Publications by authors named "Piero Candoli"

15 Publications

  • Page 1 of 1

Predictors of Worse Prognosis in Young and Middle-Aged Adults Hospitalized with COVID-19 Pneumonia: A Multi-Center Italian Study (COVID-UNDER50).

J Clin Med 2021 Mar 15;10(6). Epub 2021 Mar 15.

Center of Epidemiology, Biostatistics and Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60020 Ancona, Italy.

Obesity as well as metabolic and cardiovascular comorbidities are established, significant predictors of worse prognosis in the overall COVID-19 population, but limited information is available on their roles in young and middle-aged adults (aged ≤ 50 years). The main objectives of the present Italian multi-center study were to describe clinical characteristics and role of selected prognostic predictors in a large cohort of young and middle-aged hospitalized patients. Nine pulmonology units, across north and center of Italy, were involved in this retrospective study. Comorbidities were classified according to their known or potential association with COVID-19. A total of 263 subjects were included. The prevalence of obesity was 25.9%, mechanical ventilation (MV) was needed in 27.7%, and 28 in-hospital deaths occurred (10.6%). Obesity and older age were the only independent, significant predictors for MV. Comorbidities, such as hypertension, diabetes, asthma, and increased D-dimer levels were significantly associated with higher mortality risk, regardless of age, body mass index, and MV. Obesity in young and middle-aged adults is a strong predictor of a more complicated COVID-19, without, however, evidence of a significant effect on in-hospital mortality. Selected comorbidities, including hypertension, diabetes and asthma, significantly impact survival even in a younger population, suggesting the need for prompt recognition of these conditions.
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http://dx.doi.org/10.3390/jcm10061218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999047PMC
March 2021

Assessing coronavirus disease 2019 (COVID-19) transmission to healthcare personnel: The global ACT-HCP case-control study.

Infect Control Hosp Epidemiol 2021 04 9;42(4):381-387. Epub 2020 Sep 9.

Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, United States.

Objective: To characterize associations between exposures within and outside the medical workplace with healthcare personnel (HCP) SARS-CoV-2 infection, including the effect of various forms of respiratory protection.

Design: Case-control study.

Setting: We collected data from international participants via an online survey.

Participants: In total, 1,130 HCP (244 cases with laboratory-confirmed COVID-19, and 886 controls healthy throughout the pandemic) from 67 countries not meeting prespecified exclusion (ie, healthy but not working, missing workplace exposure data, COVID symptoms without lab confirmation) were included in this study.

Methods: Respondents were queried regarding workplace exposures, respiratory protection, and extra-occupational activities. Odds ratios for HCP infection were calculated using multivariable logistic regression and sensitivity analyses controlling for confounders and known biases.

Results: HCP infection was associated with non-aerosol-generating contact with COVID-19 patients (adjusted OR, 1.4; 95% CI, 1.04-1.9; P = .03) and extra-occupational exposures including gatherings of ≥10 people, patronizing restaurants or bars, and public transportation (adjusted OR range, 3.1-16.2). Respirator use during aerosol-generating procedures (AGPs) was associated with lower odds of HCP infection (adjusted OR, 0.4; 95% CI, 0.2-0.8, P = .005), as was exposure to intensive care and dedicated COVID units, negative pressure rooms, and personal protective equipment (PPE) observers (adjusted OR range, 0.4-0.7).

Conclusions: COVID-19 transmission to HCP was associated with medical exposures currently considered lower-risk and multiple extra-occupational exposures, and exposures associated with proper use of appropriate PPE were protective. Closer scrutiny of infection control measures surrounding healthcare activities and medical settings considered lower risk, and continued awareness of the risks of public congregation, may reduce the incidence of HCP infection.
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http://dx.doi.org/10.1017/ice.2020.455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542323PMC
April 2021

Successful recovery from COVID-19 pneumonia after receiving baricitinib, tocilizumab, and remdesivir. A case report: Review of treatments and clinical role of computed tomography analysis.

Respir Med Case Rep 2020 27;31:101115. Epub 2020 Jun 27.

Internal Medicine Center, Marche Nord Hospital, Pesaro, Fano, Italy.

The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic, threatening global public health. In the current paper, we describe our successful treatment of one COVID-19 pneumonia patient case with high mortality risk factors. Our experience underlines the importance of the use of a multidisciplinary therapeutic approach in order to achieve a favorable clinical outcome. Further, enhancing the capability of the COVID-19 diagnosis with the use of the chest imaging modalities is discussed.
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http://dx.doi.org/10.1016/j.rmcr.2020.101115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320265PMC
June 2020

Predictive Value of Endobronchial Ultrasound Strain Elastography in Mediastinal Lymph Node Staging: The E-Predict Multicenter Study Results.

Respiration 2020;99(6):484-492. Epub 2020 Jun 3.

Department of Pulmonology, Radboudumc, Nijmegen, The Netherlands,

Background: Systematic assessment of lymph node status by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is indicated in (suspected) lung cancer. Sampling is herein guided by nodal size and FDG-PET characteristics. Ultrasound strain elastography (SE) might further improve risk stratification. By imaging tissue deformation over time, SE computes relative tissue strain. In several tissues, a lower strain (deformation) has been associated with a higher likelihood of malignancy.

Objectives: To assess if EBUS-SE can independently help predict malignancy, and when combined with size and FDG uptake information.

Methods: This multicenter (n = 5 centers) prospective trial included patients with suspected or proven lung cancer using a standardized measurement protocol. Cytopathology combined with surgery or follow-up imaging (>6 months) were used as reference standard.

Results: Between June 2016 and July 2018, 327 patients and 525 lymph nodes were included (mean size 12.3 mm, malignancy prevalence 0.48). EBUS-SE had an overall AUC of 0.77. A mean strain <115 (range 0-255) showed 90% sensitivity, 43% specificity, 60% positive predictive value, and 82% negative predictive value. Combining EBUS-SE (<115) with size (<8 mm) and FDG-PET information into a risk stratification algorithm increased the accuracy. Combining size and SE showed that the 48% a priori chance of malignancy changed to 11 and 70% in double negative or positive nodes, respectively. In the subset where FDG-PET was available (n = 370), triple negative and positive nodes went from a 42% a priori chance of malignancy to 9 and 73%, respectively.

Conclusions: EBUS-SE can help predict lymph node malignancy and may be useful for risk stratification when combined with size and PET information.
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http://dx.doi.org/10.1159/000507592DOI Listing
June 2020

Competence in endosonographic techniques.

Panminerva Med 2019 Sep 9;61(3):249-279. Epub 2018 Nov 9.

Università degli Studi di Firenze, SOD Pneumologia Interventistica AOUC, Florence, Italy.

Endobronchial ultrasound (EBUS) has revolutionized the field of bronchoscopy because it allows to observe peribronchial structures and distal peripheral lung lesions. The use of EBUS was first described by Hurte and Hanrath in 1992. EBUS technology exists in two forms: radial and convex transducer probes. The radial EBUS probe has a 20-MHZ (12-30 MHz available) rotating transducer that can be inserted together with or without a guide sheath through the working channel (2.0-2.8 mm) of a standard flexible bronchoscope. The transducer rotates and produces a 360-degree circular image around the central position of the probe. There are two types of radial EBUS probes: "peripheral" probes, used to identify parenchymal lung lesions, and "central" probes, with balloon sheaths, used for the assessment of airway walls and peribronchial lymph nodes.
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http://dx.doi.org/10.23736/S0031-0808.18.03570-XDOI Listing
September 2019

Image enhancement technology in bronchoscopy: a prospective multicentre study in lung cancer.

BMJ Open Respir Res 2018 18;5(1):e000295. Epub 2018 May 18.

Department of Pulmonary Diseases (614), Radboud University Medical Center, Nijmegen, The Netherlands.

Introduction: Patients with lung cancer may present with additional lesions in the central airways. Earlier studies have shown a relationship between vessel diameter, pattern and grade of malignancy. High-definition (HD+) bronchoscopy with image enhancement techniques (i-scan) detected more vascular abnormalities but correlation with pathology has not yet been established.

Methods: In this investigator-initiated, randomised, controlled, crossover, multicentre study in patients with suspected lung cancer, a HD+ bronchoscopy was performed with i-scan1 and i-scan2 settings in random order. Biopsies, visual grade and vascular pattern classification were obtained by endoscopists and blinded evaluation.

Results: In 107 patients, vascular patterns were classified in 48 tumours. Abrupt-ending vessels were predominantly found in squamous cell carcinoma but overall correlation between vessel pattern and histology was not significant (p=0.339). Additional lesions were detected in 35 patients (33%) with a correlation between vessel pattern and high-grade (pre-)invasive lesions (p<0.001). In 8.4% of the patients, relevant second lesions were detected which determined treatment and staging in 3% of all patients. Interobserver agreement was excellent for visual grading of the airway epithelium, but low for classifying vascular patterns. No significant detection rate difference was found by blinded and unblinded evaluation.

Conclusion: HD+ bronchoscopy with i-scan image enhancement readily detects additional lesions. In one-third of all the patients, additional lesions were detected. Their vascular pattern correlates to pathology outcome, but the interobserver correlation for vascular pattern classification is low. These lesions were relevant in 8.4% and affected treatment and work-up in 3% of the cases.

Trial Registration Number: NCT02285426; Results.
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http://dx.doi.org/10.1136/bmjresp-2018-000295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5976136PMC
May 2018

EBUS-STAT Subscore Analysis to Predict the Efficacy and Assess the Validity of Virtual Reality Simulation for EBUS-TBNA Training Among Experienced Bronchoscopists.

J Bronchology Interv Pulmonol 2017 Apr;24(2):110-116

*Geriatrics-Unit of Respiratory Pathophysiology and Thoracic Endoscopy, Campus Bio Medico University and Teaching Hospital ∥Public Health and Statistics Unit, Campus Bio Medico University, Rome †Pneumology Outpatient Clinic, Casa di Cura convenzionata San Marco, Latina ‡Pulmonary and Thoracic Endoscopy Unit, AUSL, Ravenna §Unit of Diagnostic and Interventional Bronchology, Careggi University Hospital, Florence, Italy.

Background: Linear endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) represents a pivotal innovation in interventional pulmonology; determining the best approach to guarantee systematic and efficient training is expected to become a main issue in the forthcoming years. Virtual reality simulators have been proposed as potential EBUS-TBNA training instruments, to avoid unskilled beginners practicing directly in real-life settings. A validated and perfected simulation program could be used before allowing beginners to practice on patients. Our goal was to test the reliability of the EBUS-Skills and Task Assessment Tool (STAT) and its subscores for measuring the competence of experienced bronchoscopists approaching EBUS-guided TBNA, using only the virtual reality simulator as both a training and an assessment tool.

Methods: Fifteen experienced bronchoscopists, with poor or no experience in EBUS-TBNA, participated in this study. They were all administered the Italian version of the EBUS-STAT evaluation tool, during a high-fidelity virtual reality simulation. This was followed by a single 7-hour theoretical and practical (on simulators) session on EBUS-TBNA, at the end of which their skills were reassessed by EBUS-STAT.

Results: An overall, significant improvement in EBUS-TBNA skills was observed, thereby confirming that (a) virtual reality simulation can facilitate practical learning among practitioners, and (b) EBUS-STAT is capable of detecting these improvements. The test's overall ability to detect differences was negatively influenced by the minimal variation of the scores relating to items 1 and 2, was not influenced by the training, and improved significantly when the 2 items were not considered. Apart from these 2 items, all the remaining subscores were equally capable of revealing improvements in the learner. Lastly, we found that trainees with presimulation EBUS-STAT scores above 79 did not show any significant improvement after virtual reality training, suggesting that this score represents a cutoff value capable of predicting the likelihood that simulation can be beneficial.

Conclusions: Virtual reality simulation is capable of providing a practical learning tool for practitioners with previous experience in flexible bronchoscopy, and the EBUS-STAT questionnaire is capable of detecting these changes. A pretraining EBUS-STAT score below 79 is a good indicator of those candidates who will benefit from the simulation training. Further studies are needed to verify whether a modified version of the questionnaire would be capable of improving its performance among experienced bronchoscopists.
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http://dx.doi.org/10.1097/LBR.0000000000000349DOI Listing
April 2017

Easily detectable cytomorphological features to evaluate during ROSE for rapid lung cancer diagnosis: from cytology to histology.

Oncotarget 2017 Feb;8(7):11199-11205

Pathology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy.

In lung cancer patients, the only available diagnostic material often comes from biopsy or from cytological samples obtained by fine needle aspiration (FNA). There is a lack of easily detectable cytomorphological features for rapid on-site evaluation (ROSE) to orient lung cancer diagnosis towards a specific tumor histotype. We studied the cytological features evaluated on site to define tumor histotype and to establish the number of specimens to be taken. Cytological specimens from 273 consecutive patients were analyzed with ROSE: bronchoscopy with transbronchial needle aspiration (TBNA) had been performed in 72 patients and with endobronchial ultrasound (EBUS)-TBNA in 201. Cytomorphological features were correlated with the final diagnosis and diagnostic accuracy was measured. Analysis of the different cytomorphological parameters showed that the best sensitivity and specificity were obtained for adenocarcinoma by combining the presence of nucleoli and small/medium cell clusters, and for squamous cell carcinoma by considering the presence of necrosis ≥50% and large cell clusters. For small cell carcinoma, the best diagnostic accuracy was obtained by combining moderate necrosis (<50%) and the presence of single cells. Overall accuracy ranged from 90% to 97%. We showed that it was possible to establish the histotype of the most frequent lung cancers during ROSE using only a few easily identifiable cytomorphological parameters. An accurate diagnosis during ROSE could help endoscopists to decide how many tumor samples must be taken, e.g.a higher number of samples is needed for the biomolecular characterization of adenocarcinoma, whereas one sample may be sufficient for squamous cell carcinoma.
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http://dx.doi.org/10.18632/oncotarget.13204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5355257PMC
February 2017

Ex vivo pulmonary nodule detection with miniaturized ultrasound convex probes.

J Surg Res 2016 May 13;202(1):49-57. Epub 2015 Dec 13.

Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy; PhD Course in Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Division of Thoracic Surgery, Maria Cecilia Hospital-GVM Care and Research, Cotignola, Ravenna, Italy. Electronic address:

Background: The intraoperative localization of small and deep pulmonary nodules is often difficult during minimally invasive thoracic surgery. We compared the performance of three miniaturized ultrasound (US) convex probes, one of which is currently used for thoracic endoscopic diagnostic procedures, for the detection of lung nodules in an ex vivo lung perfusion model.

Methods: Three porcine cardiopulmonary blocks were perfused, preserved at 4°C for 6 h and reconditioned. Lungs were randomly seeded with different patterns of echogenicity target nodules (9 water balls, 10 fat, and 11 muscles; total n = 30). Three micro-convex US probes were assessed in an open setting on the pleural surface: PROBE 1, endobronchial US 5-10 MHz; PROBE 2, laparoscopic 4-13 MHz; PROBE 3, fingertip micro-convex probe 5-10 MHz. US probes were evaluated regarding the number of nodules localized/not localized, the correlation between US and open specimen measurements, and imaging quality.

Results: For detecting target nodules, the sensitivity was 100% for PROBE 1, 86.6% for PROBE 2, and 78.1% for PROBE 3. A closer correlation between US and open specimen measurements of target diameter (r = 0.87; P = 0.0001) and intrapulmonary depth (r = 0.97; P = 0.0001) was calculated for PROBE 1 than for PROBES 2 and 3. The imaging quality was significantly higher for PROBE 1 than for PROBES 2 and 3 (P < 0.04).

Conclusions: US examination with micro-convex probes to detect pulmonary nodules is feasible in an ex vivo lung perfusion model. PROBE 1 achieved the best performance. Clinical research with the endobronchial US micro-convex probe during minimally invasive thoracic surgery is advisable.
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http://dx.doi.org/10.1016/j.jss.2015.12.005DOI Listing
May 2016

COPD: adherence to therapy.

Multidiscip Respir Med 2014 22;9(1):60. Epub 2014 Nov 22.

Department of Respiratory Diseases, Monaldi Hospital, University Federico II, Naples, Italy.

Adherence to medical therapies is a growing issue, so much so that the World Health Organization defined it as "a new pharmacological problem". The main factors affecting compliance are: frequency of administration, rapid onset of action, role of device. The most severe consequence of non-adherence is the increased risk of poor clinical outcome, associated with worsening of the quality of life and increase in health-care expenditure. It appears crucial to identify those COPD patients who are "poorly or not at all compliant with their treatment". In order to evaluate adherence to the medical therapy, several methods were proposed, the most effective of which turned out to be self-reports, i.e. simple, brief questionnaires (e.g. Morisky test). To increase the likelihood of quickly identifying non-compliant patients, it may be useful to administer a simple questionnaire to naïve subjects (for example, in the waiting room before an examination) including six specific items allowing to identify the patient's key characteristics. Depending on the answers, patients who do not comply with their pharmacological treatment may be classified as belonging to 6 phenotypes. For patients who are already under treatment it might be useful to administer another short questionnaire during follow up examination. Once the risk of non-compliance is identified, four possible types of measures can be taken: prescription-related, educational, behavioral and complex combined measures (combination of two or more actions). Therefore, while it is clear that adherence in COPD is a critical issue, it is also obvious that raising awareness on the disease and improving cooperation among specialists, general practitioners, health-care professionals, and patients is the starting point at which this evolution should immediately begin. Each medication is able to foster good compliance with the therapy, and consequently to maximize the efficacy, by virtue of its specific inhaler and its own active ingredient.
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http://dx.doi.org/10.1186/2049-6958-9-60DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4256899PMC
December 2014

The bacterial lysate Lantigen B reduces the number of acute episodes in patients with recurrent infections of the respiratory tract: the results of a double blind, placebo controlled, multicenter clinical trial.

Immunol Lett 2014 Dec 3;162(2 Pt B):185-93. Epub 2014 Nov 3.

Centro Asma, Struttura Complessa Pneumologia, Ospedale Santa Corona, Via XXV Aprile, 38, Pietra Ligure, SV, Italy.

Studies in the 1970s and 1980s reported that bacterial lysates (BL) had a prophylactic effect on recurrent respiratory tract infections (RRTI). However, controlled clinical study procedures have evolved substantially since then. We performed a trial using updated methods to evaluate the efficacy of Lantigen B®, a chemical BL. This double blind, placebo controlled, multi-center clinical trial had the primary objective of assessing the capacity of Lantigen B to significantly reduce the total number of infectious episodes in patients with RRTI. Secondary aims were the RRTI duration, the frequency and the severity of the acute episodes, the use of drugs and the number of missed workdays. In the subgroup of allergic patients with RRTI, the number of allergic episodes (AE) and the use of anti-allergic drugs were also evaluated. One hundred and sixty patients, 79 allocated to the treated group (TG) and 81 to the placebo group (PG), were enrolled; 30 were lost during the study and 120 (79 females and 38 males) were evaluated. The PG had 1.43 episodes in the 8-months of follow-up while the TG had 0.86 episodes (p=0.036). A similar result was observed in the allergic patients (1.80 and 0.86 episodes for the PG and the TG, respectively, p=0.047). The use of antibiotics was reduced (mean 1.24 and 2.83 days of treatment for the TG and the PG). Logistic regression analysis indicated that the estimated risk of needing antibiotics and NSAIDs was reduced by 52.1 and 30.6%, respectively. With regard to the number of AE, no significant difference was observed between the two groups, but bronchodilators, antihistamines and local corticosteroids were reduced by 25.7%, 56.2% and 41.6%, respectively, in the TG. Lantigen B significantly reduced the number of infectious episodes in patients with RRTI. This finding suggests a first line use of this drug for the prophylaxis of infectious episodes in these patients.
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http://dx.doi.org/10.1016/j.imlet.2014.10.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173099PMC
December 2014

Molecular determinations of EGFR and EML4-ALK on a single slide of NSCLC tissue.

J Clin Pathol 2013 Aug 26;66(8):708-10. Epub 2013 Mar 26.

Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST-IRCCS), Meldola, FC, Italy.

Introduction: Tyrosine kinase inhibitors (TKIs) and anti-anaplastic lymphoma kinase (ALK) agents are highly effective for the treatment of non-small cell lung cancer (NSCLC) patients harbouring specific alterations, and molecular characterisation of the tumour is needed even when limited tumour material is available.

Methods: 20 patients with a known epidermal growth factor receptor (EGFR) gene status were enrolled: 10 had mutated and 10 had wild type tumours. FISH analysis was performed on one cytological or histological sample to determine EML4-ALK status, after which the same cells scraped off each slide were used to evaluate the EGFR status.

Results: In the 10 EGFR mutated patients, molecular analysis showed the same results as those obtained before the FISH test. One patient with an EGFR mutation also showed an EML4-ALK translocation, and both FISH-positive and FISH-negative cells maintained the EGFR mutation.

Conclusions: EGFR mutation analysis can be performed on the same sample previously submitted to the EML4-ALK FISH procedure.
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http://dx.doi.org/10.1136/jclinpath-2013-201502DOI Listing
August 2013

Bronchoalveolar lavage findings in severe community-acquired pneumonia due to Legionella pneumophila serogroup 1.

Respir Med 2004 Dec;98(12):1222-6

Maggiore Hospital, Largo Nigrisoli 2, 40133 Bologna, Italy.

Background: No specific data are available in the literature on the bronchoalveolar Lavage (BAL) findings of Legionella pneumophila pneumonia. We report on the cytological and immunophenotypical BAL data of three immunocompetent patients with severe community-acquired pneumonia due to L. pneumophila serogroup 1.

Methods: Retrospective chart review. The microbiologial diagnosis was obtained by BAL culture or/and urinary antigen assay.

Results: All patients presented with high-grade fever, bilateral chest infiltrates and severe respiratory failure requiring ventilatory support. The cytological BAL pattern at presentation showed in all patients the association of a marked neutrophilia with a variable but remarkable percentage of lymphoblasts. Increased levels of activated T-Lymphocytes (both HLA-DR + and CD25 + cells) and, in 2 out of 3 patients, of T-cells bearing the gamma/delta T-cell receptor were the main immunophenotypical findings on flow cytometric analysis.

Conclusions: We suggest that the association of lymphoblasts with a marked neutrophilia in BAL fluid of patients with a clinical-radiological setting compatible with acute pneumonia should suggest L. pneumophila as a possible etiologic agent.
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http://dx.doi.org/10.1016/j.rmed.2004.04.015DOI Listing
December 2004

Transbronchial needle aspiration improves the diagnostic yield of bronchoscopy in sarcoidosis.

Sarcoidosis Vasc Diffuse Lung Dis 2004 Jun;21(2):147-51

Unit of Thoracic Endoscopy, Maggiore Hospital, Bologna, Italy.

Background And Aim: Transbronchial needle aspiration (TBNA) is a minimally invasive bronchoscopic procedure that allows sampling of hilar and mediastinal lymph nodes in close contact with the airways. We undertook this study to assess the value of TBNA in the diagnosis of sarcoidosis manifesting with intrathoracic lymphadenopathies (stages I and II), and to compare its yield with that of transbronchial lung biopsy (TBLB).

Methods: The results of bronchoscopy with combined TBNA and TBLB in 32 patients with stage I or II sarcoidosis were retrospectively analyzed.

Results: Sensitivity was 65.6% for TBNA (stage I, 82.3 %; stage II, 46.6%), and 62.5% for TBLB (stage 1, 52.9%; stage II, 73.3%). The combination of the two methods was associated with the highest diagnostic yield (93.7% overall sensitivity), and allowed significantly better results over both TBNA alone (93.7% vs 65.6%; p = 0.011) and TBLB alone (93.7% vs 62.5%; p = 0.005).

Conclusions: The results of our study suggest that a diagnostic approach combining TBNA and TBLB is safe and effective in the setting of stage I and II sarcoidosis. It also confirmed the value of TBNA, with excellent diagnostic yields especially in stage I of the disease.
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June 2004