Utility of radial endobronchial ultrasonography combined with transbronchial lung cryobiopsy in patients with diffuse parenchymal lung diseases: a multicentre prospective study.
bronchoscopy
interstitial fibrosis
rare lung diseases
Journal
BMJ open respiratory research
ISSN: 2052-4439
Titre abrégé: BMJ Open Respir Res
Pays: England
ID NLM: 101638061
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
05
11
2020
revised:
14
12
2020
accepted:
17
12
2020
entrez:
14
1
2021
pubmed:
15
1
2021
medline:
29
10
2021
Statut:
ppublish
Résumé
Radial endobronchial ultrasonography (R-EBUS) has been used in conjunction with transbronchial lung cryobiopsy (TBLC) to diagnose diffuse parenchymal lung disease (DPLD) and to decrease the risk of bleeding complications. The diagnostic utility of different R-EBUS signs, however, remains unknown. This study aimed to determine whether different R-EBUS signs could be used to more accurately diagnose DPLD and whether bronchial bleeding could be prevented with use of R-EBUS during TBLC. Eighty-seven patients with DPLD were included in this multicentre prospective study, with 49 patients undergoing R-EBUS. R-EBUS signals were characterised as displaying either dense or blizzard signs. Pathological confidence of specimens obtained from TBLC was compared between patients with dense versus blizzard signs, and severity of bronchial bleeding was determined based on whether R-EBUS was performed or not. All patients with dense signs on R-EBUS showed consolidation on high-resolution CT (HRCT) imaging. Pathological confidence of lung specimens was significantly higher in patients with dense signs versus those with blizzard signs (p<0.01) and versus those who did not undergo R-EBUS (p<0.05). Patients who underwent TBLC with R-EBUS were more likely to experience no or mild bronchial bleeding than patients who did not undergo R-EBUS (p<0.01), with shorter procedure times (p<0.01). The dense R-EBUS sign corresponded with consolidation on HRCT. High-quality lung specimens may be obtainable when the dense sign is observed on R-EBUS, and R-EBUS combined with TBLC may reduce risk of bronchial bleeding and shorten procedure times.
Sections du résumé
BACKGROUND
Radial endobronchial ultrasonography (R-EBUS) has been used in conjunction with transbronchial lung cryobiopsy (TBLC) to diagnose diffuse parenchymal lung disease (DPLD) and to decrease the risk of bleeding complications. The diagnostic utility of different R-EBUS signs, however, remains unknown.
OBJECTIVES
This study aimed to determine whether different R-EBUS signs could be used to more accurately diagnose DPLD and whether bronchial bleeding could be prevented with use of R-EBUS during TBLC.
METHOD
Eighty-seven patients with DPLD were included in this multicentre prospective study, with 49 patients undergoing R-EBUS. R-EBUS signals were characterised as displaying either dense or blizzard signs. Pathological confidence of specimens obtained from TBLC was compared between patients with dense versus blizzard signs, and severity of bronchial bleeding was determined based on whether R-EBUS was performed or not.
RESULTS
All patients with dense signs on R-EBUS showed consolidation on high-resolution CT (HRCT) imaging. Pathological confidence of lung specimens was significantly higher in patients with dense signs versus those with blizzard signs (p<0.01) and versus those who did not undergo R-EBUS (p<0.05). Patients who underwent TBLC with R-EBUS were more likely to experience no or mild bronchial bleeding than patients who did not undergo R-EBUS (p<0.01), with shorter procedure times (p<0.01).
CONCLUSIONS
The dense R-EBUS sign corresponded with consolidation on HRCT. High-quality lung specimens may be obtainable when the dense sign is observed on R-EBUS, and R-EBUS combined with TBLC may reduce risk of bronchial bleeding and shorten procedure times.
Identifiants
pubmed: 33441374
pii: 8/1/e000826
doi: 10.1136/bmjresp-2020-000826
pmc: PMC7812092
pii:
doi:
Banques de données
UMIN-CTR
['UMIN000033284']
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Am J Respir Crit Care Med. 2019 May 15;199(10):1249-1256
pubmed: 30864813
Lancet Respir Med. 2020 Feb;8(2):171-181
pubmed: 31578168
Respirology. 2014 Jul;19(5):683-8
pubmed: 24750376
BMC Pulm Med. 2019 Oct 31;19(1):193
pubmed: 31672128
J Thorac Dis. 2019 Jan;11(1):329-334
pubmed: 30863611
Respirology. 2014 Aug;19(6):900-6
pubmed: 24890124
Ann Thorac Surg. 2000 Nov;70(5):1647-50
pubmed: 11093503
Chest. 2012 Aug;142(2):385-393
pubmed: 21980059
J Bronchology Interv Pulmonol. 2017 Apr;24(2):131-135
pubmed: 28323726
Respir Res. 2019 Jul 5;20(1):140
pubmed: 31277659
Respiration. 2016;91(3):215-27
pubmed: 26926876
ERJ Open Res. 2020 Jun 22;6(2):
pubmed: 32607371
Am J Respir Crit Care Med. 2016 Apr 1;193(7):745-52
pubmed: 26562389
Eur Respir J. 2015 Jun;45(6):1661-8
pubmed: 25573408
Chest. 2017 Feb;151(2):400-408
pubmed: 27660154
Arch Pathol Lab Med. 2017 Jul;141(7):891-900
pubmed: 27588334
Eur Respir J. 2009 Dec;34(6):1284-7
pubmed: 19460785
J Bronchology Interv Pulmonol. 2016 Jul;23(3):204-9
pubmed: 27261937
J Bronchology Interv Pulmonol. 2019 Oct;26(4):245-249
pubmed: 30676396
J Bronchology Interv Pulmonol. 2017 Apr;24(2):170-173
pubmed: 28323734
Respiration. 2017;93(4):285-292
pubmed: 28245447
Clin Respir J. 2016 Sep;10(5):589-95
pubmed: 25620578
Am J Respir Crit Care Med. 2018 Sep 1;198(5):e44-e68
pubmed: 30168753
Respir Investig. 2019 May;57(3):245-251
pubmed: 30745273
Chest. 2006 Jan;129(1):147-50
pubmed: 16424425
Chest. 2002 Dec;122(6):1887-94
pubmed: 12475821
Adv Respir Med. 2020;88(2):123-128
pubmed: 32383463
BMC Pulm Med. 2014 Nov 03;14:171
pubmed: 25366106