Poor concordance between sequential transbronchial lung cryobiopsy and surgical lung biopsy in the diagnosis of diffuse interstitial lung diseases
| Autor: | Isabelle Vachier, Alberto Cavazza, Jean Pierre Mallet, Maurizio Zompatori, Isabelle Serre, Giorgia Dalpiaz, Carey M. Suehs, Alessandra Cancellieri, Paul Reynaud, Nicolas Molinari, Jean Philippe Berthet, Andrea Dell’Amore, Rocco Trisolini, Arnaud Bourdin, Giampiero Dolci, Thomas V. Colby, Laurence Solovei, Stefano Nava, Aldo Guerrieri, Anne Sophie Gamez, Micaela Romagnoli, Sébastien Bommart |
|---|---|
| Přispěvatelé: | Policlinico S. Orsola-Malpighi, Mayo Clinic [Scottsdale], Mayo Clinic, Service de chirurgie thoracique et cardio-vasculaire, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Département pneumologie et addictologie [Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Maggiore and S'Orsola-Malpighi hospital, Bologna, Italy., Dept of Oncology and Advanced Technologies - Operative Unit of Oncology, Arcispedale Santa Maria Nuova (ASMN), S. Maria Nuova Hospital-I.R.C.C.S., Univ Bologna, Bellaria hospital, Radiology, Bologna, Italy., Università di Bologna, Malpighi Hospital, Centres de Ressources et de Compétences de la Mucoviscidose [Montpellier] (CRCM [Montpellier]), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve-Service des Maladies Respiratoires, Mathématiques, Informatique et STatistique pour l'Environnement et l'Agronomie (MISTEA), Institut National de la Recherche Agronomique (INRA)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Alma Mater Studiorum Università di Bologna [Bologna] (UNIBO), Institut Montpelliérain Alexander Grothendieck (IMAG), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Romagnoli M., Colby T.V., Berthet J.-P., Gamez A.S., Mallet J.-P., Serre I., Cancellieri A., Cavazza A., Solovei L., Dell'Amore A., Dolci G., Guerrieri A., Reynaud P., Bommart S., Zompatori M., Dalpiaz G., Nava S., Trisolini R., Suehs C.M., Vachier I., Molinari N., Bourdin A. |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
Lung Diseases Male medicine.medical_specialty Concordance [SDV]Life Sciences [q-bio] Biopsy Diagnostic concordance Idiopathic pulmonary fibrosis Lung biopsy Critical Care and Intensive Care Medicine [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract Cryosurgery 03 medical and health sciences 0302 clinical medicine Bronchoscopy medicine [SDV.MHEP.AHA]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO] Humans 030212 general & internal medicine Prospective Studies Prospective cohort study Tomography Aged Idiopathic pulmonary fibrosi Lung Multidisciplinary approach medicine.diagnostic_test business.industry Lung histology Interstitial lung disease respiratory system Middle Aged medicine.disease respiratory tract diseases 3. Good health X-Ray Computed medicine.anatomical_structure 030228 respiratory system Deep sedation Female Idiopathic Pulmonary Fibrosis Lung Diseases Interstitial Tomography X-Ray Computed Radiology business Interstitial |
| Zdroj: | American Journal of Respiratory and Critical Care Medicine American Journal of Respiratory and Critical Care Medicine, American Thoracic Society, 2019, ⟨10.1164/rccm.201810-1947OC⟩ American Journal of Respiratory and Critical Care Medicine, American Thoracic Society, 2019, 199 (10), pp.1249-1256. ⟨10.1164/rccm.201810-1947OC⟩ |
| ISSN: | 1073-449X 1535-4970 |
| Popis: | International audience; Rationale: The diagnostic concordance between transbronchial lung cryobiopsy (TBLC)—versus surgical lung biopsy (SLB) as the current gold standard—in interstitial lung disease (ILD) cases requiring histology remains controversial.Objectives: To assess diagnostic concordance between TBLC and SLB sequentially performed in the same patients, the diagnostic yield of both techniques, and subsequent changes in multidisciplinary assessment (MDA) decisions.Methods: A two-center prospective study included patients with ILD with a nondefinite usual interstitial pneumonia pattern (on high-resolution computed tomography scan) confirmed at a first MDA. Patients underwent TBLC immediately followed by video-assisted thoracoscopy for SLB at the same anatomical locations. After open reading of both sample types by local pathologists and final diagnosis at a second MDA (MDA2), anonymized TBLC and SLB slides were blindly assessed by an external expert pathologist (T.V.C.). Kappa-concordance coefficients and percentage agreement were computed for: TBLC versus SLB, MDA2 versus TBLC, MDA2 versus SLB, and blinded pathology versus routine pathology.Measurements and Main Results: Twenty-one patients were included. The median TBLC biopsy size (longest axis) was 7 mm (interquartile range, 5–8 mm). SLB biopsy sizes averaged 46.1 ± 13.8 mm. Concordance coefficients and percentage agreement were: TBLC versus SLB: κ = 0.22 (95% confidence interval [CI], 0.01–0.44), percentage agreement = 38% (95% CI, 18–62%); MDA2 versus TBLC: κ = 0.31 (95% CI, 0.06–0.56), percentage agreement = 48% (95% CI, 26–70)%; MDA2 versus SLB: κ = 0.51 (95% CI, 0.27–0.75), percentage agreement = 62% (95% CI, 38–82%); two pneumothoraces (9.5%) were recorded during TBLC. TBLC would have led to a different treatment if SLB was not performed in 11 of 21 (52%) of cases.Conclusions: Pathological results from TBLC and SLB were poorly concordant in the assessment of ILD. SLBs were more frequently concordant with the final diagnosis retained at MDA |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|