radial probe endobronchial ultrasonography (RP EBUS) can be used as a guide for transbronchial pulmonary biopsy (TBPB) to obtain tissue samples, and thus can be a useful tool in the diagnostic management of peripheral pulmonary lesions. Organizing pneumonia (OP) is a particular type of DPLD characterized by lung inflammation and scarring that obstruct the small airways and air sacs of the lung.  In this study, we describe how and when RP EBUS can be used to guide TBPB and significantly help in the diagnosis of OP.

scholarly journals Safety and Usefulness of Cryobiopsy and Stamp Cytology for the Diagnosis of Peripheral Pulmonary Lesions

Cancers ◽  
2019 ◽  
Vol 11 (3) ◽  
pp. 410 ◽  
Author(s):  
Tatsuya Imabayashi ◽  
Junji Uchino ◽  
Akihiro Yoshimura ◽  
Yusuke Chihara ◽  
Nobuyo Tamiya ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Diagnostic Yield ◽  
Diagnostic Technique ◽  
Histological Diagnosis ◽  
Tissue Samples ◽  
Pulmonary Lesions ◽  
Lung Cancer Diagnosis ◽  
Thoracic Drainage ◽  
Endobronchial Ultrasonography ◽  
Peripheral Pulmonary Lesions

Reports on the use of cryobiopsy (CB) for lung cancer diagnosis are limited. The aims of the present study were to evaluate the safety and usefulness of CB using radial endobronchial ultrasonography, without a guide sheath, for the diagnosis of peripheral pulmonary lesions and determine the utility of stamp cytology, an on-site diagnostic technique for determining tumor inclusion in CB samples. We retrospectively analyzed data for 35 patients (36 lesions) with suspected peripheral lung cancer who underwent CB between August 2017 and February 2019 at our medical facility. The diagnostic yield, incidence of complications, and the utility of stamp cytology for diagnosis were investigated. The diagnostic yield of CB was 86.1% (31/36) with histological diagnosis, and 80.5% (29/36) with diagnosis using stamp cytology; the overall yield was 91.6% (33/36). Pneumothorax requiring thoracic drainage occurred in two patients, both of whom had lesions contacting the pleura. Grade 2 and grade 1 bleeding occurred in one and 25 patients, respectively. CB enables the collection of very large, nearly intact tissue samples, thus resulting in an improvement in the true diagnosis rate and facilitating the measurement of multiple biomarkers as well as rapid histological diagnosis.

scholarly journals Radial Endobronchial Ultrasonography with a Guide Sheath for the Diagnosis of Diffuse Parenchymal Lung Diseases

2019 ◽  
Author(s):  
Minoru Inomata ◽  
Naoyuki Kuse ◽  
Nobuyasu Awano ◽  
Mari Tone ◽  
Hanako Yoshimura ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Ground Glass Opacity ◽  
Tissue Samples ◽  
Ct Findings ◽  
Diffuse Parenchymal Lung Diseases ◽  
Diffuse Parenchymal Lung Disease ◽  
Endobronchial Ultrasonography ◽  
Parenchymal Lung Disease ◽  
Dense Pattern ◽  
Parenchymal Lung

Abstract Background Radial-endobronchial ultrasonography (R-EBUS) is a useful bronchoscopic tool for the diagnosis of solitary pulmonary peripheral lesions. However, the utility of R-EBUS for the diagnosis of diffuse parenchymal lung disease (DPLD) remains unclear. This study aimed to examine the characteristics of R-EBUS patterns in association with computed tomography (CT) findings in diagnosing DPLD. Methods Transbronchial lung biopsy (TBLB) was performed using R-EBUS and a guide sheath (GS) in consecutive 35 patients with suspected DPLD on chest CT between March–November 2017. Consolidation, ground glass opacity (GGO), reticular, and nodular patterns were diagnosed, and the mean CT Hounsfield units in the sampled area were measured in patients with consolidation. R-EBUS characteristics and their association with CT findings and pathological diagnostic yield were evaluated. Results R-EBUS showed a dense pattern only in patients with consolidation, and a blizzard pattern in patients with consolidation, GGO, reticular, and nodular patterns on CT. The biopsied area’s mean CT value was significantly higher in patients with dense than with blizzard patterns (p < 0.0001), and pathological findings were also dense in patients with R-EBUS dense pattern. The pathological diagnostic yield was significantly higher in patients with overt R-EBUS patterns than in patients without R-EBUS patterns by obtaining better lung tissue samples with the GS (p < 0.0001). Conclusions Dense and blizzard R-EBUS patterns were novel findings in diagnosing DPLD, and TBLB with R-EBUS-GS may be a valuable tool in diagnosing DPLD

scholarly journals Fibrotic Idiopathic Interstitial Lung Disease: The Molecular and Cellular Key Players

2021 ◽  
Vol 22 (16) ◽  
pp. 8952
Author(s):  
Anna Valeria Samarelli ◽  
Roberto Tonelli ◽  
Alessandro Marchioni ◽  
Giulia Bruzzi ◽  
Filippo Gozzi ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Interstitial Pneumonia ◽  
Lung Diseases ◽  
Alveolar Epithelium ◽  
Interstitial Lung Diseases ◽  
Organizing Pneumonia ◽  
Cryptogenic Organizing Pneumonia ◽  
Diffuse Parenchymal Lung Diseases ◽  
Key Players

Interstitial lung diseases (ILDs) that are known as diffuse parenchymal lung diseases (DPLDs) lead to the damage of alveolar epithelium and lung parenchyma, culminating in inflammation and widespread fibrosis. ILDs that account for more than 200 different pathologies can be divided into two groups: ILDs that have a known cause and those where the cause is unknown, classified as idiopathic interstitial pneumonia (IIP). IIPs include idiopathic pulmonary fibrosis (IPF), non-specific interstitial pneumonia (NSIP), cryptogenic organizing pneumonia (COP) known also as bronchiolitis obliterans organizing pneumonia (BOOP), acute interstitial pneumonia (AIP), desquamative interstitial pneumonia (DIP), respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), and lymphocytic interstitial pneumonia (LIP). In this review, our aim is to describe the pathogenic mechanisms that lead to the onset and progression of the different IIPs, starting from IPF as the most studied, in order to find both the common and standalone molecular and cellular key players among them. Finally, a deeper molecular and cellular characterization of different interstitial lung diseases without a known cause would contribute to giving a more accurate diagnosis to the patients, which would translate to a more effective treatment decision.

scholarly journals E-Cigarette or Vaping Product Use-Associated Lung Injury: A Review for Pathologists

2020 ◽  
Vol 144 (12) ◽  
pp. 1490-1500
Author(s):  
Matthew J. Cecchini ◽  
Sanjay Mukhopadhyay ◽  
Andrea V. Arrossi ◽  
Mary B. Beasley ◽  
Yasmeen M. Butt ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Diffuse Alveolar Damage ◽  
Respiratory Illness ◽  
The United States ◽  
Small Airways ◽  
Organizing Pneumonia ◽  
Tissue Samples ◽  
Lipoid Pneumonia ◽  
Pathologic Features

Context.— Vaping is the inhalation of heated aerosol from a small battery-powered device as a method to deliver nicotine or other substances. A recent outbreak of severe respiratory illness primarily in the United States has put a spotlight on vaping and its potential risks. Objective.— To familiarize pathologists with vaping, the cytologic and histopathologic features of vaping-associated acute lung injury, and the role of pathology in this diagnosis. Data Sources.— A targeted literature review was performed. Conclusions.— Most cases of vaping-associated lung injury have been linked to vaping products containing tetrahydrocannabinol or other cannabinoids. Lung biopsies show a spectrum of nonspecific acute lung injury patterns (organizing pneumonia, diffuse alveolar damage, acute fibrinous, and organizing pneumonia, or combinations of the above), accompanied by prominent, foamy macrophage accumulation. Injury is usually accentuated around small airways. Lipid-laden macrophages can be identified in bronchioloalveolar lavage fluid in most patients and these can be highlighted using lipid stains, such as oil red O, but the clinical utility of this finding remains unclear, as lipid-laden macrophages can be seen in a wide variety of processes and should not be relied upon to make the diagnosis. Classic histologic features of exogenous lipoid pneumonia have not been identified in tissue samples. Lightly pigmented macrophages, similar to those seen with traditional cigarette smoking, are present in some cases but are usually a minor feature. To date, no specific pathologic features for vaping-related injury have been identified, and it remains a diagnosis of exclusion that requires clinicopathologic correlation.

Ability and limitations of endobronchial ultrasonography to diagnose peripheral pulmonary lesions

2019 ◽  
Vol 1 (10) ◽  
pp. 48-53
Author(s):  
V. N. Korolyov ◽  
D. V. Gogoleva ◽  
O. A. Gladkov ◽  
A. M. Mikita
Keyword(s):  
Pulmonary Lesions ◽  
Endobronchial Ultrasonography ◽  
Peripheral Pulmonary Lesions

scholarly journals Lung Cryobiopsy Outside of the Operating Room: A Safe Alternative to Surgical Biopsy

2021 ◽  
pp. 155698452110345
Author(s):  
Vanessa Menezes ◽  
Juan Carlos Molina ◽  
Clare Pollock ◽  
Philippe Romeo ◽  
Julie Morisset ◽  
...  
Keyword(s):  
Operating Room ◽  
Lung Diseases ◽  
Diagnostic Yield ◽  
Interstitial Lung Diseases ◽  
Minor Bleeding ◽  
Hypoxemic Respiratory Failure ◽  
Surgical Biopsy ◽  
Histologic Diagnosis ◽  
Safe Alternative ◽  
Diffuse Parenchymal Lung Diseases

Objective Transbronchial lung cryobiopsy (TBLC) is a promising technique that can provide a histologic diagnosis in interstitial lung diseases (ILD) and is an alternative to surgical lung biopsy. The main concerns with the procedure are safety and diagnostic accuracy. The technique is applicable in patients unable to undergo surgical biopsy due to severe comorbidities or when patient transport to the operating room is dangerous. This study reports the initial experience with TBLC on a thoracic surgical service as a first attempt at diagnosis in patients with diffuse parenchymal lung diseases (DPLD). Methods Between May 2018 and July 2020, 32 patients underwent TBLC using bedside flexible bronchoscopy for suspected ILD on a thoracic surgical endoscopy service. Retrospective evaluation of the procedure details, complications, and diagnostic yield were analyzed and reported. Results A total of 89 pathological samples were obtained (mean 2.8 per patient). Pneumothorax and minor bleeding occurred in 25% and 16.7% of patients, respectively. Sixty-seven percent of complications occurred with use of the 2.4 mm cryoprobe ( P = 0.036). Concordance between the histologic diagnosis and final clinical diagnosis was observed in 62.5% of patients and the pathology guided the final treatment in 71% ( P = 0.027) with Kappa-concordance of 0.60 ( P < 0.001). Conclusions Cryobiopsy is becoming part of the diagnostic evaluation in patients with indeterminate DPLD or hypoxemic respiratory failure. TBLC is easy to perform and has a favorable safety profile. Thoracic specialists should consider adding TBLC to their procedural armamentarium as a first option for patients with indeterminate PLD.

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