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Prospective evaluation of drug-induced lung toxicity with high-resolution CT and transbronchial biopsy

Valutazione prospettica della tossicità polmonare farmaco indotta con TC ad alta risoluzione e biopsia transbronchiale

  • Chest Radiology / Radiologia Toracica
  • Published:
La radiologia medica

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.

Riassunto

Obiettivo

Lo scopo del nostro lavoro è stato confrontare i reperti della tomografia computerizzata (TC) ad alta risoluzione (HRCT) con il dato cito-istologico fornito dalla biopsia transbronchiale, nella valutazione della tossicità polmonare farmaco indotta (DR-ILD).

Materiali e metodi

I pazienti con diagnosi clinicoradiologica di polmonite da farmaci sono stati prospettivamente inclusi in un protocollo di studio durato 5 anni. Tutti i pazienti erano sottoposti a broncoscopia, con biopsia transbronchiale o broncolavaggio (BAL) in seguito ad una HRCT che poneva il sospetto di DR-ILD. Due radiologi (un senior ed un junior) hanno riportato in cieco i dati riguardanti i singoli reperti, la distribuzione e il pattern predominante alla HRCT. In un secondo step, nei casi di rilevata discrepanza, la diagnosi è stata raggiunta per consenso. È stato considerato quale goal standard nel processo diagnostico di DR-ILD la diagnosi citoistologica. I pazienti che non potevano essere sottoposti a procedura endoscopica venivano esclusi dallo studio.

Risultati

Quarantadue pazienti sono stati inclusi nello studio (25 maschi; 17 femmine; range di età 20–84 anni). La biopsia transbronchiale è stata effettuata in tutti i casi, fatta eccezione per un caso di emorragia alveolare e tre casi di polmonite lipoidea, in cui la diagnosi è stata raggiunta con il BAL. Le interpretazioni TC includevano i seguenti pattern: edema polmonare non cardiogeno (n=13); organizing pneumonia (OP) (n=9); hypersensitivity pneumonitis (HP) (n=2); alveolar haemorrage (AH) (n=2); non specific interstitial pneumonia (NSIP) (n=5); lipoid pneumonia (LP) (n=1); sarcoid-like pattern (n=1). La diagnosi anatomopatologica ha mostrato: danno alveolare diffuso (DAD) in 11 pazienti, OP in 7, HP in 3, AH in 3, polmonite interstiziale cronica (CIP) in 8, LP in 3; pseudosarcoidosi in 1. Dividendo i farmaci in antineoplastici e nonantineoplastici, i pattern più frequenti sono stati CIP (n=6); DAD (n=2); OP (n=2) per il gruppo degli antineoplastici. I pattern predominanti dei nonantineoplastici sono stati: DAD (n=9) e OP (n=5). Eccellente è stata la sensibilità e la specificità dell’analisi radiologica, soprattutto per pattern quali OP e DAD (OP: sensibilità pari a 0,86; specificità pari a 0,88; DAD: sensibilità 1; specificità 0,93).

Conclusioni

La TC ad alta risoluzione ha mostrato un’eccellente sensibilità e specificità. Nei casi in cui la HRCT ha mostrato bassa specificità, è stata utile nel planning di una corretta biopsia e nel monitoraggio clnico-radiologico dopo la sospensione del farmaco.

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Authors and Affiliations

  1. Area di Radiologia, IRST-Istituto Romagnolo Studio e cura dei Tumori, Meldola, Forlì, Italy

    S. Piciucchi & G. Gavelli

  2. Unità Operativa di Pneumologia Interventistica, Ospedale Pierantoni-Morgagni, Forlì, Italy

    M. Romagnoli, C. Bigliazzi & V. Poletti

  3. Istituto di Anatomia Patologica, Università di Verona, Verona, Italy

    M. Chilosi

  4. Unità operativa di Anatomia Patologica, Ospedale Pierantoni-Morgagni, Forlì, Italy

    A. Dubini

  5. Istituto di Radiologia, Università Campus Bio-Medico, Roma, Italy

    B. Beomonte Zobel

  6. Unità Operativa di Radiologia, Azienda ospedaliera “Santa Maria” di Terni, Terni, Italy

    A. Carloni

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  1. S. Piciucchi
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Correspondence to S. Piciucchi.

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Piciucchi, S., Romagnoli, M., Chilosi, M. et al. Prospective evaluation of drug-induced lung toxicity with high-resolution CT and transbronchial biopsy. Radiol med 116, 246–263 (2011). https://doi.org/10.1007/s11547-010-0608-y

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  • DOI: https://doi.org/10.1007/s11547-010-0608-y

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