TY  - JOUR
AB  - BACKGROUND: Diagnosis of diffuse parenchymal lung disease (DPLD) is based on clinical evaluation, radiological imaging and histology. However, additional techniques are warranted to improve diagnosis. AIMS AND OBJECTIVE: Probe based confocal laser endomicroscopy (pCLE) allows real time in vivo visualisation of the alveolar compartment during bronchoscopy based on autofluorescence of elastic fibres. We used pCLE (Cellvizio®, Mauna Kea Technology. Inc, Paris, France) to characterise alveolar patterns in patients with different types of DPLD. METHODS: In this pilot study we included 42 therapy naive patients (13 female, age 72.6 +/- 2.3 years), who underwent bronchoscopy for workup of DPLD. pCLE images were obtained during rigid bronchoscopy in affected lung segments according to HR-CT scan, followed by cryobiopsies in the identical area. Diagnoses were made by a multidisciplinary panel. The description of pCLE patterns was based on the degree of distortion of the hexagonal alveolar pattern, the density of alveolar structures, the presence of consolidations or loaded alveolar macrophages (AM). The assessment was performed by 2 investigators blinded for the final diagnosis. RESULTS: The normal lung showed a typical alveolar loop pattern. In amiodarone lung disease loaded AM were predominant. COP showed characteristic focal consolidations. IPF was characterized by significant distortion and destruction, NSIP showed significant increase in density, and chronic HP presented with consolidations, mild distortion and density. CONCLUSION: pCLE shows potential as an adjunctive bronchoscopic imaging technique in the differential diagnosis of DPLD. Structured and quantitative analysis of the images is required.
AU  - Silbernagel, E.*
AU  - Stacher-Priehse, E.*
AU  - Dinkel, J.
AU  - Stepp, H.*
AU  - Gesierich, W.*
AU  - Lindner, M.*
AU  - Behr, J.*
AU  - Reichenberger, F.*
C1  - 67022
C2  - 53380
TI  - Bronchoscopic probe-based confocal laser endomicroscopy to diagnose diffuse parenchymal lung diseases.
JO  - Sarcoidosis Vasc. Diffus. Lung Dis.
VL  - 39
IS  - 2
PY  - 2022
SN  - 1124-0490
ER  - 

TY  - JOUR
AB  - Increased knowledge of Idiopathic Pulmonary Fibrosis (IPF) led to the development of evidence-based diagnosis and treatment guidelines. A 2011 update of the American Thoracic Society and the European Respiratory Society, together with the Japanese Respiratory Society (JRS) and Latin American Thoracic Association (ALAT) provided new guidance on the diagnosis and treatment of IPF. Although the 2011 statement was a major advance, the application of guideline recommendations has identified limitations. The guidelines focus primarily on 'definite' IPF, most often diagnosed from typical High-Resolution Computed Tomography (HRCT) appearances. The definition of 'probable' and 'possible' IPF is an advance, but there is a lack of management guidance for these highly prevalent clinical scenarios. The integration of HRCT and histological data in assigning of diagnostic likelihood is also important, but does not always meet the needs of some patients in whom a multidisciplinary diagnosis of definite IPF should be made. Moreover, the committee did not find sufficient evidence to support the use of any specific pharmacological therapy for patients with IPF. These issues highlight the need for updating available clinical guidelines. Since 2012, several national European recommendations documents and guidelines have been updated. These generally follow the 2011 guidelines, but reflect more recently available clinical study data. Following the publication of the CAPACITY trials showing positive effects of pirfenidone in IPF and its approval in the European Union, many of these updated guideline documents recommend that patients with mild-to-moderate IPF should be offered this therapy. This review analyses the recently developed European country updates, comparing and contrasting recommendations on the diagnosis and treatment of IPF.
AU  - Xaubet, A.*
AU  - Behr, J.
AU  - Bendstrup, E.*
AU  - Cottin, V.*
AU  - Hirani, N.*
AU  - Kaehler, C.M.*
AU  - Skold, C.M.*
C1  - 44247
C2  - 36856
CY  - Fidenza
SP  - 249-261
TI  - Review of IPF diagnosis and management recommendations in Europe.
JO  - Sarcoidosis Vasc. Diffus. Lung Dis.
VL  - 30
IS  - 4
PB  - Mattioli 1885
PY  - 2013
SN  - 1124-0490
ER  -