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Background and objectives: Elastography is a technology that has strongly impacted several medical specialties; however, it is not yet applied as part of standard clinical practice in the field of pulmonology. The objective of this systematic review is to analyse the evidence available to date in relation to pleuropulmonary ultrasound elastography, focusing on the three pathologies with the most publications: subpleural consolidations, interstitial lung diseases and pleural effusion. Methods: Original in vivo studies published up until 12 August 2023 in the Embase, MEDLINE or Web of Science databases were included. The QUADAS-2 tool was applied to analyse bias. Results: We found 613 records in database search. After duplicates removal, we screened 246 records and finally included 18 papers. The average cohort sample size was 109 patients. The elastography modes most frequently used were strain (22.2%), transient elastography (22.2%), point shear-wave elastography (38.9%) and two-dimensional shear-wave elastography (22.2%). The possibility of a meta-analysis was ruled out because of the heterogeneity of the studies included. Discussion: The currently available literature indicates that pleuropulmonary ultrasound elastography produces promising and consistent results, although the lack of standardisation in the use of the technique and in the elastography modes employed still impedes its use in daily clinical pneumology practice. The development of a clinical guideline establishing a common nomenclature and standardised techniques for pleuropulmonary elastography will be imperative to generate quality scientific evidence in this field.
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INTRODUCTION: Although a reduction in admissions for pathologies other than SARS-CoV-2 has been reported during the pandemic, there are hardly any specific studies in relation to COPD. The objective of this study was to analyse differences in the profile of those admitted for AEPOC and their prognosis during this period. METHODS: Prospective study (SocioEPOC validation cohort) conducted in two hospitals. Demographic, clinical and social characteristics were compared among patients admitted for an AECOPD before and after the declaration of the COVID-19 healthcare emergency. Mortality and the need for hospital care in the following 3 months were analysed. RESULTS: 340 patients (76.6% male, 72 years, FEV1 43.5%) were included, 174 in the post-pandemic phase. During pandemic, especially before population-level vaccination, admissions for AECOPD were in patients with more severe disease and with a higher level of eosinophils. No differences were found in social profile, except they had more informal caregivers. The mortality rate at 90 days was the same (9%), although those admitted during the pandemic came for more hospital visits in the following 3 months (53.8% vs. 42%; p = 0.003), with the pandemic phase being an independent predictor of this possibility (OR = 1.6.; 95% IC = 1.1-2.6). CONCLUSIONS: In the first few months of the pandemic, the clinical profile of patients hospitalised for an AECOPD differed from that both prior to this period and during the latter months of the pandemic, with minimal changes at the social level. Although the mortality rate were similar, unscheduled hospital visits increased during the COVID-19 pandemic.
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COVID-19 , Pulmonary Disease, Chronic Obstructive , Pulmonary Medicine , Humans , Male , Female , SARS-CoV-2 , Pandemics , COVID-19/epidemiology , Prospective Studies , Pulmonary Disease, Chronic Obstructive/epidemiology , DemographyABSTRACT
INTRODUCTION: New tools such as cryobiopsy of mediastinal lymph nodes (cryoEBUS) have been described to improve the diagnostic usefulness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The literature suggests that this novel procedure could be associated with greater diagnostic usefulness than conventional EBUS-TBNA. METHODS: To develop a systematic analysis and meta-analysis on the diagnostic diagnostic yield and safety of cryobiopsy of hilar and mediastinal adenopathies compared to EBUS-TBNA. RESULTS: Seven studies that had included a total of 555 patients were considered in this review, with 365 (65.7%) of these patients having an etiology of malignant lymph node involvement. The overall diagnostic usefulness of cryoEBUS was higher compared to EBUS-TBNA (92% vs. 80%). However, when the results were analysed according to the specific aetiologies of the adenopathies, cryoEBUS was especially useful in cases of lymphomas or non-pulmonary carcinomas (83% vs. 42%) and in cases that were benign (87% vs. 60.1%), with no significant differences being found in specific cases of lung cancer. For lymphoma, cryoEBUS was diagnostic in 87% of cases compared to 12% for EBUS-TBNA and in addition, also allowed the characterisation of every lymphoma subtype. Genetic studies and immunohistochemical determination of PD-L1 was possible in almost all (97%) of the samples obtained by cryoEBUS, while this was only possible in 79% of those obtained by EBUS-TBNA. The most frequent complication was light bleeding, which was described in up to 85% of cases in some series. CONCLUSION: CryoEBUS could represent a promising technique in the diagnostic algorithm used for mediastinal and hilar involvement. Although cryoEBUS did not significantly improve the diagnosis of lung cancer compared to EBUS-TBNA, the results were significantly better in patients with benign pathologies and other tumour types, including lymphomas. In addition, it seems that the samples obtained by cryoEBUS better defined the histological subtypes of lymphoma and allowed complete molecular characterisation in cases of lung cancer. The technique has proven to be safe and no serious complications were described after the procedure.
Subject(s)
Lung Neoplasms , Lymphadenopathy , Lymphoma , Humans , Bronchoscopy/methods , Mediastinum/pathology , Lymph Nodes/pathology , Lung Neoplasms/diagnosis , Lung Neoplasms/pathology , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Lymphadenopathy/diagnosis , Lymphoma/pathology , Retrospective StudiesABSTRACT
OBJECTIVE: Thoracic ultrasound has been shown to be useful in the diagnosis of COVID-19 pulmonary involvement. Several scores for quantifying the degree of involvement have been described, although there is no evidence to show that they have any capacity for predicting unfavorable progress. METHODOLOGY: Prospective cohort study of patients hospitalized for COVID-19. The sample was stratified according to clinical course, and patients requiring invasive or non-invasive respiratory support were classified as having unfavorable progress. Biomarkers were analyzed at admission and on the same day that thoracic ultrasound was performed. Prognostic scales were also determined at admission. The ultrasound score was obtained in 8 or 14 areas, depending on the patient's ability to sit. RESULTS: We included 44 patients, 13 (29,5%) of whom subsequently needed ventilatory support. Eight areas were explored in all patients and 14 areas in 35 (79.5%). The most affected areas were the posterior lower lobes. Significant differences were found between the 2 groups on the SOFA and quick SOFA multidimensional scales, and PCR and LDH on the same day as thoracic ultrasound, and the ultrasound scores. The best area under the ROC curve (AUC) was obtained with the 14-area score, with a result of 0.88 (95% CI: 0.75-0.99). Its sensitivity and specificity for a cut-off score of 13.5 were 100% and 61.5%, respectively. CONCLUSIONS: The use of scores to quantify lung involvement measured by thoracic ultrasound provides useful information, facilitating risk stratification in patients hospitalized with COVID-19.
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OBJETIVO: La ecografía torácica ha mostrado ser útil para el diagnóstico de la afectación pulmonar por COVID-19. Para cuantificar el grado de afectación se han descrito varias escalas, aunque no existe evidencia de si su determinación podría tener alguna capacidad predictiva de evolución desfavorable. METODOLOGÍA: Estudio prospectivo de cohortes en el que se incluyó a pacientes ingresados por COVID-19. La muestra se estratificó en función de la evolución clínica, considerándose desfavorable en los pacientes que precisaron soporte respiratorio invasivo o no invasivo. Se analizaron biomarcadores al ingreso y el mismo día de la ecografía torácica, así como las escalas pronósticas al ingreso. Según la posibilidad de sedestación o no, se aplicó clasificación ecográfica en 8 o 14 áreas. RESULTADOS: Se incluyó a 44 pacientes, 13 (29,5%) con necesidad posterior de soporte ventilatorio. En todos se exploraron 8 áreas y en 35 (79,5%) las 14. Las zonas más afectadas fueron los lóbulos inferiores en la zona posterior. Se detectaron diferencias significativas entre los 2 grupos en las escalas multidimensionales SOFA y quick SOFA, la PCR y LDH del mismo día de la ecografía torácica y la puntuación de las escalas ecográficas. La mejor área bajo la curva ROC (AUC) se obtuvo con la escala de 14 áreas, que fue de 0,88 (IC 95%: 0,75-0,99). Su sensibilidad y especificidad para un punto de corte 13,5 fue del 100% y del 61,5%. CONCLUSIONES: El uso de escalas para cuantificar la afectación pulmonar mediante ecografía torácica proporciona información útil para facilitar la estratificación del riesgo en los pacientes hospitalizados con COVID-19
OBJECTIVE: Thoracic ultrasound has been shown to be useful in the diagnosis of COVID-19 pulmonary involvement. Several scores for quantifying the degree of involvement have been described, although there is no evidence to show that they have any capacity for predicting unfavorable progress. METHODOLOGY: Prospective cohort study of patients hospitalized for COVID-19. The sample was stratified according to clinical course, and patients requiring invasive or non-invasive respiratory support were classified as having unfavorable progress. Biomarkers were analyzed at admission and on the same day that thoracic ultrasound was performed. Prognostic scales were also determined at admission. The ultrasound score was obtained in 8 or 14 areas, depending on the patient's ability to sit. RESULTS: We included 44 patients, 13 (29,5%) of whom subsequently needed ventilatory support. Eight areas were explored in all patients and 14 areas in 35 (79.5%). The most affected areas were the posterior lower lobes. Significant differences were found between the 2 groups on the SOFA and quick SOFA multidimensional scales, and PCR and LDH on the same day as thoracic ultrasound, and the ultrasound scores. The best area under the ROC curve (AUC) was obtained with the 14-area score, with a result of 0.88 (95% CI: 0.75-0.99). Its sensitivity and specificity for a cut-off score of 13.5 were 100% and 61.5%, respectively. CONCLUSIONS: The use of scores to quantify lung involvement measured by thoracic ultrasound provides useful information, facilitating risk stratification in patients hospitalized with COVID-19