Evaluation Of Interstitial Lung Disease Research Articles

Multidisciplinary Evaluation of Interstitial Lung Diseases: New Opportunities Linked to Rheumatologist Involvement.

Multidisciplinary team (MDT) discussion is the gold standard in the management of interstitial lung disease (ILD). The rheumatologist is not routinely involved in MDT, even if up to 20% of ILD are related to systemic autoimmune rheumatic diseases (SARD). The study aims to assess the agreement and its variation over time between rheumatologists and pulmonologists in the screening of SARD and between rheumatologists and an MDT extended to rheumatologists (eMDT) in evaluating the progression of SARD. We computed the agreement between the pulmonologist and rheumatologist in the identification of red flags for SARDs of 81 ILD cases and between the rheumatologist alone and eMDT in the confirmation of 70 suspected SARD-ILD progressions. The agreement between rheumatologists and pulmonologists was moderate for the detection of autoimmunity test positivity (κ = 0.475, p < 0.001) and family history of SARD (κ = 0.491, p < 0.001) and fair for the identification of extrapulmonary symptoms (κ = 0.225, p = 0.064) or routine laboratory abnormalities consistent with SARD. The average agreement between the rheumatologist and eMDT in the identification of ILD progression was moderate (κ = 0.436, p < 0.001). The class of agreement improved from the first to the third semester. The average agreement with the rheumatologist ranged from fair to moderate, suggesting that a shared evaluation of SARD-ILD in eMDT could improve the diagnostic work-up and the evaluation of ILD progression.

Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Interstitial Lung Disease.

Bronchoalveolar lavage and transbronchial biopsy can be a useful tool in the evaluation of interstitial lung disease (ILD), but patient selection for this procedure remains poorly defined. Determining clinical characteristics that help with patient selection for bronchoscopy may improve confidence of ILD classification while limiting potential adverse outcomes associated with surgical lung biopsy. The purpose of this study is to identify factors that were associated with change in multidisciplinary ILD diagnosis (MDD) before and after incorporation of BAL and TBBx data. We conducted a retrospective cohort study of ILD patients at a single center who underwent bronchoscopy in the diagnostic workup of ILD. We performed sequential MDD both pre- and post-bronchoscopy to calculate the frequency of change in diagnosis after incorporating information from BAL and TBBx and identify features associated with change in diagnosis. 245 patients were included in the study. Bronchoscopy led to a change in diagnosis in 58 patients (23.7%). The addition of TBBx to BAL increased diagnostic yield from 21.8 to 34.1% (p = 0.027). Identification of antigen, HRCT scan inconsistent with UIP, and absence of a pre-bronchoscopy diagnosis of CTD-ILD or IPAF were associated with a change in diagnosis after bronchoscopy. Our study suggests clinical features that may assist with patient selection for bronchoscopy. We suggest bronchoscopy in patients with identified antigen or an HRCT that is consistent with a non-IPF diagnosis. Appropriate patient selection for bronchoscopy may improve ILD diagnostic confidence and avoid potential complications from more invasive and higher risk procedures.

Diagnostic value of TBLC in idiopathic pulmonary fibrosis

Over the past 5 years, evidence has been growing for the use of transbronchial lung cryobiopsy (TBLC) in the diagnostic evaluation of interstitial lung disease. 1 Maldonado F Danoff SK Wells AU et al. Transbronchial cryobiopsy for the diagnosis of interstitial lung diseases: CHEST Guideline and Expert Panel Report. Chest. 2020; 157: 1030-1042 Summary Full Text Full Text PDF PubMed Scopus (43) Google Scholar , 2 Lentz RJ Argento AC Colby TV Rickman OB Maldonado F Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges. J Thorac Dis. 2017; 9: 2186-2203 Crossref PubMed Scopus (72) Google Scholar , 3 Troy LK Grainge C Corte TJ et al. Diagnostic accuracy of transbronchial lung cryobiopsy for interstitial lung disease diagnosis (COLDICE): a prospective, comparative study. Lancet Respir Med. 2020; 8: 171-181 Summary Full Text Full Text PDF PubMed Scopus (96) Google Scholar In The Lancet Respiratory Medicine, Sara Tomassetti and colleagues 4 Tomassetti S Ravaglia C Wells AU et al. Prognostic value of transbronchial lung cryobiopsy for the multidisciplinary diagnosis of idiopathic pulmonary fibrosis: a retrospective validation study. Lancet Respir Med. 2020; 8: 786-794 Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar report the long-term outcomes of patients with interstitial lung disease diagnosed by TBLC or surgical lung biopsy (SLB) and hypothesise that if diagnostic accuracy were similar between the two modalities, prognostic outcome would also be similar, and further would be distinct for idiopathic pulmonary fibrosis versus other interstitial lung diseases. A well-designed, single-centre, retrospective study was done of 426 consecutive patients with interstitial lung disease, of whom 160 had undergone SLB and 266 had undergone TBLC. The primary study conclusion was that idiopathic pulmonary fibrosis cases diagnosed by TBLC had (expectedly) poorer clinical outcomes compared with patients with an alternative diagnosis (transplant-free survival adjusted HR 2·98, 95% CI 1·19–7·47; p=0·02), and therefore TBLC, similarly to SLB, could be relied on to provide accurate histopathological information to multidisciplinary team (MDT) discussions in the work-up of undifferentiated interstitial lung disease. Additionally, the investigators found that adjusted comparative survival in idiopathic pulmonary fibrosis appeared worse for those diagnosed by SLB compared with those diagnosed by TBLC (adjusted HR 4·07, 95% CI 2·01–8·24; p<0·0001). Prognostic value of transbronchial lung cryobiopsy for the multidisciplinary diagnosis of idiopathic pulmonary fibrosis: a retrospective validation studyTBLC makes an important diagnostic contribution in interstitial lung disease, on the basis of the prognostic distinction between idiopathic pulmonary fibrosis and other interstitial lung diseases when TBLC findings are included in multidisciplinary diagnosis. Full-Text PDF

The qualitative and quantitative high-resolution computed tomography in the evaluation of interstitial lung diseases

BackgroundHigh-resolution computed tomography (HRCT) is the most accepted imaging tool for the detection, characterization, and monitoring of interstitial lung diseases (ILDs). The correct interpretation of HRCT findings still represents often a problem for the radiologists since there is wide interobserver variability. Therefore, a quantitative and noninvasive imaging method able to permit an accurate assessment of ILD is highly desirable. The purpose of this study is to compare the visual method and quantitative CT histogram in the evaluation of ILDs and to identify the best quantitative parameter in the prediction of severity of ILDs.ResultsThere is a correlation between the HRCT score by the qualitative method and CT histogram parameters by the quantitative method in the evaluation of ILDs. Total lung volume inspiratory, mean lung density expiratory, and high attenuation area expiratory showed a significant correlation with the HRCT score.ConclusionThe single best predictor of fibrosis severity in interstitial lung disease is HAAs % expiratory.

Ice Capades: Skating Around Current Practice of Cryobiopsy for ILD.

Transbronchial lung cryobiopsy (TBLC) has been proposed as a potentially safer alternative in the diagnosis of interstitial lung disease. The current practice of TBLC is unknown as most published data come from case reports, case series, and a few trials. The authors report the practice patterns of TBLC on the basis of survey responses. The authors created an anonymous online survey to assess how proceduralists evaluate patients, perform, and manage complications of TBLC. Surveys were distributed through social media and e-mail distribution lists from the American Association of Bronchology and Interventional Pulmonology and the Society of Advanced Bronchoscopists. Aggregated responses are reported as counts, percentages, and averages. Surveys show significant variation in parameters providers use to assess appropriate patients for procedures, how specific aspects of TBLC are performed, and how complications and results are managed. This is the first and largest survey of providers describing the current large variation in the use of cryobiopsy for the evaluation of interstitial lung disease. The standardized practice is essential to understand the true diagnostic accuracy or rate of complications related to TBLC.

Lung US Surface Wave Elastography in Interstitial Lung Disease Staging.

Background Lung US surface wave elastography (SWE) can noninvasively quantify lung surface stiffness or fibrosis by evaluating the rate of surface wave propagation. Purpose To assess the utility of lung US SWE for evaluation of interstitial lung disease. Materials and Methods In this prospective study, lung US SWE was used to assess 91 participants (women, 51; men, 40; mean age ± standard deviation [SD], 62.4 years ± 12.9) with interstitial lung disease and 30 healthy subjects (women, 16; men, 14; mean age, 45.4 years ± 14.6) from February 2016 through May 2017. Severity of interstitial lung disease was graded as none (healthy lung [F0]), mild (F1), moderate (F2), or severe (F3) based on pulmonary function tests, high-resolution CT, and clinical assessments. We propagated surface waves on the lung through gentle mechanical excitation of the external chest wall and measured the lung surface wave speed with a US probe. Lung US SWE performance was assessed, and the optimal cutoff wave speed values for fibrosis grades F0 through F3 were determined with receiver operating characteristic (ROC) curve analysis. Results Lung US SWE had a sensitivity of 92% (95% confidence intervals [CI]: 84%, 96%; P < .001) and a specificity of 89% (95% CI: 81%, 94%; P < .001) for differentiating between healthy subjects (F0) and participants with any grade of interstitial lung disease (F1-F3). It had a sensitivity of 50% and a specificity of 81% for differentiating interstitial lung disease grades F0-F2 from F3. The sensitivity was 88% and the specificity was 97% for differentiating between F0 and F1. The highest area under the ROC curve (AUC) values were obtained at 200 Hz and ranged from 0.83 to 0.94 to distinguish between healthy subjects and study participants with any interstitial lung disease. Conclusion Lung US surface wave elastography may be adjunct to high-resolution CT for noninvasive evaluation of interstitial lung disease. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Verschakelen in this issue.

High Resolution Computed Tomography (HRCT) Evaluation of Suspected Interstitial Lung Disease Cases.

Background: Interstitial lung disease (ILD) refers to a large group of diseases that causes scarring of lung tissue. Diagnosis of exact etiology of ILD is usually by clinico-radiologic-pathologic correlation. HRCT of Lung plays a crucial role in diagnosis of etiology of ILD &amp; determining prognosis. Objective: To describe the HRCT findings in clinically suspected cases of ILD and to compare the role of HRCT with Chest X ray in diagnosis of ILD. Subjects and Methods: A descriptive study was conducted among 50 consecutive, consenting patients with clinical suspicion of interstitial lung disease. History and clinical details of all study participants were noted and first examined with chest radiography and then exposed to HRCT. The data thus collected was properly coded and entered in Microsoft Excel and analysis was done using the software SPSS version 16.0. Results: Mean age of the study population was 48.84 years (SD=14.46).60% of the study participants were males. Specific diagnoses could be made in 25.7% of abnormal case with radiograph and clinical correlation and in 57% with HRCT and clinical correlation. Most common pattern identified was reticular (60%) and most common anatomical area of involvement identified was lower lobe (54.28%). Most common etiology among the cases was idiopathic pulmonary fibrosis (20%) followed by sarcoidosis (11.4%). Conclusion: Idiopathic pulmonary fibrosis, sarcoidosis and Hypersensitivity pneumonitis along with non specific type were the most frequent types of ILD identified in the study. The current study demonstrates a better diagnostic efficacy for HRCT when compared to chest X ray in the evaluation of interstitial lung disease.

Machine learning assisted evaluation of interstitial lung diseases

Interstitial lung disease (ILD) is an inflammatory condition encompassing greater than 200 different chronic disorders that often lead to pulmonary fibrosis and the attendant morbidity and mortality. Distinguishing one ILD from another can be challenging even for experts given similar clinical manifestations. However, firm diagnosis is important for management, counseling, and surveillance. Computer-Aided Lung Informatics for Pathology Evaluation and Ratings (CALIPER, Mayo Clinic, Rochester, MN, USA), a machine learned image analysis tool for characterizing and quantifying diffused lung diseases on CT, has been shown to correlate with ILD mortality such as for idiopathic pulmonary fibrosis. The CALIPER assessment of ILD is not influenced by confounding conditions such as emphysema or pulmonary hypertension that may affect pulmonary function measurements. Moreover, CALIPER can provide more reproducible results with less inter- and intraobserver variability compared to the conventional subjective visual assessment of CT scans by radiologists. Herein, we aim to provide an overview of ILD and discuss CALIPER evaluation of ILD.

HRCT Evaluation of Interstitial Lung Diseases in South Indian Population

HRCT Evaluation of Interstitial Lung Diseases in South Indian Population

The utility of bronchoalveolar lavage in the evaluation of interstitial lung diseases: A clinicopathological perspective.

Bronchoalveolar lavage (BAL) is a noninvasive and well-tolerated procedure that is performed with a fiberoptic bronchoscope in the wedged position within a selected bronchopulmonary segment. After it was introduced to clinical practice, BAL rapidly gained acceptance in a large number of centers as a procedure that could be applied to the clinical evaluation of patients with various pulmonary disorders, especially the group of interstitial lung diseases (ILD). Cytological and flow cytometric analysis of BAL fluid in ILD is done with knowledge of the clinical presentation and radiological findings. BAL typically reveals variations in the types and numbers of nucleated immune cells and acellular components in patients with ILD, which differ from those seen in normal control subjects. Many clinicians currently use this technique as a guide in the differential diagnoses of ILD; it can also be used to monitor the course of disease and possible response to therapeutic interventions. This article summarizes current clinicopathological information concerning the use of BAL by pulmonologists and pathologists.

Ultrasound B-lines in the evaluation of interstitial lung disease in patients with systemic sclerosis: Cut-off point definition for the presence of significant pulmonary fibrosis.

The aim of this study was to establish the cut-off point of ultrasound (US) B-lines number for detecting the presence of significant interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) (SSc-ILD) in relation to high-resolution computed tomography (HRCT) findings.Consecutive SSc-ILD patients underwent chest HRCT, lung US (LUS), pulmonary function test, and clinical assessment. Exclusion criteria were represented by the presence of a coexisting congestive heart failure and a clinical history suggestive of lung or pleural diseases. HRCT images were scored for the presence of ILD by 2 readers, in accordance with the Warrick scoring system. US assessment was performed by a US skilled rheumatologist, blinded to HRCT results and clinical data, and included the bilateral evaluation of 14 lung intercostal spaces (LIS). In each LIS, the number of B-lines was recorded and summed. To test discriminant validity, we used the receiver operating characteristic (ROC) curve analysis applying a Warrick score of 7 as external criterion for the presence of SSc-ILD.Forty patients completed the study. The US B-lines number and the Warrick score confirmed excellent correlation (Spearman rho: 0.958, P = .0001). The ROC curve analysis revealed that the presence of 10 US B-lines is the cut-off point with the greatest positive likelihood ratio (12.52) for the presence of significant SSc-ILD.The detection of 10 B-lines is highly predictive for the HRCT presence of significant SSc-ILD. In SSc patients, the LUS assessment as first imaging tool may represent an effective model to improve the correct timing of chest HRCT.

Observer Agreement in the Evaluation of Interstitial Lung Diseases in Argentina

SESSION TITLE: Diffuse Lung Disease 1 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Primary objective: To evaluate the agreement in the diagnosis and treatment of Interstitial Lung Diseases (ILD) between multiple observers in Argentina. Secondary objective: To evaluate the agreement of performing a surgical biopsy to confirm the diagnosis. METHODS: Patients with diagnosis of ILD were analyzed retrospectively. The clinical cases were reviewed by 5 pulmonologists ( 4 of them with 5 to 10 years of experience in the management of patients with ILD, and the last one with more than 20 years of experience in the management of these patients). Relevant clinical and laboratory data, including autoantibodies, bronchoalveolar lavage, transbronchial biopsy, lung function and high resolution computed tomography (HRCT) were evaluated in each case. The interobserver agreement was evaluated analyzing the different HRCT patterns, the final diagnosis of each observer, the therapeutic approach and the need to perform or not a surgical biopsy to confirm the diagnosis. Descriptive analysis was performed. The kappa was calculated for multiple observers. RESULTS: Twenty patients with diagnosis of ILD were evaluated (12 men and 8 women). The mean age of the patients was 63 ± 11.75 years old. Seventy percent (14 patients) were current or former smokers. The mean forced vital capacity (FVC) was 2.86± 0.77 litters in absolute values and 73% ± 11.85 expressed in percentage of the predicted value, and the mean DLCO expressed in percentage of predicted value was 58% ± 18.31. Regarding the HRCT pattern, the agreement was 0.65 (CI 95%: 0.54-0.75), with a greater agreement in the definition of possible usual interstitial pneumonia (UIP) pattern 0.65 (CI 95%: 0.48-0.82), definitive UIP pattern 0.59 (CI 95%: 0.44-0.75) and nonspecific interstitial pneumonia (NISP) pattern 0.57 (CI 95%: 0.46-0.69). In concern to the final the diagnosis, the agreement was 0.78 (CI 95%: 0.66-0.89), with a perfect degree of agreement in the diagnosis of the collagen tissue diseases (CTD)-ILD (kappa=1), moderate in idiopathic pulmonary fibrosis (IPF) 0.60 (CI 95%: 0.47-0.73) and weak in possible UIP 0.24 (CI 95%: 0.015-051). The need for surgical biopsy showed a moderate agreement of 0.45 (CI 95%: 0.31-0.59).The therapeutic approach showed a kappa of 0.49 (CI 95%: 0.40-0.57). The concordance was very good in regard to the indication of antifibrotic treatment 0.85 (CI 95%: 0.76-0.94), oral steroids and good in immunosuppressive drugs 0.68 (CI 95%: 0.56-0.79). There was less agreement in the choice of the immunosuppressive and its route of administration: oral (mycophenolate) or intravenous (cyclophosphamide or pulses with steroids). CONCLUSIONS: The overall agreement in the HRCT patterns and final diagnosis between the different observers was good. There was good agreement in the indication of antifibrotics and immunosuppression. The decision to perform a lung surgical biopsy showed a moderate agreement. CLINICAL IMPLICATIONS: In spite of a significant agreement in the CT pattern and potential diagnosis, the considerable lack of agreement about the need on biopsy and choice of treatment emphasizes the importance of the discussion in the multidisciplinary team. DISCLOSURE: The following authors have nothing to disclose: Brenda Varela, Gabriela Tabaj, Silvia Quadrelli, Juan Ignacio Enghelmayer, Maria Otaola, Carlos Nigro No Product/Research Disclosure Information

Effects of pure and hybrid iterative reconstruction algorithms on high-resolution computed tomography in the evaluation of interstitial lung disease

ObjectivesTo compare image quality characteristics of high-resolution computed tomography (HRCT) in the evaluation of interstitial lung disease using three different reconstruction methods: model-based iterative reconstruction (MBIR), adaptive statistical iterative reconstruction (ASIR), and filtered back projection (FBP). MethodsEighty-nine consecutive patients with interstitial lung disease underwent standard-of-care chest CT with 64-row multi-detector CT. HRCT images were reconstructed in 0.625-mm contiguous axial slices using FBP, ASIR, and MBIR. Two radiologists independently assessed the images in a blinded manner for subjective image noise, streak artifacts, and visualization of normal and pathologic structures. Objective image noise was measured in the lung parenchyma. Spatial resolution was assessed by measuring the modulation transfer function (MTF). ResultsMBIR offered significantly lower objective image noise (22.24±4.53, P<0.01 among all pairs, Student's t-test) compared with ASIR (39.76±7.41) and FBP (51.91±9.71). MTF (spatial resolution) was increased using MBIR compared with ASIR and FBP. MBIR showed improvements in visualization of normal and pathologic structures over ASIR and FBP, while ASIR was rated quite similarly to FBP. MBIR significantly improved subjective image noise (P<0.01 among all pairs, the sign test), and streak artifacts (P<0.01 each for MBIR vs. the other 2 image data sets). ConclusionMBIR provides high-quality HRCT images for interstitial lung disease by reducing image noise and streak artifacts and improving spatial resolution compared with ASIR and FBP.

Multidisciplinary evaluation of interstitial lung diseases: current insights: Number 1 in the Series "Radiology" Edited by Nicola Sverzellati and Sujal Desai.

Multidisciplinary team (MDT) diagnosis is regarded as the diagnostic reference standard for interstitial lung disease (ILD). Several studies have reported that MDT diagnosis is associated with higher levels of diagnostic confidence and better interobserver agreement when compared to the individual components of the MDT in isolation. Although this recommendation is widely accepted, no guideline statement specifies what constitutes an MDT meeting and how its participants should govern it. Furthermore, the precise role of an MDT meeting in the setting of ILD may vary from one group to another. For example, in some cases, the meeting will confine its discussion to characterising the disease and formulating diagnosis. In others, management decisions may also be part of the discussion. Surprisingly, there is no consensus on how MDT diagnosis is validated. As multidisciplinary evaluation contains all the available clinical information on an individual patient, there is no reference standard against which the veracity of MDT diagnosis can be tested. Finally, many of these uncertainties surrounding MDT meeting practice are unlikely to be answered by traditional evidence-based studies, which create difficulties when generating guideline recommendations. There is clearly a need for expert consensus on what constitutes acceptable MDT meeting practice. This consensus will need to be flexible to accommodate the variability in resources available to fledgling MDT groups and the variable nature of patients requiring discussion.

High resolution computed tomography in the evaluation of interstitial lung diseases: Imaging perspective revisited with review of literature

Aims and Objectives: The study was designed with a broad objective of studying the imaging findings of the common interstitial lung diseases and to assess the severity of the disease and determine the reversibility capability of the pulmonary parenchymal damage in ILD’s. Patients and Methods: This was a prospective, observational study in which we evaluated 50 patients suspected of having interstitial lung diseases based on radiographic or clinical findings, by high resolution computed tomography (HRCT) over a period of one year. Results: Out of the 50 patients, majority of them had idiopathic pulmonary fibrosis (n=16) followed by interstitial pulmonary involvement in patients of rheumatoid arthritis (n=13), scleroderma (n=10) and systemic lupus erythematosis (n=9). The less common ILD’s included were Occupational lung disease (n=1) and Mycosis fungoides (n=1). Conclusion: HRCT of the lung in cases of the suspected interstitial lung diseases forms an invaluable tool for accurate and early identification and in conjunction with the clinical findings can obviate the need of lung biopsy in diagnosis of ILD’s.

Lung ultrasound in the evaluation of interstitial lung diseases

Lung ultrasound in the evaluation of interstitial lung diseases

Diagnostic Yield and Complications of Transbronchial Lung Cryobiopsy for Interstitial Lung Disease. A Systematic Review and Metaanalysis.

The diagnostic usefulness and safety of transbronchial lung cryobiopsy for the evaluation of interstitial lung disease remain unclear. This systematic review and metaanalysis aims to establish the diagnostic accuracy and yield of transbronchial cryobiopsy for interstitial lung diseases. We searched MedLine, EMBASE, Cochrane Central Register of Controlled Trials, and conference proceedings to identify studies assessing the diagnostic accuracy (compared with surgical biopsy) or yield of transbronchial lung cryobiopsy for interstitial lung disease (from database inception to January 2016). The diagnostic accuracy and yield were quantified and stratified by the method of diagnosis determination (histologic interpretation in isolation vs. incorporation within a multidisciplinary discussion). The frequency of procedure-related complications was also assessed from these reports. For full-text studies, random-effects models were used to calculate pooled estimates of diagnostic accuracy, yield, and complication frequency. Of 900 citations, 11 studies were selected for inclusion in this systematic review (7 full text, 4 abstracts). The selected studies reported on a total of 731 patients. No studies reported the diagnostic accuracy of transbronchial cryobiopsy. Diagnostic yield ranged from 74 to 98% when transbronchial cryobiopsy findings were interpreted in isolation, with a pooled estimate of 83% (95% confidence interval [CI], 73-94). Diagnostic yield ranged from 51 to 98% when transbronchial cryobiopsy was reviewed within a multidisciplinary discussion, with a pooled estimate of 79% (95% CI, 65-93). Pooled estimates for pneumothorax and moderate/severe bleeding were 12% (95% CI, 3-21) and 39% (95% CI, 3-76), respectively. The diagnostic accuracy of transbronchial lung cryobiopsy cannot be determined given the absence of studies directly comparing cryobiopsy diagnoses with diagnoses derived from surgical lung biopsies interpreted within multidisciplinary discussions. The histopathological and multidisciplinary discussion-based diagnostic yield of transbronchial cryobiopsy appears high, but with variable frequencies of complications dominated by pneumothorax and moderate-to-severe hemorrhage.

AB029. Clinical utility of a molecular diagnostic in evaluation of interstitial lung disease

Background The accurate diagnosis of idiopathic pulmonary fibrosis (IPF) continues to be challenging due to its overlapping features with other interstitial lung diseases (ILDs). With the approval of pirfenidone and nintedanib for treatment of IPF, there is greater urgency to identify patients with IPF without requiring surgical lung biopsy (SLB). In this study, we evaluated the clinical utility of a genomic classifier under development to identify usual interstitial pneumonia (UIP), the pathology pattern associated with IPF, using bronchoscopically collected samples.

Idiopathic Interstitial Pneumonias (IIPs): Review of Clinical, Radiographic and High-Resolution Computed Tomography (HRCT)

Making a confident diagnosis is a complex task for a specific form of interstitial lung disease and providing appropriate management in an attempt to achieve normalization of the disease can put up an alarming process for the clinicians. A set of diffuse and restrictive lung diseases incorporate with idiopathic interstitial pneumonias, showing inflammation and fibrosis of the interstitium due to parenchymal damage. High-resolution computed tomography (HRCT) has magnified the diagnostic standpoint in stepwise identification and classified various patterns in the evaluation of interstitial lung disease. The aim of our review is to elaborate clinical, radiographic and typical and atypical HRCT findings of idiopathic interstitial pneumonias by correlating with its differential diagnosis. Idiopathic pulmonary fibrosis is the most predominant idiopathic interstitial pneumonias and its diagnosis needs to omit all other well-known causes of interstitial lung diseases. According to the 2011 evidence-based guidelines, usual interstitial pneumonia can be diagnosed by HRCT when all criteria are fulfilled. Non-specific interstitial pneumonia is distinguished by bilateral patchy ground-glass opacities and irregular linear/reticular opacities. Respiratory bronchiolitis associated-interstitial lung disease and desquamative interstitial pneumonia show centrolobular nodules and ground-glass opacities as imaging patterns. Cryptogenic organizing pneumonia consists of patchy peripheral or peribronchial consolidations, while ground-glass opacities with tendency for migration, which is evolving to fibrosis, in acute interstitial pneumonia. Lymphoid interstitial pneumonia and idiopathic pleuro-parenchymal fibroelastosis are classified under rare idiopathic interstitial pneumonias. HRCT images help radiologists in diagnosis and mapping specific patterns of idiopathic interstitial pneumonias. This article reviews the stages of evolution in HRCT features for idiopathic interstitial pneumonias.

Lung Ultrasonography in the Evaluation of Interstitial Lung Disease in Systemic Connective Tissue Diseases: Criteria andSeverity of Pulmonary Fibrosis - Analysis of 52 Patients.

Patients with a diagnosed systemic connective tissue disease require regular monitoring from the point of view of interstitial lung disease. The main aim of this work is a description of the criteria for pulmonary fibrosis and the degree of the severity of the fibrosis during the course of interstitial lung disease through the TLU (transthoracic lung ultrasound). 52 patients with diagnosed diffuse interstitial lung disease were qualified for this research, together with 50 volunteers in the control group. The patients in both groups were over 18 years of age and were of both sexes. The results of the TLU of the patients underwent statistical analysis and were compared to High-Resolution Computed Tomography (HRCT) results. As a consequence of the statistical analysis, we defined our own criteria for pulmonary fibrosis in TLU: irregularity of the pleura line, tightening of the pleura line, the fragmentary nature of the pleura line, blurring of the pleura line, thickening of the pleura line, artifacts of line B ≤ 3 and ≥ 4, artifacts of Am line and subpleural consolidations < 5 mm. As a result of the conducted research, a scale of severity of pulmonary fibrosis in TLU was devised (UFI - Ultrasound Fibrosis Index), enabling a division to be made into mild, moderate and severe cases. Transthoracic Lung Ultrasonography (TLU) gives a new outlook on the diagnostic possibilities, non-invasive and devoid of ionising radiation, of pulmonary fibrosis. This research work has allowed to discover two new ultrasound symptoms of pulmonary fibrosis (blurred pleural line and Am lines).