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1. DIAGNOSTIC EFFICACY OF ULTRASOUND-GUIDED CORE-NEEDLE BIOPSY OF PERIPHERAL LYMPH NODES IN SARCOIDOSIS

Author

Boussouar, S., Medjhoul, A., Bernaudin, J. F., Tayebjee, O., Soussan, M., Uzunhan, Y., Nunes, H., Kambouchner, M., Martin, A., dominique Valeyre, and Brillet, P. Y.

Subjects
Adult, Male, Granuloma, Palpation, Databases, Factual, Sarcoidosis, Middle Aged, Multimodal Imaging, Young Adult, Fluorodeoxyglucose F18, Predictive Value of Tests, Positron-Emission Tomography, Humans, Female, Biopsy, Large-Core Needle, France, Lymph Nodes, Radiopharmaceuticals, Tomography, X-Ray Computed, Ultrasonography, Interventional, Aged, Retrospective Studies
Abstract

Core-needle biopsy guided by ultrasound can be performed for investigating peripheral lymph node (PLN). The aim of this study was to determine the efficacy of this technique in sarcoidosis.Retrospective review of files of all patients in the database of the radiology department of Avicenne university hospital who underwent PLN biopsies guided by ultrasound from January 2008 to June 2011 (n=292). Cases with either granulomas at histology with the procedure or with a final diagnosis of sarcoidosis were included in the study.The histological specimens were adequate in 282 out of 292 cases (96%) showing non-caseating granulomas in 22 cases (n=20 patients with a final diagnosis of sarcoidosis and n=2 patients with tuberculosis). After reviewing clinical files of the 282 patient, 22 were confirmed to have sarcoidosis, at initial presentation (n=19) or later during flare-up or relapse (n=3) with only 2 patients having no granuloma on PLN biopsy. PLN were palpable in 18 cases and only detected by (18F)FDG-PET/CT showing increased PLN uptake in 4 cases. The sensitivity and specificity of adequate biopsy were 91 and 99% and the positive and negative predictive values were 91 and 99%, respectively.Core-needle biopsy guided by ultrasound has a high efficacy for evidencing granulomas in sarcoidosis patients with PLN involvement either clinically palpable or in the presence of (18F)FDG-PET/CT uptake.

2. Efficacy of anti-TNF alpha in severe and refractory major vessel involvement of Behcet's disease: A multicenter observational study of 18 patients

Author

Laurent Perard, A. Hot, Marc Lambert, F. Ackermann, Laurent Alric, F. Cohen, F. Bernard, Patrice Cacoub, Nicolas Noel, Olga Addimanda, Lucie Biard, Anne Claire Desbois, Eric Hachulla, David Launay, David Saadoun, C. Mausservey, Tristan Mirault, M. Resche-Rigon, S. Boussouar, François Maurier, Service de médecine interne et d'immunologie clinique [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Departement Hospitalo- Universitaire - Inflammation, Immunopathologie, Biothérapie [Paris] (DHU - I2B), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Université Pierre et Marie Curie - Paris 6 (UPMC), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Università degli Studi di Modena e Reggio Emilia (UNIMORE), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre de référence des maladies auto-immunes systémiques rares du Nord et Nord Ouest [CHRU Lille], Hôpital Claude Huriez [Lille], CHU Lille-CHU Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Lille Inflammation Research International Center - U 995 (LIRIC), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Foch [Suresnes], Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpitaux Privés de Metz (HPMetz), Centre Hospitalier Chalon-sur-Saône William Morey, Hôpital Nord [CHU - APHM], AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Institut de Chimie du CNRS (INC)-Institut de Recherche pour le Développement (IRD), Hôpital Corentin Celton [Issy-les-Moulineaux], Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de médecine interne [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Desbois, A.C., Biard, L., Addimanda, O., Lambert, M., Hachulla, E., Launay, D., Ackermann, F., Pérard, L., Hot, A., Maurier, F., Mausservey, C., Bernard, F., Noel, N., Alric, L., Mirault, T., Cohen, F., Boussouar, S., Resche-Rigon, M., Cacoub, P., Saadoun, D., Service de Département de médecine interne et immunologie clinique [CHU Pitié-Salpêtrière] (DMIIC), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Pierre et Marie Curie - Paris 6 (UPMC), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Università degli Studi di Modena e Reggio Emilia = University of Modena and Reggio Emilia (UNIMORE), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)

Subjects
Male, Behcet's disease, Budd-Chiari Syndrome, 030204 cardiovascular system & hematology, Severity of Illness Index, Gastroenterology, 0302 clinical medicine, Recurrence, Immunology and Allergy, Behçet's disease, Behcet Syndrome, Remission Induction, Middle Aged, [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences, Pulmonary edema, Thrombosis, 3. Good health, medicine.vein, Antirheumatic Agents, Budd–Chiari syndrome, Female, Vasculitis, Immunosuppressive Agents, medicine.drug, Adult, Vasculiti, medicine.medical_specialty, Heart Diseases, Angio-Behçet's, Immunology, Aortic Diseases, Pulmonary Edema, Vena Cava, Inferior, Pulmonary Artery, Infections, Inferior vena cava, Young Adult, 03 medical and health sciences, Anti-TNFα, Internal medicine, medicine.artery, medicine, Humans, Vascular Diseases, Retrospective Studies, Major vessel disease, 030203 arthritis & rheumatology, Tumor Necrosis Factor-alpha, business.industry, Adalimumab, medicine.disease, Infliximab, Treatment, Logistic Models, Angio-Behçet', Pulmonary artery, business
Abstract

Objective To describe the outcome and tolerance in patients treated with anti-TNFα in severe and refractory major vessel disease in Behcet's disease (BD). Methods A multicenter study evaluating 18 refractory BD patients with major vessel involvement [pulmonary artery (n = 4), aorta (n = 4) or peripheral artery aneurysm (n = 1) and/or pulmonary artery (n = 7), inferior vena cava (n = 5), or intra-cardiac (n = 3) thrombosis or Budd Chiari Syndrome (n = 2)] treated with anti-TNFα agents. Results Vascular remission was achieved in 16 (89%) patients. The 9 months risk of relapse was significantly higher with conventional immunosuppressants used prior anti-TNFα agents as compared to anti-TNFα therapy [OR = 8.7 (1.42–62.6), p = 0.03]. The median daily dose of corticosteroids significantly decreased at 12 months. Side effects included infection (n = 4) and pulmonary edema (n = 1). Conclusion TNFα-antagonists are safe and might be associated with a decreased risk of relapse at 9 months compared to conventional immunosuppressants in BD patients with major vessels disease.

Published
2018

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