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Prospective evaluation of drug-induced lung toxicity with high-resolution CT and transbronchial biopsy.
Radiol Med. 2011 Mar; 116(2):246-63.RM

Abstract

PURPOSE

This study compared the results of high-resolution computed tomography (HRCT) and cytohistology after transbronchial biopsy in the evaluation of drug-related interstitial lung disease (DR-ILD).

MATERIALS AND METHODS

Patients with a clinical and imaging diagnosis of DR-ILD were prospectively included in a study protocol lasting 5 years. All patients were evaluated by bronchoscopy with transbronchial biopsy or bronchoalveolar lavage (BAL) following an HRCT examination that raised a suspicion of DR-ILD. Two radiologists (one senior and one junior), unaware of the diagnosis, reported the single HRCT findings, their distribution and predominant pattern. In the event of disagreement, the diagnosis was subsequently reached by consensus. Cytohistological examination was considered the gold standard in the diagnosis of DR-ILD. Patients who were unable to undergo the endoscopic procedure were excluded from the study.

RESULTS

The study included 42 patients (25 men, 17 women; age range 20-84 years). Transbronchial biopsy was performed in all but four patients (one case of alveolar haemorrhage and three cases of lipoid pneumonia) in whom the diagnosis was established with BAL. Assessment of the HRCT images revealed the following patterns: noncardiogenic pulmonary oedema (n=13); organising pneumonia (OP) (n=9); hypersensitivity pneumonitis (HP) (n=2); alveolar haemorrhage (AH) (n=2); nonspecific interstitial pneumonia (NSIP) (n=5); lipoid pneumonia (LP) (n=1); sarcoid-like pattern (n=1). Cytohistological diagnosis revealed diffuse alveolar damage (DAD) in 11 patients, OP in seven, HP in three, AH in three, chronic interstitial pneumonia (CIP) in eight, LP in three and pseudosarcoidosis in one. Subdivision of the drugs into antineoplastic and nonantineoplastic agents showed that the most common patterns were CIP (n=6), DAD (n=2) and OP (n=2) in the antineoplastic group and DAD (n=9) and OP (n=5) in the nonantineoplastic group. Sensitivity and specificity of the radiological analysis was excellent, especially for patterns such as OP and DAD (sensitivity 0.86 and specificity 0.88 for OP; sensitivity 1 and specificity 0.93 for DAD).

CONCLUSIONS

HRCT demonstrated excellent sensitivity and specificity. In cases in which its specificity was low, HRCT was nonetheless useful for biopsy planning and clinical-radiological monitoring after discontinuation of the drug treatment.

Authors+Show Affiliations

Area di Radiologia, IRST-Istituto Romagnolo Studio e cura dei Tumori, Meldola, Forlì, Italy. s.piciucchi@alice.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng ita

PubMed ID

21311994

Citation

Piciucchi, S, et al. "Prospective Evaluation of Drug-induced Lung Toxicity With High-resolution CT and Transbronchial Biopsy." La Radiologia Medica, vol. 116, no. 2, 2011, pp. 246-63.
Piciucchi S, Romagnoli M, Chilosi M, et al. Prospective evaluation of drug-induced lung toxicity with high-resolution CT and transbronchial biopsy. Radiol Med. 2011;116(2):246-63.
Piciucchi, S., Romagnoli, M., Chilosi, M., Bigliazzi, C., Dubini, A., Beomonte Zobel, B., Gavelli, G., Carloni, A., & Poletti, V. (2011). Prospective evaluation of drug-induced lung toxicity with high-resolution CT and transbronchial biopsy. La Radiologia Medica, 116(2), 246-63. https://doi.org/10.1007/s11547-010-0608-y
Piciucchi S, et al. Prospective Evaluation of Drug-induced Lung Toxicity With High-resolution CT and Transbronchial Biopsy. Radiol Med. 2011;116(2):246-63. PubMed PMID: 21311994.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective evaluation of drug-induced lung toxicity with high-resolution CT and transbronchial biopsy. AU - Piciucchi,S, AU - Romagnoli,M, AU - Chilosi,M, AU - Bigliazzi,C, AU - Dubini,A, AU - Beomonte Zobel,B, AU - Gavelli,G, AU - Carloni,A, AU - Poletti,V, Y1 - 2010/12/03/ PY - 2009/11/13/received PY - 2010/05/06/accepted PY - 2011/2/12/entrez PY - 2011/2/12/pubmed PY - 2011/6/3/medline SP - 246 EP - 63 JF - La Radiologia medica JO - Radiol Med VL - 116 IS - 2 N2 - PURPOSE: This study compared the results of high-resolution computed tomography (HRCT) and cytohistology after transbronchial biopsy in the evaluation of drug-related interstitial lung disease (DR-ILD). MATERIALS AND METHODS: Patients with a clinical and imaging diagnosis of DR-ILD were prospectively included in a study protocol lasting 5 years. All patients were evaluated by bronchoscopy with transbronchial biopsy or bronchoalveolar lavage (BAL) following an HRCT examination that raised a suspicion of DR-ILD. Two radiologists (one senior and one junior), unaware of the diagnosis, reported the single HRCT findings, their distribution and predominant pattern. In the event of disagreement, the diagnosis was subsequently reached by consensus. Cytohistological examination was considered the gold standard in the diagnosis of DR-ILD. Patients who were unable to undergo the endoscopic procedure were excluded from the study. RESULTS: The study included 42 patients (25 men, 17 women; age range 20-84 years). Transbronchial biopsy was performed in all but four patients (one case of alveolar haemorrhage and three cases of lipoid pneumonia) in whom the diagnosis was established with BAL. Assessment of the HRCT images revealed the following patterns: noncardiogenic pulmonary oedema (n=13); organising pneumonia (OP) (n=9); hypersensitivity pneumonitis (HP) (n=2); alveolar haemorrhage (AH) (n=2); nonspecific interstitial pneumonia (NSIP) (n=5); lipoid pneumonia (LP) (n=1); sarcoid-like pattern (n=1). Cytohistological diagnosis revealed diffuse alveolar damage (DAD) in 11 patients, OP in seven, HP in three, AH in three, chronic interstitial pneumonia (CIP) in eight, LP in three and pseudosarcoidosis in one. Subdivision of the drugs into antineoplastic and nonantineoplastic agents showed that the most common patterns were CIP (n=6), DAD (n=2) and OP (n=2) in the antineoplastic group and DAD (n=9) and OP (n=5) in the nonantineoplastic group. Sensitivity and specificity of the radiological analysis was excellent, especially for patterns such as OP and DAD (sensitivity 0.86 and specificity 0.88 for OP; sensitivity 1 and specificity 0.93 for DAD). CONCLUSIONS: HRCT demonstrated excellent sensitivity and specificity. In cases in which its specificity was low, HRCT was nonetheless useful for biopsy planning and clinical-radiological monitoring after discontinuation of the drug treatment. SN - 1826-6983 UR - https://www.unboundmedicine.com/medline/citation/21311994/Prospective_evaluation_of_drug_induced_lung_toxicity_with_high_resolution_CT_and_transbronchial_biopsy_ L2 - https://dx.doi.org/10.1007/s11547-010-0608-y DB - PRIME DP - Unbound Medicine ER -