[Diagnoses and diagnostic procedures in 500 consecutive patients with clinical suspicion of interstitial lung disease]. / Diagnósticos y procedimientos en 500 pacientes consecutivos con sospecha clínica de enfermedad pulmonar intersticial.
Arch Bronconeumol
; 44(4): 185-91, 2008 Apr.
Article
em Es
| MEDLINE
| ID: mdl-18423179
ABSTRACT
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 ANDMETHODS:
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.
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Base de dados:
MEDLINE
Assunto principal:
Doenças Pulmonares Intersticiais
Tipo de estudo:
Diagnostic_studies
/
Guideline
Limite:
Adolescent
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Adult
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Aged
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Aged80
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Child
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Female
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Humans
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Male
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Middle aged
Idioma:
Es
Ano de publicação:
2008
Tipo de documento:
Article