The diagnostic value of bronchoalveolar lavage and transbronchial lung biopsy in cryptogenic organizing pneumonia
TLDR
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.read more
Citations
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Rapidly progressive Bronchiolitis Obliterans Organising Pneumonia presenting with pneumothorax, persistent air leak, acute respiratory distress syndrome and multi-organ dysfunction: a case report
TL;DR: Bronchiolitis Obliterans Organising Pneumonia is exquisitely sensitive to oral corticosteroids but if the diagnosis is not considered in such patients and appropriate treatment instituted early, BOOP may often lead to prolonged hospital admission with considerable morbidity.
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Présentation nodulaire d’une pneumopathie organisée cryptogénique
TL;DR: La gravite et the frequence du diagnostic alternatif rendent necessaire une investigation anatomopathologique, sans que l’anamnese ou l”endoscopie n’aient pu faire evoquer le diagnostic.
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The contribution of CT-guided transthoracic lung biopsy to the diagnosis of organising pneumonia.
TL;DR: CT-guided transthoracic lung biopsy may be considered in place of transbronchial biopsy in the diagnosis of organising pneumonia and to compare it to the usual diagnostic tools.
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Cryptogenic organizing pneumonia
TL;DR: Organizing pneumonia is a particular type of inflammatory reaction of the lung which gives rise to a clinico-pathological syndrome as discussed by the authors, which is called secondary when a cause such as an infection, drug toxicity, or a connective tissue disease can be identified, or "cryptogenic" when no cause is identified.
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The role of transbronchial biopsy in the diagnosis of diffuse parenchymal lung diseases: Pro
Gianluca Casoni,C.R. Cordeiro,S. Tomassetti,Micaela Romagnoli,Marco Chilosi,Alessandra Cancellieri,Christian Gurioli,Venerino Poletti +7 more
TL;DR: The introduction of the flexible bronchoscope in the late 1960s increased the popularity of the technique and demonstrated that TBLB with the flexible instrument may be obtained with minimal mortality and morbidity and the main utility of the T BLB rests in the possibility of making a specific diagnosis in a patient with DPLD and avoiding a surgical lung biopsy.
References
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Journal ArticleDOI
Cryptogenic organizing pneumonitis.
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.
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Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients.
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.
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Cryptogenic organizing pneumonia: CT findings in 43 patients.
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.
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Rapidly progressive bronchiolitis obliterans with organizing pneumonia.
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.