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Journal ArticleDOI

The diagnostic value of bronchoalveolar lavage and transbronchial lung biopsy in cryptogenic organizing pneumonia

01 Dec 1996-European Respiratory Journal (Eur Respir J)-Vol. 9, Iss: 12, pp 2513-2516
TL;DR: In this article, the diagnostic value of bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) in cryptogenic organizing pneumonia (COP) was determined.
Abstract: In order to determine the diagnostic value of bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) in cryptogenic organizing pneumonia (COP) a prospective study was carried out. Thirty seven consecutive patients (20 males and 17 females) with clinicoradiological features of COP were enrolled in the study. The statistical analyses were completed in 35 cases. Twenty eight patients were diagnosed to have COP, all of them with a confirmatory biopsy. In seven cases, a different diagnosis was made. BAL cytological and phenotypical criteria considered for the diagnosis of COP were: a lymphocytosis of more than 25% (with a CD4/CD8 ratio less than 0.9); combined with at least two of the following data (foamy macrophages of > 20%, and/or neutrophils of > 5%, and/or eosinophils of > 2% and < 25%). TBLB specimens were classified as positive for COP if they showed: buds of granulation tissue within the centrilobular air spaces; infiltration of alveolar walls with chronic inflammatory cells; and preservation of alveolar architecture. BAL was performed in 34 patients; 17 cases were consistent with the final diagnosis of COP (sensitivity 63%), and four cases were correctly classified as negative (specificity 57%). BAL had a positive predictive value (PPV) of 85% and a negative predictive value (NPV) of 29%. TBLB was performed in 32 patients; it correctly identified COP in 16 cases (sensitivity 64%), and six cases were correctly classified as negative (specificity 86%). TBLB had a PPV of 94% and a NPV of 40%. The accuracy of the examinations, that is the probability of correctly diagnosing both diseased and nondiseased patients by BAL or TBLB, was 62 and 69%, respectively. Our findings suggest that the combination of cytological bronchoalveolar lavage and histological transbronchial lung biopsy data obtained during a fibreoptic procedure appears to be an effective method for the initial investigation in cryptogenic organizing patients pneumonia presenting with patchy radiographic shadows.
Citations
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Journal ArticleDOI
William D. Travis, Talmadge E. King, Eric D. Bateman, David A. Lynch, Frédrique Capron, Thomas V. Colby, Jean-François Cordier, Roland M. Dubois, Jeffrey R. Galvin, Philippe Grenier, David M. Hansell, Gary W. Hunninghake, Masanori Kitaichi, Nestor L. Müller, Jeffrey L. Myers, Sonoko Nagai, Andrew G. Nicholson, Ganesh Raghu, Benoit Wallaert, Christian Brambilla, Kevin K. Brown, Andrew L. Cherniaev, Ulrich Costabel, David B. Coultas, Gerald S. Davis, Maurits G. Demedts, William W. Douglas, Jim J. Egan, Anders Eklund, Leonarda M. Fabbri, Craig A. Henke, Richard Hubbard, Y. Inoue, Takateru Izumi, H. M. Jansen, Ian Johnston, Dong Soon Kim, Nasreen Khalil, Fiona R. Lake, Giuseppe Lungarella, Joseph P. Lynch, Douglas W. Mapel, Fernando J. Martinez, Richard A. Matthay, Lee S. Newman, Paul W. Noble, Ken Ohta, Dario Olivieri, Luis A. Ortiz, Venerino Poletti, Robert Rodriguez-Roisin, William N. Rom, Jay Hoon Ryu, Paulo Hilário Nascimento Saldiva, Raúl H Sansores, Marvin L. Schwarz, Moisés Selman, Cecelia M. Smith, Zhaohui Tong, Zarir F Udwadia, Dominique Valeyre, Athol U. Wells, Robert A. Wise, Antonio Xaubet, Emilio Alvarez Fernandez, Elisabeth Brambilla, Vera Luiza Capelozzi, Andrew Cherniaev, Peter Dalquen, Gerhard Dekan, Philip S. Hasleton, James C. Hogg, N. A. Jambhekar, Anna Luise A Katzenstein, Michael Koss, Osamu Matsubara, Klaus Michael Müller, F. B.J.M. Thunnissen, James A. Waldron, Wei Hua Li, Paul J. Friedman, Martin Remy-Jardin, Theresa C. McLoud 
TL;DR: The Diagnostic Process Is Dynamic Clinical Evaluation Radiological Evaluation Role of Surgical Lung Biopsy Unclassifiable Interstitial Pneumonia Bronchoalveolar Lavage Fluid Evaluation Idiopathic Pulmonary Fibrosis.
Abstract: Executive Summary Objectives Participants Evidence Validation Key Messages Introduction Rationale for a Change in the Approach to Classification of Idiopathic Interstitial Pneumonias Development of a New Classification of Idiopathic Interstitial Pneumonia Current Classification of IIP New ATS/ERS Classification Principles Guiding the Assessment of Patients with Idiopathic Interstitial Pneumonias The Diagnostic Process Is Dynamic Clinical Evaluation Radiological Evaluation Role of Surgical Lung Biopsy Unclassifiable Interstitial Pneumonia Bronchoalveolar Lavage Fluid Evaluation Idiopathic Pulmonary Fibrosis Clinical Features Radiologic Features Histologic Features IPF: Areas of Uncertainty Nonspecific Interstitial Pneumonia Clinical Features Radiologic Features Histologic Features NSIP: Areas of Uncertainty Cryptogenic Organizing Pneumonia Clinical Features Radiologic Features Histologic Features COP: Areas of Uncertainty Acute Interstitial Pneumonia Clinical Features Radiologic Features Histologic Features AIP: Areas of Uncertainty Respiratory Bronchiolitis-Associated Interstitial Lung Disease Clinical Features Radiologic Features Histologic Features RB-ILD: Areas of Uncertainty Desquamative Interstitial Pneumonia Clinical Features Radiologic Features Histologic Features DIP: Areas of Uncertainty Lymphoid Interstitial Pneumonia Clinical Features Radiologic Features Histologic Features LIP: Areas of Uncertainty References Appendix

3,591 citations

Journal ArticleDOI
01 Sep 2008-Thorax
TL;DR: Since the publication of the first BTS guidelines for diffuse lung disease nearly 10 years ago, the specialty has seen considerable change and has led to a radical change in accepted diagnostic gold standards, which have become increasingly multidisciplinary and dependent equally upon the skills of pathologists, radiologists and clinicians.
Abstract: ### 1.1 An overview of the ILD guideline Since the publication of the first BTS guidelines for diffuse lung disease nearly 10 years ago,1 the specialty has seen considerable change. The early discussions of the Guideline Group centred upon whether the revised document might consist of the 1999 document with minor adaptations. However, it was considered that too much change had taken place in the intervening years to justify a simple editorial approach. The last decade had seen the development of a new consensus terminology for the idiopathic interstitial pneumonias (IIP)2 stimulated, in part, by the identification of non-specific interstitial pneumonia (NSIP) as a discrete histological pattern with increasingly recognised clinical correlates.3 The better prognosis seen in fibrotic NSIP than in idiopathic pulmonary fibrosis (IPF)4 5 fuelled a more intense approach to diagnosis in cases of suspected IPF. This in turn has led to a radical change in accepted diagnostic gold standards, which have become increasingly multidisciplinary and dependent equally upon the skills of pathologists, radiologists and clinicians.6 NSIP, as a new entity, has posed particular difficulties. With more detailed studies of outcome specific to individual IIPs, especially IPF and fibrotic NSIP, the prognostic weighting given to pulmonary function impairment has been refined, especially with regard to longitudinal functional trends.7 Most important, with the standardisation of terminology, it became possible to recruit patients into multicentre treatment studies.8–10 With regard to IPF in particular, the last 3 years have seen more studies of treatment than in the previous history of the speciality, yet there is no universally accepted “best current treatment”. ### 1.2 Methodology for constructing guidelines and making recommendations The overall process for generating BTS guidelines has been addressed in numerous recently published documents (available at http://www.brit-thoracic.org.uk/guidelines.html). The methodology applied herein is broadly similar and is not therefore described in detail. However, there are specific aspects in the …

773 citations

Journal ArticleDOI
TL;DR: Organising pneumonia is defined histopathologically by intra-alveolar buds of granulation tissue, consisting of intermixed myofibroblasts and connective tissue, and rapid clinical and imaging improvement is obtained with corticosteroid treatment.
Abstract: Organising pneumonia is defined histopathologically by intra-alveolar buds of granulation tissue, consisting of intermixed myofibroblasts and connective tissue. Although nonspecific, this histopathological pattern, together with characteristic clinical and imaging features, defines cryptogenic organising pneumonia when no cause or peculiar underlying context is found. Rapid clinical and imaging improvement is obtained with corticosteroid treatment, but relapses are common after stopping treatment.

454 citations

Journal ArticleDOI
28 Feb 2014-PLOS ONE
TL;DR: TBLC has a good diagnostic yield in the clinical-radiologic setting of f-DPLD without diagnostic HRCT features of usual interstitial pneumonia, and should be considered as a potential alternative to SLBx in f- DPLD.
Abstract: Background Histology is a key element for the multidisciplinary diagnosis of fibrotic diffuse parenchymal lung diseases (f-DPLD) when the clinical-radiological picture is nondiagnostic. Transbronchial lung cryobiopsy (TBLC) have been shown to be useful for obtaining large and well-preserved biopsies of lung parenchyma, but experience with TBLC in f-DPLD is limited. Objectives To evaluate safety, feasibility and diagnostic yield of TBLC in f-DPLD. Method Prospective study of 69 cases of TBLC using flexible cryoprobe in the clinical-radiological setting of f-DPLD with nondiagnostic high resolution computed tomography (HRCT) features. Results Safety: pneumothorax occurred in 19 patients (28%). One patient (1.4%) died of acute exacerbation. Feasibility: adequate cryobiopsies were obtained in 68 cases (99%). The median size of cryobiopsies was 43.11 mm2 (range, 11.94–76.25). Diagnostic yield: among adequate TBLC the pathologists were confident (“high confidence”) that histopathologic criteria sufficient to define a specific pattern in 52 patients (76%), including 36 of 47 with UIP (77%) and 9 nonspecific interstitial pneumonia (6 fibrosing and 3 cellular), 2 desquamative interstitial pneumonia/respiratory bronchiolitis–interstitial lung disease, 1 organizing pneumonia, 1 eosinophilic pneumonia, 1 diffuse alveolar damage, 1 hypersensitivity pneumonitis and 1 follicular bronchiolitis. In 11 diagnoses of UIP the pathologists were less confident (“low confidence”). Agreement between pathologists in the detection of UIP was very good with a Kappa coefficient of 0.83 (95% CI, 0.69–0.97). Using the current consensus guidelines for clinical-radiologic-pathologic correlation 32% (20/63) of cases were classified as Idiopathic Pulmonary Fibrosis (IPF), 30% (19/63) as possible IPF, 25% (16/63) as other f-DPLDs and 13% (8/63) were unclassifiable. Conclusions TBLC in the diagnosis of f-DPLD appears safe and feasible. TBLC has a good diagnostic yield in the clinical-radiological setting of f-DPLD without diagnostic HRCT features of usual interstitial pneumonia. Future studies should consider TBLC as a potential alternative to SLBx in f-DPLD.

268 citations

Journal ArticleDOI
01 Apr 2000-Thorax
TL;DR: This terminology is preferred to the other name used for this condition—namely, idiopathic bronchiolitis obliterans with organising pneumonia (BOOP)—which may be confused with other types of Bronchiolar disorders, particularly constrictive bronchiola obliterans which is mainly characterised by airflow obstruction.
Abstract: Organising pneumonia is defined pathologically by the presence in the distal air spaces of buds of granulation tissue progressing from fibrin exudates to loose collagen containing fibroblasts (fig 1). 2 The lesions occur predominantly within the alveolar spaces but are often associated with buds of granulation tissue occupying the bronchiolar lumen (bronchiolitis obliterans). This pathological pattern is not specific for any disorder or cause, but reflects one type of inflammatory process resulting from lung injury. It may also be a feature of the organising stage of adult respiratory distress syndrome and may be an accessory finding in other inflammatory disorders such as vasculitis. However, organising pneumonia is the particular pathological hallmark of a characteristic clinicoradiological entity called cryptogenic organising pneumonia. This terminology is preferred to the other name used for this condition—namely, idiopathic bronchiolitis obliterans with organising pneumonia (BOOP)—which may be confused with other types of bronchiolar disorders, particularly constrictive bronchiolitis obliterans which is mainly characterised by airflow obstruction.

260 citations

References
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Journal ArticleDOI
TL;DR: Eight patients with histological intra-alveolar organization, but no evidence of an infective or other aetiological agent, are reported, and the term cryptogenic organizing pneumonitis is suggested to avoid confusion with post-infective organizing pneumonia.
Abstract: Eight patients with histological intra-alveolar organization, but no evidence of an infective or other aetiological agent, are reported. They characteristically presented with a short history of severe dyspnoea, cough, malaise, weight loss, bilateral radiographic shadowing and a raised ESR. There was a dramatic response clinically and radiologically to prednisolone but relapse occurred quickly as the dose was reduced. Control was re-established with an increased dose of prednisolone. In order to avoid confusion with post-infective organizing pneumonia the term cryptogenic organizing pneumonitis is suggested.

358 citations

Journal ArticleDOI
01 Nov 1989-Chest
TL;DR: Three characteristic clinical and imaging profiles in patients with idiopathic BOOP are distinguished: multiple patchy pneumonia, solitary pneumonia, and diffuse interstitial lung disease.

300 citations

Journal ArticleDOI
TL;DR: It is concluded that in immunocompetent patients the CT findings in cryptogenic organizing pneumonia most commonly consist of bilateral areas of consolidation involving mainly the subpleural and/or peribronchovascular regions.
Abstract: Description of the CT findings of cryptogenic organizing pneumonia has been limited to a small number of cases. This study was performed to characterize the CT findings of this disease in a larger number of cases and to compare the findings in immunocompetent and immunocompromised patients.The CT scans of 43 (32 immunocompetent and 11 immunocompromised) patients who had biopsy-proved cryptogenic organizing pneumonia were reviewed. The scans were obtained by using contiguous 8- or 10-mm collimation and selected thin (1.5 or 2.0 mm) section (n = 23), thin-section collimation at 10-mm intervals (n = 12), or 8- or 10-mm collimation only (n = 8). The scans were analyzed by three observers, and final decisions were reached by consensus.The most common pattern seen was consolidation, which was present alone or as part of a mixed pattern in 34 cases (79%). The consolidation had a predominantly subpleural and/or peribronchovascular distribution in 27 cases (63%). Ground-glass attenuation and nodules were seen in 2...

278 citations

Journal ArticleDOI
TL;DR: There is a subset of patients with BOOP who present with a fulminant course leading to death or chronic severe fibrosis and marked impairment of lung function and the histologic picture of BOOP may be a manifestation of early lung injury that can resolve or progress rapidly to alveolar septal inflammation, end-stage fibrosis, and honeycombing.
Abstract: Bronchiolitis obliterans with organizing pneumonia (BOOP) is a distinct clinical pathologic syndrome. Most patients experience a good response to therapy, and death from progressive BOOP is uncommon. This report describes the clinical features, etiologic factors, pathologic findings, and outcome of 10 patients with rapidly progressive BOOP that was characterized by severe respiratory failure. The major clinical manifestations were dyspnea, cough, fever, crackles on chest examination, and hypoxemia at rest. Underlying conditions or exposures included connective-tissue disease, exposure to birds, and chronic nitrofurantoin therapy. All patients had the characteristic histopathologic findings of BOOP. However, at autopsy in six patients, the predominant histologic pattern was that of alveolar septal inflammation and fibrotic honeycombing. Seven patients died and three patients survived but had persistent pulmonary dysfunction despite aggressive care. In two patients BOOP has progressed, with severe chronic respiratory decompensation. Thus, there is a subset of patients with BOOP who present with a fulminant course leading to death or chronic severe fibrosis and marked impairment of lung function. In addition, the histologic picture of BOOP may be a manifestation of early lung injury that can resolve or progress rapidly to alveolar septal inflammation, end-stage fibrosis, and honeycombing.

207 citations

Trending Questions (1)
Can a lung nodule be mistaken for pneumonia?

Our findings suggest that the combination of cytological bronchoalveolar lavage and histological transbronchial lung biopsy data obtained during a fibreoptic procedure appears to be an effective method for the initial investigation in cryptogenic organizing patients pneumonia presenting with patchy radiographic shadows.