Diagnostic Accuracy of Endobronchial Optical Coherence Tomography for the Microscopic Diagnosis of Usual Interstitial Pneumonia
| Autor: | Harald C. Ott, John C. Wain, Paul A. VanderLaan, Benjamin W. Roop, Cameron D. Wright, Michael Lanuti, Henning A. Gaissert, Benjamin D. Medoff, Peter Caravan, Diane L. Davies, Maxwell L. Smith, Sarita R. Berigei, Hugh Auchincloss, Christopher R. Morse, Melissa J. Suter, Rebecca A Raphaely, Mari Mino-Kenudson, Sreyankar Nandy, Amita Sharma, Lida P. Hariri, Margit V. Szabari, Lloyd L. Liang, Ashok Muniappan, Andrew M. Tager, Colleen Keyes, Nora Horick, Maria L. Garcia-Moliner, Thomas V. Colby, Angela R. Shih |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Diagnostic methods medicine.diagnostic_test business.industry Interstitial lung disease Diagnostic accuracy Original Articles respiratory system Critical Care and Intensive Care Medicine medicine.disease Usual interstitial pneumonitis Fibrosis humanities respiratory tract diseases Idiopathic pulmonary fibrosis Optical coherence tomography Usual interstitial pneumonia medicine In vivo microscopy Humans Radiology business Lung Diseases Interstitial Tomography Optical Coherence |
| Zdroj: | Am J Respir Crit Care Med |
| Popis: | Rationale: Early, accurate diagnosis of interstitial lung disease (ILD) informs prognosis and therapy, especially in idiopathic pulmonary fibrosis (IPF). Current diagnostic methods are imperfect. High-resolution computed tomography has limited resolution, and surgical lung biopsy (SLB) carries risks of morbidity and mortality. Endobronchial optical coherence tomography (EB-OCT) is a low-risk, bronchoscope-compatible modality that images large lung volumes in vivo with microscopic resolution, including subpleural lung, and has the potential to improve the diagnostic accuracy of bronchoscopy for ILD diagnosis. Objectives: We performed a prospective diagnostic accuracy study of EB-OCT in patients with ILD with a low-confidence diagnosis undergoing SLB. The primary endpoints were EB-OCT sensitivity/specificity for diagnosis of the histopathologic pattern of usual interstitial pneumonia (UIP) and clinical IPF. The secondary endpoint was agreement between EB-OCT and SLB for diagnosis of the ILD fibrosis pattern. Methods: EB-OCT was performed immediately before SLB. The resulting EB-OCT images and histopathology were interpreted by blinded, independent pathologists. Clinical diagnosis was obtained from the treating pulmonologists after SLB, blinded to EB-OCT. Measurements and Main Results: We enrolled 31 patients, and 4 were excluded because of inconclusive histopathology or lack of EB-OCT data. Twenty-seven patients were included in the analysis (16 men, average age: 65.0 yr): 12 were diagnosed with UIP and 15 with non-UIP ILD. Average FVC and Dl(CO) were 75.3% (SD, 18.5) and 53.5% (SD, 16.4), respectively. Sensitivity and specificity of EB-OCT was 100% (95% confidence interval, 75.8–100.0%) and 100% (79.6–100%), respectively, for both histopathologic UIP and clinical diagnosis of IPF. There was high agreement between EB-OCT and histopathology for diagnosis of ILD fibrosis pattern (weighted κ: 0.87 [0.72–1.0]). Conclusions: EB-OCT is a safe, accurate method for microscopic ILD diagnosis, as a complement to high-resolution computed tomography and an alternative to SLB. |
| Databáze: | OpenAIRE |
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