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Vol. 44. Issue 4.
Pages 185-191 (January 2008)
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Vol. 44. Issue 4.
Pages 185-191 (January 2008)
Original Articles
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Diagnoses and Diagnostic Procedures in 500 Consecutive Patients With Clinical Suspicion of Interstitial Lung Disease
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Ferran Morella,
Corresponding author
fmorell@vhebron.net

Correspondence: Dr F. Morell. Servei de Pneumologia, Hospital Universitari Vall d'Hebron Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain
, Leonardo Reyesa, Gema Doménechb, Javier de Graciaa, Joaquim Majód, Jaume Ferrera
a Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain Departament de Medicina UAB, CIBERES CB 06/036, Instituto de Salud Carlos III, Madrid, Spain
b Laboratori de Bioestadística i Epidemiologia, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
d Servei d'Anatomia Patològica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Objective

To determine the diagnostic yield achieved with the application of current recommendations for evaluating patients with suspected interstitial lung disease (ILD) and the procedures that must be applied to reach a definitive diagnosis.

Patients and methods

Over a 10-year period, 500 consecutive patients attending an ILD outpatient clinic who showed features of diffuse lung involvement were assessed with a single diagnostic protocol. Results were introduced in a dedicated database and diagnoses for idiopathic interstitial pneumonia were established according to a recent consensus classification.

Results

A definitive diagnosis was reached in 427 (85%) patients: in 125 without invasive procedures and in 302 with invasive procedures. In 73 (14.6%) cases a definitive diagnosis was not reached, and patients were placed in the group of unclassifiable interstitial pneumonia. Idiopathic interstitial pneumonia was the predominant group with 193 (39%) patients. The main specific entities included sarcoidosis with 93 (19%) patients, usual interstitial pneumonia with 84 (17%) patients, and hypersensitivity pneumonitis with 75 (15%) patients. Thirty (6%) patients were diagnosed with an illness other than ILD (false ILD). In 332 patients, we performed a total of 433 invasive procedures: transbronchial biopsy in 252 (direct diagnostic yield, 38%, or if used also to exclude other specific diagnosis, 50%), bronchoalveolar lavage in 260 (yield, 5%), and open lung biopsy in 141 (yield, 93%). Hence, following the current diagnostic approach, a definitive diagnosis was established for 85% of patients, for 25% solely on clinical grounds and imaging criteria and for 60% on the basis of invasive procedures. Diagnosis by open lung biopsy was still required for 141 (28%) patients.

Conclusions

The diagnostic yield was high when the recommended study protocol was followed. A quarter of the diagnoses were reached with clinical criteria alone, but another quarter could only be made after open lung biopsy.

Key words:
Interstitial lung diseases
Idiopathic interstitial pneumonias
Unclassified interstitial pneumonia
Nonspecific interstitial pneumonia
Sarcoidosis
Hypersensitivity pneumonitis
Diagnostic yield
Open lung biopsy
Bronchoalveolar lavage
Objetivo

Determinar las tasas de diagnósticos alcanzados con el seguimiento de las directrices actuales y los procedimientos que deben utilizarse para establecer el diagnóstico definitivo mediante la aplicación del nuevo protocolo en la evaluación de los pacientes con sospecha de enfermedad pulmonar intersticial (EPI).

Pacientes y métodos

Durante un período de 10 años se evaluó, mediante un único protocolo diagnóstico, a 500 pacientes consecutivos atendidos en una consulta ambulatoria de EPI que presentaban las características de esta enfermedad. Los resultados se introdujeron en una base de datos específica y los diagnósticos de neumonía intersticial idiopática (NII) se establecieron siguiendo los criterios del reciente Consenso.

Resultados

Se estableció un diagnóstico definitivo en 427 pacientes (85%), en 125 de ellos sin procedimientos invasivos y en 302 con procedimientos invasivos. En 73 casos (14,6%) no se alcanzó un diagnóstico definitivo y en estos pacientes se estableció el diagnóstico de neumonía intersticial no clasificable. La NII constituyó el grupo predominante, con 193 casos (39%). Las entidades específicas principales fueron: sarcoidosis (n = 93; 19%), neumonía intersticial usual (n = 84; 17%) y neumonitis por hipersensibilidad (n = 75; 15%). En 30 pacientes (6%) se estableció el diagnóstico de una enfermedad distinta a la EPI (falsa neumonía inters-ticial). Se realizó un total de 433 procedimientos invasivos en 332 pacientes (66%): biopsia transbronquial en 252 (rendimiento diagnóstico directo: 38% y rendimiento diagnóstico cuando se utilizó para excluir otros diagnósticos específicos: 50%); lavado broncoalveolar en 260 (rendimiento diagnóstico: 5%), y biopsia pulmonar quirúrgica en 141 (rendimiento diagnóstico: 93%). Por lo tanto, siguiendo el protocolo diagnóstico actual, se estableció un diagnóstico definitivo en el 85% de los pacientes; de ellos, en el 25% el diagnóstico se estableció únicamente en función de los datos clínicos y de los criterios de imagen, mientras que en el 60% se realizó con procedimientos invasivos. En 141 pacientes (28%) fue necesaria la biopsia pulmonar quirúrgica para establecer el diagnóstico.

Conclusiones

La tasa de diagnósticos es elevada cuando se utiliza el protocolo de estudio recomendado. La cuarta parte de los diagnósticos se efectúa mediante criterios clínicos como procedimiento único; sin embargo, otra cuarta parte de los diagnósticos requiere la realización de una biopsia pulmonar quirúrgica.

Palabras clave:
Neumonitis intersticial
Procedimientos diagnósticos
Rendimiento diagnóstico
Enfermedad pulmonar intersticial (EPI)
Neumonías intersticiales idiopáticas
Neumonía intersticial usual
Neumonía intersticial no clasificable
Neumonía intersticial no específica
Biopsia pulmonar quirúrgica
Sarcoidosis
Neumonitis por hipersensibilidad
Lavado broncoalveolar
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This study was funded in part by Fundació Catalana de Pneumologia (FUCAP) and CIBER CB 06/036, Carlos III Institute of Health.

Copyright © 2008. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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