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Bronchoscopy and Surgical Procedures for Inspection and Biopsy

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Diffuse Lung Disorders

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Abstract

Diffuse interstitial lung disease (ILD) represents a heterogenous group of both acute and chronic disorders characterized by similar radiographic, clinical, and pathologic presentations. The differential diagnosis includes over 130 distinct clinicopathologic entities, thus making the diagnosis of ILD clinically challenging. Although little epidemiologic data is available, diffuse lung disease affects one in 3000–4000 people in Britain and results in 3000 deaths per year [1]. In the United States, pulmonologists encounter this diagnostic and management dilemma in nearly 15% of their patients [2]. Additionally, when less invasive measures are nondiagnostic, there is marked variability among practicing clinicians to pursue a specific diagnosis of ILD with open lung biopsy, ranging from 7.5% to 42% of patients with ILD [3,4].

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References

  1. Office of Population (1991) London, HMSO DH2 No 17.

    Google Scholar 

  2. U.S. Department of Health, Education, and Welfare. Respiratory Task Force: Reports on problems, research, approaches, and needs. Washington DC: U.S. Government Printing Office; (1972, 1976) DHEW Publication. NIH 76–432.

    Google Scholar 

  3. Johnson I, Gomm S, Kalra A et al. (1993) The management of cryptogenic fibrosing alveolitis in three regions of the United Kingdom. Eur Respir J 6: 891–3.

    Google Scholar 

  4. Smith C, Holbrook T (1990) Utilization of the transbronchial biopsy and open lung biopsy for tissue to establish the diagnosis of idiopathic pulmonary fibrosis: Survey of the California Thoracic Society Membership. Am Rev Respir Dis 141: 1762.

    Article  Google Scholar 

  5. Raghu G (1987) Idiopathic pulmonary fibrosis: a rational clinical approach. Chest 92: 148–54.

    Article  PubMed  CAS  Google Scholar 

  6. Raghu G (1995) Interstitial Lung Disease: A Diagnostic Approach. Am J Respir Crit Care Med 151: 909–14.

    PubMed  CAS  Google Scholar 

  7. Hunninghake G, Kalica A (1995) Approaches to the treatment of pulmonary fibrosis. Am J Respir Crit Care Med 151: 915–8.

    PubMed  CAS  Google Scholar 

  8. Walters E, Booth H, Johns D; Walters, du Bois R, eds. (1995) Immunology and management of interstitial lung diseases. Chapman & Hall Medical, Great Britian.

    Google Scholar 

  9. du Bois R (1994) Diffuse Lung Disease: an approach to management. BMJ 309: 175–9.

    Google Scholar 

  10. Pue C, Pacht E (1995) Complications of fiberoptic bronchoscopy at a university hospital. Chest 107: 430–2.

    Article  PubMed  CAS  Google Scholar 

  11. Bokulic R, Hillman B (1994) Interstitial Lung Disease in Children. Ped Clin NA 41: 543–67.

    CAS  Google Scholar 

  12. Whitehead B, Scott J, Helms P et al. (1992) Technique and use of transbronchial biopsy in children and adolescents. Pediatr Pulmonol 12: 240–6.

    Article  PubMed  CAS  Google Scholar 

  13. Wall C, Gaensler E, Carrington C, Hayes J (1981) Comparison of transbronchial and open biopsies in chronic infiltrative lung diseases. Am Rev Respir Dis 123: 280–5.

    PubMed  CAS  Google Scholar 

  14. Zhang K, Phan S (1996) Cytokines and pulmonary fibrosis. Biological Signals 5: 232–9.

    Article  PubMed  CAS  Google Scholar 

  15. Carre P, Mortenson R, King T Jr et al. (1991) Increased expression of the interleukin-8 gene by alveolar macrophages in idiopathic pulmonary fibrosis. J Clin Invest 88: 1802–10.

    Article  PubMed  CAS  Google Scholar 

  16. Nakamura H, Fujishima S, Yasuhiro W et al. (1995) Priming of alveolar macrophages for interleukin-8 production in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 152: 1579–86.

    PubMed  CAS  Google Scholar 

  17. Strieter R, Chensue S, Basha M et al. (1990) Human alveolar macrophage gene expression of interleukin- 8 by tumor necrosis factor alpha, lipopolysaccharide, and interleukin-1 beta. Am J Respir Cell Mol Biol 2: 321–6.

    PubMed  CAS  Google Scholar 

  18. Hunninghake G (1984) Release of interleukin-1 by alveolar macrophages of patients with active pulmonary sarcoidosis. Am Rev of Resp Dis 129: 569–72.

    CAS  Google Scholar 

  19. Perez T, Farre J, Gosset P et al. (1989) Subclinical alveolar inflammation in rheumatoid arthritis: superoxide anion, neutrophil chemotactic activity and fibronectin generation by alveolar macrophages. Eur Respir J 2: 7–13.

    PubMed  CAS  Google Scholar 

  20. McDonald J (1992) Idiopathic pulmonary fibrosis. A paradigm for lung injury and repair. Chest 99: 87S–93S.

    Article  Google Scholar 

  21. Springer T (1990) Adhesion receptors of the immune system. Nature 346: 425–34.

    Article  PubMed  CAS  Google Scholar 

  22. du Bois R, Hellewell P, Hemingway I etal. (1992) Soluble cell adhesion molecules ICAM-1, ELAM-1 and VCAM-1 are present in epithelial lining fluid in patients with interestitial lung disease. Am Rev Respir Dis 145: A190 (Abstr).

    Google Scholar 

  23. Shijubo N, Hirasawa M, Koba H etal. (1992) Measurement of circulating ICAM-1 in sera of patients with IPF. Am Rev Respir Dis 145: A189 (Abstr).

    Google Scholar 

  24. Reynolds H (1987) Bronchoalveolar lavage. Am Rev Respir Dis 135: 250–63.

    PubMed  CAS  Google Scholar 

  25. von Essen S, Robbins R, Rennard S (1989) Airways inflammation after bronchoscopy with bronchoalveolar lavage. Am Rev Respir Dis 139: 381.

    Google Scholar 

  26. Iber C, Stanley M, Henry-Stanley M etal. (1991) Clinical aspects of bronchoalveolar lavage. Bronchoalveolar lavage: cytology and clinical applications; Igoku-Shoin, New York, pp. 1–25.

    Google Scholar 

  27. The BAL Cooperative Steering Committee (1990) Bronchoalveolar lavage constituents in healthy indi-viduals, idiopathic pulmonary fibrosis, and selected comparison groups. Am Rev Respir Dis 141 (suppl):l–200.

    Google Scholar 

  28. Henry-Stanley M, Stanley M, Iber C, Laboratory processing of BAL fluid. Bronchoalveolar lavage: cytology and clinical applications. Igoku-Shoin, New York; pp. 213–28.

    Google Scholar 

  29. Rankin J, Naegel G, Reynold H (1986) Use of a central laboratory for analysis of bronchoalveolar fluid. Am Rev Respir Dis 133: 186–90.

    PubMed  CAS  Google Scholar 

  30. Chamberlain D, Braude A, Rebuck A (1987) A critical evaluation of bronchoalveolar lavage: Criteria for identifying unsatisfactory specimens. Acta Cyto 31: 599–605.

    CAS  Google Scholar 

  31. Davis G, Giancola M, Costanza M et al. (1982) Analyses of sequential bronchoalveolar lavage samples from healthy volunteers. Am Rev Respir Dis 126: 611–6.

    PubMed  CAS  Google Scholar 

  32. Strumpf I, Feld M, Cornelius M et al. (1981) Safety of bronchoalveolar lavage in evaluation of interstitial lung disease. Chest 80: 268–71.

    Article  PubMed  CAS  Google Scholar 

  33. Pingleton S, Harrison G, Stechschulte D et al. (1983) Effect of location, pH, and temperature of instillate in bronchoalveolar lavage in normal volunteers. Am Rev of Resp Dis 128: 1035–7.

    CAS  Google Scholar 

  34. Turner-Warwick M, Haslam P (1987) The value of serial bronchoalveolar lavages in assessing the clinical progress of patients with cryptogenic fibrosing alveolitis. Am Rev Respir 135: 26–34.

    CAS  Google Scholar 

  35. Rudd R, Haslam P, Turner-Warwick M (1981) Cryptogenic fibrosing alveolitis. Relationships of pulmonary physiology and bronchoalveolar lavage to response to treatment and diagnosis. Am Rev Respir Dis 124: 1–8.

    PubMed  CAS  Google Scholar 

  36. DePaso W, Winterbauer R (1991). Interstitial lung disease. Disease-A-Month 37: 61–133.

    PubMed  CAS  Google Scholar 

  37. Milman N, Graudal N, Jocobsen G (1995) Bronchoalveolar lavage in radiologically detected diffuse lung disease. APMIS 103: 764–8.

    Google Scholar 

  38. Drent M, van Nierop M, Gerritsen F, Wouters E, Mulder P (1996) A computer program using BALF- analysis results as a diagnostic tool in interstitial lung diseases. Am J Respir Crit Care Med 153: 736–41.

    PubMed  CAS  Google Scholar 

  39. Kantrow S, Meyer K, Calhoun W et al. (1994) The T helper suppressor ratio in bronchoalveolar lavage is highly variable in sarcoidosis. Am J Resp Crit Care Med 149: A606.

    Google Scholar 

  40. Birbeck M, Breathnach A, Everall J (1961) An electron microscope study of basal melanocytes and high-level clear cells (Langerhans cells) in vitiligo. J Invest Dermatol 37: 51–64.

    Google Scholar 

  41. Chollet S, Soler P, Dournovo et al. (1984) The diag-nosis of pulmonary histiocytosis X by immunodetection of Langerhan’s cells in BALF. Am J Pathol 37: 104–9.

    Google Scholar 

  42. Manganelli P, Salaffi F, Pesci A (1997) Clinical and subclinical alveolitis in connective tissue diseases assessed by bronchoalveolar lavage. Semin Arthritis Rheum 26: 740–54.

    Article  PubMed  CAS  Google Scholar 

  43. Spertini F, Aubert J, Leimgruber A (1996) The potential of bronchoalveolar lavage in the prognosis and treatment of connective-vascular disease. Clin Exp Rheumatol 14: 681–8.

    PubMed  CAS  Google Scholar 

  44. Schnabel A, Richter C, Bauerfeind S et al. (1997) Bronchoalveolar lavage cell profile in methotrexate induced pneumonitis. Thorax 52: 377–9.

    Article  PubMed  CAS  Google Scholar 

  45. Sokolowski Jr J, Burgher L, Jones Jr F et al. (1989) Guidelines for Percutaneous Transthoracic Needle Biopsy. Am Rev Respir Dis 140: 255–6.

    Article  PubMed  Google Scholar 

  46. Steel S, Winstanley D (1967) Trephine Biopsy for Diffuse Lung Lesions. Br Med J 3: 30–2.

    Article  PubMed  CAS  Google Scholar 

  47. Golden J; Baum G, Wolinsky E. (1994) Interstitial (diffuse parenchymal) lung disease: tissue diagnosis and therapy. Textbook of Pulmonary Diseases. Little Brown; Boston, pp. 1067–95.

    Google Scholar 

  48. Niden A, Salem F (1997) A safe high-yield technique for cutting needle biopsy of the lung in patients with diffuse lung disease. Chest 111: 1615–21.

    Article  PubMed  CAS  Google Scholar 

  49. Gaensler E, Carrington C (1980) Open biopsy for chronic diffuse infiltrative lung disease: clinical, roentgenographic, and physiological correlations in 502 patients. Ann Thor Surg 30: 411–26.

    Article  CAS  Google Scholar 

  50. Wall C, Gaensler E, Carrington C et al. (1981) Comparison of transbronchial and open biopsies in chronic infiltrative lung diseases. Am Rev Respir Dis 123: 280–5.

    PubMed  CAS  Google Scholar 

  51. LoCicero J (1994) Does every patient with enigmatic lung disease deserve a lung biopsy? The continuing dilemma. Chest 106: 706–8.

    Article  PubMed  Google Scholar 

  52. Walker W, Cole F Jr, Khandekar A et al. (1989) Does open lung biopsy affect treatment in patients with diffuse pulmonary infiltrates? J Thorac Cardiovasc Surg 97: 534–40.

    PubMed  CAS  Google Scholar 

  53. Warner D, Warner M, Divertie M (1988) Open lung biopsy in patients with diffuse pulmonary infiltrates and acute respiratory failure. Am Rev Respir Dis 137: 90–4.

    Article  PubMed  CAS  Google Scholar 

  54. Klassen K, Andrews N (1967) Biopsy of diffuse pul-monary lesions. Ann Thorac Surg 4: 117–24.

    Article  PubMed  CAS  Google Scholar 

  55. Flint A, Martinez F, Young M et al. (1995) Influence of sample number and biopsy site on the histologic diagnosis of diffuse lung disease. Ann Thorac Surg 60: 1605–8.

    Article  PubMed  CAS  Google Scholar 

  56. Chechani V, Landreneau R, Shaikh S (1992) Open lung biopsy for diffuse infiltrative lung disease. Ann Thorac Surg 54: 296–300.

    Article  PubMed  CAS  Google Scholar 

  57. Jacobeus H (1927) The practical importance of thoracoscopy in surgery of the chest. Surg Gynecol Obstet 34: 289–96.

    Google Scholar 

  58. McCarthy J, Hurberg J, Wood A (1997) The diverse potential of thoracoscopic assisted surgery. Int Surg 82: 29–31.

    PubMed  CAS  Google Scholar 

  59. Ferson P (1993) Thoracoscopic wedge resection of the lung. Surgical Rounds, 16: 341–9.

    Google Scholar 

  60. Ferguson M (1993) Thoracoscopy for diagnosis of diffuse lung disease. Ann Thorac Surg 56: 694–6.

    Article  PubMed  CAS  Google Scholar 

  61. Molin L, Steinberg J, Lanza L (1994) VATS increases costs in patients undergoing lung biopsy for interstitial lung disease. Ann Thorac Surg 58: 1595–8.

    Article  PubMed  CAS  Google Scholar 

  62. Bensard D, Mclntyre Jr. R, Waring B et al. (1993) Comparison of video thoracoscopic lung biopsy to open lung biopsy in the diagnosis of interstitial lung disease. Chest 103: 765–70.

    Article  PubMed  CAS  Google Scholar 

  63. Rothenberg S, Wagner J, Chang J, et al. (1996) The safety and efficacy of thoracoscopic lung biopsy for diagnosis and treatment in infants and children. J Pediatr Surg 31: 100–3.

    Article  PubMed  CAS  Google Scholar 

  64. Deshmukh S, Krasna M, McLaughlin J (1996) Video- assisted thoracoscopic biopsy for interstitial lung disease. Int Surg 81: 330–2.

    PubMed  CAS  Google Scholar 

  65. Ferson P, Landreneau R, Dowling R et al. (1993) Comparison of open versus thoracoscopic lung biopsy for diffuse infiltrative pulmonary disease. J Thorac Cardiovasc Surg 106: 194–9.

    PubMed  CAS  Google Scholar 

  66. Kadokura M, Colby T, Myers J et al. (1994) Pathological comparison of video-assisted thoracic surgical lung biopsy and traditional open lung biopsy. J Thorac Cardiovasc Surg 494: 8.

    Google Scholar 

  67. Krasna M, White C, Aisner S et al. (1995) The role of thoracoscopy in the diagnosis of interstitial lung disease. Ann Thorac Surg 59: 348–51.

    Article  PubMed  CAS  Google Scholar 

  68. Ray J III, Lawton B, Myers W et al. (1976) Open pulmonary biopsy. Nineteen-year experience with 416 consecutive operations. Chest 69: 43–7.

    Article  PubMed  Google Scholar 

  69. Wagner J, Stahler C, Knox S et al. (1992) Clinical utility of open lung biopsy for undiagnosed pul-monary infiltrates. Am J Surg 164: 104–7.

    Article  PubMed  CAS  Google Scholar 

  70. Lachapelle K, Morin J (1995) Benefit of open lung biopsy in patients with respiratory failure. Can J Surg 38: 316–21.

    PubMed  CAS  Google Scholar 

  71. Thurlbeck/Miller, Muller/Rosenow (1991) Diffuse diseases of the lung: a team approach. Abnormal structure and function of the lung. BC Decker, Philadelphia, Pennsylvania.

    Google Scholar 

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Authors
  1. Sheila Goodnight-White
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Editors and Affiliations

  1. The Cardiothoracic Centre, University of Liverpool, Liverpool, UK

    Miriam Sperber M.D. (Consultant Radiologist) (Consultant Radiologist)

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© 1999 Springer-Verlag London Limited

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Goodnight-White, S. (1999). Bronchoscopy and Surgical Procedures for Inspection and Biopsy. In: Sperber, M. (eds) Diffuse Lung Disorders. Springer, London. https://doi.org/10.1007/978-1-4471-3440-4_6

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  • DOI: https://doi.org/10.1007/978-1-4471-3440-4_6

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-3442-8

  • Online ISBN: 978-1-4471-3440-4

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