Cristina Represas

Assessment of the Portable COPD-6 Device for Detecting Obstructive Airway Diseases

Objectives: To evaluate the agreement and the association with FEV1, FEV6 and FEV1/FEV6 measured with the Vitalograph-COPD-6 portable device and the FEV1, FVC and FEV1/FVC by conventional spirometry, and to analyse the validity of this device to detect obstruction. Methodology: A cross-sectional, descriptive, prospective study, that included 180 subjects. A conventional spirometry and a spirometry with the Vitalograph-COPD-6 were sequentially performed on them. The agreement was analysed [kappa index and interclass correlation coefficient (ICC)], as well as the association [Pearson correlation coefficient (r)], area under the ROC curve (AUC) of the FEV1/FEV6 in detecting obstruction, and the sensitivity, specificity, predictive values (PPV and NPV), and probability ratios (PR+ and PR–) of the different FEV1/FEV6 cut-off points in the detection of obstruction. Results: The prevalence of obstruction was 47 %. The kappa index was 0.59 when an FEV1/FEV6 < cut-off point of < 0.7 was used. The ICC and the r between the FEV1 measured by the two instruments, FEV6 and FEV1/FEV6 measured by the Vitalograph-COPD-6 and the FVC and FEV1/FVC determined by the spirometer were all greater than 0.92. The ROC AUC was 0.97. To detect obstruction, if the cut-off point of FEV1/FEV6 (for COPD-6) was < 0.70, the sensitivity, specificity, PPV, NPV, CR+ and CR– were, 58 %, 100 %, 100 %, 73 %, ∞ and 0.42, respectively. For a cut-off point of < 0.8, they were 96 %, 76 %, 78 %, 96 %, 3.8 and 0.05, respectively. Conclusions: The portable Vitalograph-COPD-6 device is precise for the detection of airway obstruction. The best sensitivity/specificity of FEV1/FEV6 was obtained with cut-off points greater than 0.7.

Factors associated with inadequate diagnosis of COPD: On-Sint cohort analysis

Background The purpose of this study was to evaluate the frequency of inadequate diagnosis and factors predictive of this in patients with chronic obstructive pulmonary disease (COPD) participating in the On-Sint study. Methods The On-Sint cohort was recruited for a multicenter observational study in which 356 physicians (71.6% from primary care) included adult patients who had been diagnosed with COPD. Patients’ clinical and functional information since diagnosis and details for the recruiting physicians were collected from patient files and at the inclusion visit. We performed a multivariate analysis to evaluate the influence of these variables on diagnostic inadequacy (absence of postbronchodilator forced expiratory volume in one second/forced vital capacity [FEV1/FVC] <0.70 or, if this value was missing, prebronchodilator FEV1/FVC <0.70). Results In total, 1,214 patients were included in the study. The patients had a mean age of 66.4±9.7 years and 78.8% were male. In total, 51.3% of patients did not have an obstructive spirometry performed, and 21.4% had a normal or non-obstructive spirometry pattern. Patient-related factors associated with inadequate diagnosis were: years since diagnosis (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01–1.05), number of exacerbations in the previous year (OR 1.01, 95% CI 1.01–1.02), comorbidities (OR 1.05, 95% CI 1.01–1.015), and obesity (OR 1.06, 95% CI 1.02–1.10 per kg/m2 of body mass index), while a longer smoking history (OR 0.98, 95% CI 0.97–0.99 for each pack/year) and short-acting or long-acting bronchodilator therapy (OR 0.61, 95% CI 0.44–0.76 and OR 0.46, 95% CI 0.27–0.76, respectively) were inversely related. With regard to physician-related variables, being followed up by primary care physicians (OR 3.0, 95% CI 2.11–4.34) and in rural centers (OR 1.63, 95% CI 1.12–2.38) were positively associated with an inadequate diagnosis, while having regular follow-ups in the most severe cases (OR 0.66, 95% CI 0.46–0.93) and use of quality of life questionnaires (OR 0.55, 95% CI 0.40–0.76) were negatively associated. Conclusion Diagnosis of COPD was inadequate in half of the patients from the On-Sint cohort. There were multiple factors, both patient-related and physician-related, associated with this misdiagnosis.

Intramural Hematoma of the Pulmonary Artery and Hemopneumomediastinum after Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe and effective technique for the sampling of mediastinal and hilar adenopathies. We describe the first reported case of pulmonary artery intramural hematoma after EBUS-TBNA puncture of this artery. The complication was visualized by ultrasound and resolved spontaneously.

Validación del dispositivo portátil COPD-6 para la detección de patologías obstructivas de la vía aérea

OBJECTIVES To evaluate the agreement and the association with FEV(1), FEV(6) and FEV(1)/FEV(6) measured with the Vitalograph-COPD-6 portable device and the FEV(1), FVC and FEV(1)/FVC by conventional spirometry, and to analyse the validity of this device to detect obstruction. METHODOLOGY A cross-sectional, descriptive, prospective study, that included 180 subjects. A conventional spirometry and one with the Vitalograph-COPD-6 were sequentially performed on them. The agreement was analysed [kappa index and interclass correlation coefficient (ICC)], as well as the association [Pearson correlation coefficient (r)], area under the ROC curve (AUC) of the FEV(1)/FEV(6) in detecting obstruction, and the sensitivity, specificity, predictive values (PPV and NPV), and probability ratios (PR+ and PR-) of the different FEV(1)/FEV(6) cut-off points in the detection of obstruction. RESULTS The prevalence of obstruction was 47%. The kappa index was 0.59 when an FEV(1)/FEV(6) < cut-off point of <0.7 was used. The ICC and the r between the FEV(1) measured by the two instruments, FEV(6) and FEV(1)/FEV(6) measured by the Vitalograph-COPD-6 and the FVC and FEV(1)/FVC determined by the spirometer were all greater than 0.92. The ROC AUC was 0.97. To detect obstruction, if the cut-off point of FEV(1)/FEV(6) (for COPD-6) was <0.70, the sensitivity, specificity, PPV, NPV, CR+ and CR- were, 58%, 100%, 100%, 73%, infinity and 0.42, respectively. For a cut-off point of <0.8, they were 96%, 76%, 78%, 96%, 3.8 and 0.05, respectively. CONCLUSIONS The portable Vitalograph-COPD6 device is precise for the detection of airway obstruction. The best sensitivity/specificity of FEV(1)/FEV(6) was obtained with cut-off points greater than 0.7.

Validity and reliability of transbronchial needle aspiration for diagnosing mediastinal adenopathies

BackgroundThe aim is to assess the validity and reliability of transbronchial needle aspiration (TBNA) of mediastinal and hilar adenopathies and to evaluate factors predictive of TBNA outcome.MethodsWe performed an analysis of prospectively collected data of patients (n = 580) who underwent TBNA (n = 685) from January 1998 to December 2007 in our center. Validity and reliability were evaluated for the overall sample and according to specific pathology. Factors predicting the successful acquisition of diagnostic samples were analyzed by multivariate analysis.ResultsOverall sensitivity, specificity, accuracy, and positive and negative predictive (NPV) values for TBNA were 68%, 100%, 68.8%, 100%, and 10%, respectively. The most sensitive and accurate TBNAs were obtained for patients with small cell lung carcinoma and the worst results were for patients with lymphomas. NPV were similar for all pathologies. The most predictive factors of outcome were adenopathy size and the presence of indirect signs at the puncture site.ConclusionThe sensitivity and accuracy of TBNA are high in small cell lung cancer, followed by other types of carcinoma, sarcoidosis, and tuberculosis, and low for lymphoproliferative diseases. The NPV of TBNA for all individual pathologies is low. The size of the adenopathy and the presence of indirect signs at the puncture site predict the achievement of diagnostic samples.

Efficacy and safety of the eXcelon transbronchial aspiration needle in mediastinal lymph node enlargement: a case-control study.

Background: Several different types of needles for transbronchial needle aspiration (TBNA) exist in the market. Recently, the eXcelon transbronchial needle (Boston Scientific, Boston, Mass., USA) was commercialized, and to our knowledge, no comparative studies with other types of needles have been performed up to date. Objectives: The aim of the present study was to determine the diagnostic yield and safety of the 21-gauge eXcelon transbronchial needle in the diagnosis of mediastinal lesions and to compare it with a 22-gauge Wang cytology needle (Bard-Wang, Billerica, Mass., USA). Methods: A case-control prospective study was conducted. The study group included 42 TBNA of mediastinal nodes performed in 35 patients with the eXcelon 21-gauge needle from January to June 2005. A control group included 110 TBNA carried out in 99 patients that underwent mediastinal lymph node sampling using a MW-122 needle from June 2002 to December 2004. Results: There was no statistical differentiation in the characteristics of the disease, mediastinal lymph nodes or number of passes between cases and controls. Adequate samples were obtained in 30 (71.4%) cases and 81 (73.6%) controls (p = 0.8). Technical complications occurred in 7 (16.6%) cases and 14 (12.7%) controls (p = 0.7). The only clinical complication was bleeding presented in 2 (4.8%) cases and 3 (2.7%) controls (p = 0.3). Conclusion: The eXcelon 21-gauge transbronchial needle is as effective and safe as the MW-122 needle in the diagnosis of mediastinal lymph node enlargement.

Clinical utility of transbronchial needle aspiration of mediastinal lymph nodes in the diagnosis of sarcoidosis in stages I and II

OBJECTIVE To analyze the individual and combined diagnostic yield and clinical utility of transbronchial needle aspiration and transbronchial biopsy in the histologic diagnosis of sarcoidosis in stages I and II. PATIENTS AND METHODS We performed a prospective study enrolling all the patients admitted to our hospital between July 2001 and June 2006 with mediastinal lymph nodes of a diameter of over 10 mm and clinical and radiological indication of sarcoidosis. The patients underwent the following tests in the order specified: a transbronchial needle aspiration of 1 or more lymph nodes using a 19-gauge histology needle until 2 satisfactory specimens were obtained, a bronchoalveolar lavage, and 4 to 6 transbronchial biopsies. RESULTS A total of 32 patients were enrolled during the study period. Of these, 26 were finally diagnosed with sarcoidosis. The mean (SD) age of the patients was 38.9 (10.6) years and there were 13 women (50%). The mean (SD) lymph node diameter was 23.5 (6.5) mm. The most common lymph node aspiration sites were the subcarinal station (9 patients, 34.6%) and a combination of the subcarinal and paratracheal stations (7 patients, 26.9%). Computed tomography scans of the chest revealed parenchymal involvement in 12 (46.2%) patients. Fifteen (57.7%) patients were diagnosed by transbronchial biopsy and 16 (61.5%) by transbronchial needle aspiration. These techniques were used in isolation in 7 (26.9%) and 8 (30.8%) patients, respectively (P>.05). Diagnosis was achieved with the combined results of transbronchial biopsy and needle aspiration in 23 (88.4%) patients. Overall, the diagnostic yield of the combined techniques was significantly higher than that of either one in isolation (P=.01 vs transbronchial biopsy and P=.02 vs needle aspiration). In patients with parenchymal involvement, yield was better for the combined techniques only in comparison with transbronchial biopsy (P=.01). Only 4 (15%) patients developed complications and 20 (76.9%) tolerated the procedures well. CONCLUSIONS Diagnostic yield was significantly higher when transbronchial biopsy and transbronchial needle aspiration were used in combination than when used alone, particularly in patients without parenchymal involvement. There were few complications and tolerance was good.

Primary Amyloidosis Involving Mediastinal Lymph Nodes: Diagnosis by Transbronchial Needle Aspiration

Amyloidosis is an uncommon disease caused by the deposition of abnormal proteins within soft tissues. Pulmonary and mediastinal lymph node involvement of the disease is rare. When mediastinal lymph nodes are affected, the diagnostic approach should include sample collection for pathological examination. Transbronchial fine needle aspiration is a useful and safe procedure for sampling mediastinal lymph nodes. This paper describes the first case of amyloidosis that involves mediastinal lymph nodes diagnosed by transbronchial needle aspiration.

Effect of different bronchial washing sequences on diagnostic yield in endoscopically visible lung cancer

OBJECTIVE Aspiration of bronchial wash fluid is commonly used in conjunction with brushing and forceps biopsy to diagnose endoscopically visible lung cancer. However, the optimal sequence of these procedures is subject to debate. The objective of this study was to determine if the order in which bronchial washing is performed relative to bronchial brushing and forceps biopsy has any effect on the diagnostic yield. PATIENTS AND METHODS A prospective, cross-sectional study was carried out on patients with endoscopically visible lung cancer who underwent video-assisted fiberoptic bronchoscopy for diagnostic purposes. Aspiration of bronchial wash fluid was performed on all patients both before and after bronchial brushing and forceps biopsy. The results were analyzed separately for each type of endobronchial lesion and for both together. RESULTS The study included 75 patients, with a mean age of 63.3 years; 81% were men. Bronchoscopy was diagnostic in 71 (94.7%) cases. Findings from bronchial washing fluid were positive in 40 (53.3%) patients when washing was performed prior to brushing and forceps biopsy; when washing was performed after these procedures, findings were positive in 43 (57.3%) patients (P=.6). The combined diagnostic yield of washing before and after brushing and forceps biopsy was 69.3%, a significantly better result than either washing before (P=.001) or after (P=.004) the other sampling techniques. In cases where findings from washing done after brushing and forceps biopsy were negative (14 of 32, 43.7%), blood in the aspirated sample interfered with cytology. In comparison, when washing was performed prior to brushing and biopsy, that problem arose in only 3 of the 35 cases (8.5%) (P=.002). CONCLUSIONS The order in which bronchial washing is performed in relation to other sampling techniques for diagnosing bronchial tumors does not influence the diagnostic yield. This is probably because the aspirated fluid sample is more likely to contain excessive blood when washing is performed after brushing and forceps biopsy. However, the diagnostic yield can be significantly increased by combining the findings from bronchial washings performed both before and after other sample collection procedures.

Endobronchial fibroepithelial polyp.

Benign polypoid lesions are an uncommon finding on bronchoscopic examination. The histopathologic fibroepithelial subtype is very rare in this location. In this report, we describe a 77-year-old man diagnosed with a fibroepithelial polyp located at the bifurcation of the left main bronchus; this was completely removed using flexible bronchoscope.