TY - JOUR
T1 - High-Definition Videobronchoscopy for the Diagnosis of Airway Involvement in Sarcoidosis
T2 - The Enhance Sarcoidosis Multicenter Study
AU - Livi, Vanina
AU - Sivokozov, Ilya
AU - Annema, Jouke T.
AU - Candoli, Piero
AU - Vasilev, Igor
AU - Kramer, Tess
AU - Ferrari, Marco
AU - Madan, Karan
AU - Fielding, David
AU - Murgu, Septimiu
AU - Cancellieri, Alessandra
AU - Semyonova, Lyudmila A.
AU - Puci, Mariangela
AU - Sotgiu, Giovanni
AU - Trisolini, Rocco
N1 - Funding Information: Author contributions: R. T. and V. L. conceived and designed the study; analyzed and interpreted the data; and drafted, revised, and approved the work. G. S. designed the study; analyzed and interpreted the data; and drafted, revised, and approved the work. A. C. P. C. M. F. J. T. A. T. K. I. S. L. A. S. and I. V. collected the data and revised and approved the work. M. P. analyzed and interpreted the data and revised and approved the work. D. F. S. M. and K. M. interpreted the data and revised and approved the work. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Additional information: The e-Appendix, e-Figures, e-Table, and Videos are available online under “Supplementary Data.” Publisher Copyright: © 2023 The Author(s)
PY - 2023/11
Y1 - 2023/11
N2 - Background: The ability of high-definition (HD) videobronchoscopy to detect airway involvement in sarcoidosis has not been evaluated previously. Research Question: What is the role of HD videobronchoscopy in the identification of sarcoidosis-associated airway abnormalities (AAs)? What are the patterns of AAs more commonly observed and more frequently associated with the detection of granulomas in endobronchial biopsy (EBB)? Study Design and Methods: In this prospective international multicenter cohort study, consecutive patients with suspected sarcoidosis underwent airway inspection with an HD videobronchoscope and EBB using a standardized workflow. AAs were classified according to six patterns defined a priori: nodularity, cobblestoning, thickening, plaque, increased vascularity, and miscellaneous. We assessed diagnostic yield of EBB, prevalence of AAs, and interobserver agreement for different patterns of AAs. Results: AAs were identified in 64 of 134 patients with sarcoidosis (47.8%), with nodularity (n = 23 [17.2%]), plaque (n = 19 [14.2%]), and increased vascularity (n = 19 [14.2%]) being the most prevalent. The diagnostic yield of EBB was 36.6%. AAs were significantly more prevalent in patients with than in those without nonnecrotizing granulomas on EBB (67.4% vs 36.5%; P = .001). Likewise, parenchymal disease on CT scan imaging was significantly more common in patients with than in those without nonnecrotizing granulomas on EBB (79.6% vs 54.1%; P = .003). On a per-lesion analysis, nonnecrotizing granulomas were seen especially in EBB samples obtained from areas of cobblestoning (9/10 [90%]) and nodularity (17/29 [58.6%]). The overall diagnostic yield of random EBB was low (31/134 [23.1%]). The interobserver agreement for the different patterns of AA was fair (Fleiss κ = 0.34). Interpretation: In a population with a large prevalence of White Europeans, HD videobronchoscopy detected AAs in approximately one-half of patients with sarcoidosis. The diagnostic yield of EBB was higher in patients with parenchymal involvement on CT scan imaging and in those with AAs, especially if manifesting as cobblestoning and nodularity. Trial Registry: ClinicalTrials.gov; No.: NCT4743596; URL: www.clinicaltrials.gov
AB - Background: The ability of high-definition (HD) videobronchoscopy to detect airway involvement in sarcoidosis has not been evaluated previously. Research Question: What is the role of HD videobronchoscopy in the identification of sarcoidosis-associated airway abnormalities (AAs)? What are the patterns of AAs more commonly observed and more frequently associated with the detection of granulomas in endobronchial biopsy (EBB)? Study Design and Methods: In this prospective international multicenter cohort study, consecutive patients with suspected sarcoidosis underwent airway inspection with an HD videobronchoscope and EBB using a standardized workflow. AAs were classified according to six patterns defined a priori: nodularity, cobblestoning, thickening, plaque, increased vascularity, and miscellaneous. We assessed diagnostic yield of EBB, prevalence of AAs, and interobserver agreement for different patterns of AAs. Results: AAs were identified in 64 of 134 patients with sarcoidosis (47.8%), with nodularity (n = 23 [17.2%]), plaque (n = 19 [14.2%]), and increased vascularity (n = 19 [14.2%]) being the most prevalent. The diagnostic yield of EBB was 36.6%. AAs were significantly more prevalent in patients with than in those without nonnecrotizing granulomas on EBB (67.4% vs 36.5%; P = .001). Likewise, parenchymal disease on CT scan imaging was significantly more common in patients with than in those without nonnecrotizing granulomas on EBB (79.6% vs 54.1%; P = .003). On a per-lesion analysis, nonnecrotizing granulomas were seen especially in EBB samples obtained from areas of cobblestoning (9/10 [90%]) and nodularity (17/29 [58.6%]). The overall diagnostic yield of random EBB was low (31/134 [23.1%]). The interobserver agreement for the different patterns of AA was fair (Fleiss κ = 0.34). Interpretation: In a population with a large prevalence of White Europeans, HD videobronchoscopy detected AAs in approximately one-half of patients with sarcoidosis. The diagnostic yield of EBB was higher in patients with parenchymal involvement on CT scan imaging and in those with AAs, especially if manifesting as cobblestoning and nodularity. Trial Registry: ClinicalTrials.gov; No.: NCT4743596; URL: www.clinicaltrials.gov
KW - CT scan
KW - endobronchial biopsy
KW - endobronchial ultrasound
KW - granuloma
KW - high-definition videobronchoscopy
KW - sarcoidosis
UR - http://www.scopus.com/inward/record.url?scp=85173953300&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.chest.2023.04.034
DO - https://doi.org/10.1016/j.chest.2023.04.034
M3 - Article
C2 - 37121391
SN - 0012-3692
VL - 164
SP - 1243
EP - 1252
JO - Chest
JF - Chest
IS - 5
ER -