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Current evidence on the diagnostic yield and safety of pleural cryobiopsy (CB) is based on a series of heterogeneous studies with limited cohorts. A pooled analysis of these studies could improve the evidence and contribute to a better understanding of this new technique.We performed a systematic review and meta-analysis of published studies that included data on the yield and diagnostic safety of pleural CB compared with procedures performed using conventional flexible forceps. The heterogeneity of the analysis was evaluated by determining the I2 index, while study quality was measured with the QUADAS-2 tool.Seven studies involving 356 patients were used for the final evaluation. In 55.6%, the etiology of the pleural effusion was malignant, 61.1% of which were lung cancer. The diagnostic yield of pleural CB was 95% (95% CI 92-97) vs. 91% (95% CI 87-94) with conventional flexible forceps (P = .019). Mild bleeding was reported in 67% of CB procedures (95% CI 62-72) compared with 85% of conventional flexible forceps procedures (95% CI 79-90) (P .001). CB specimens were larger, and fewer artifacts were detected. A pooled analysis of the detection of molecular changes could not be performed. Heterogeneity was moderate to high, although the quality of the studies was acceptable.Pleural CB is a safe technique with a high yield for etiological diagnosis of pleural effusion, and larger specimens with fewer artifacts are obtained. Molecular determinations should be investigated in more depth.

Introduction: Rheumatoid arthritis (RA) is a systemic autoimmune disease whose main extra-articular organ affected is the lung, sometimes in the form of diffuse interstitial lung disease (ILD) and conditions the prognosis. Methods: A multicenter, observational, descriptive and cross-sectional study of consecutive patients diagnosed with RA-ILD between 2013 and 2018. Demographic, analytical, respiratory functional and evolution characteristics were analyzed to evaluate the predictors of progression and mortality. Results: 106 patients were included. The mean age was 70.2±19.8 years and 51.9% of the patients presented UIP pattern. In the multivariate Cox analysis the age (HR 1.33, 95% CI 1.09-1.62, p=0.0045), the DLCO (%) (HR 0.85, 95% CI 0.73-0.98, p=0.0246), and the final SatO2 (%) in the 6MWT (HR 0.62, 95% CI 0.39-0.99, p=0.0465) were independent predictor variables of mortality, as well as the GAP index (HR 4.65, 95% CI 1.59 - 13.54, p=0.0051) and the CPI index (HR 1.12, 95% CI 1.03 - 1.22, p=0.0092). Also highlight that the diagnostic delay was an independent predictor of mortality (HR 1.11, CI 1.01-1.23, p = 0.035). Conclusions: This is the first study where it is objectified that the diagnostic delay in RA-ILD is associated with an increased mortality just like happens in IPF.

Introduction: Alpha 1 antitrypsin deficiency (AATD) is a genetic condition that predisposes to the development of pulmonary emphysema and liver disease. Objectives: The aim of this study was to assess the characteristics of patients with AATD and the distribution of genotypes analyzed in the CHUVI Genetics Laboratory. Methods: Retrospective analysis of patients who underwent AAT levels determination between 2012-2017. Analysis of deficient alleles, frequency and distribution. Genetic study was performed in those cases with serum concentration of Alpha-1 antitrypsin ≤ 120 mg/dl and RCP ≤ 3 mg/dl (according to laboratory protocol). Results: 491 patients. Pi*ZZ genotype was found in 18 (3.7%), Pi*SZ in 100 (20.4%), Pi*MZ in 143 (29.1%), Pi*SS in 26 (5.3%) and No-Sno-Z in 174 (35,4%): 14 rare or null variants (6 Mmalton/M, 2 Mmalton/Z, 1 Mmalton/S, 1 S/QOurem, 1 S/MHerleen, 1 I/Z, 1 PLowell/S and 1 PLowell/Z), which were diagnosed by sequencing the gene. Serum levels were ZZ: 32 mg/dl (20-64), SZ: 66 mg/dl (42-120), MZ: 83 mg/dl (21-147), SS: 88 mg/dl (56-127) and No-S No-Z: 101 mg/dl (18-390). Conclusions: Genotypes associated with severe deficiency showed worse pulmonary function. Galicia is an area of relatively high prevalence of AATD, so this diagnostic possibility should be considered in the study of patients with diseases related to this genetic condition and in relatives of affected individuals.

Molecular characterization of non-small-cell lung cancer is becoming increasingly important with the appearance of molecular testing. Tumors with somatic mutations in the gene that encodes for the tyrosine kinase domain of the epidermal growth factor receptor (EGFR) or in the gene that encodes for the anaplastic lymphoma kinase (ALK) preclude favorable responses to tyrosine kinase and ALK inhibitors, respectively. Semirigid thoracoscopy is a minimally invasive technique for pleural effusion management. However, there is scarce evidence assessing the role of semirigid thoracoscopy for molecular testing, with only one study including EGFR mutation status but no study analyzing ALK translocation. The aim of this prospective study was to evaluate the adequacy of samples obtained using semirigid thoracoscopy for EGFR mutation and ALK translocation analyses in confirmed primary lung cancers. We conducted a prospective analysis of 26 consecutive patients referred for semirigid thoracoscopy between November 2009 and July 2015. Twenty-two cases were adenocarcinomas. Fourteen samples were sent for molecular analysis. Semirigid thoracoscopy had a diagnostic yield of 95.45%for malignancy. EGFR mutation testing was possible in all (100%) cases. EGFR mutations were detected in 2/14 (14.2%) samples. ALK translocation testing was possible in all but one (90%), although negative in all of them. This study confirms the high clinical utility of samples obtained through semirigid thoracoscopy for EGFR and ALK genotyping in primary lung cancers.