Search

The objective of this study was to determine whether computed tomography (CT) could be a useful tool for nonsolid lung nodule (NSN) treatment planning, surgery or stereotactic body radiation therapy (SBRT), by assessing the macroscopic and microscopic extension of these nodules.The study prospectively included 23 patients undergoing anatomic resection at the Foch Hospital in 2020/2021 for NSN with a ground-glass component of more than 50%. Firstly, for each patient, both the macroscopic dimensions of the NSN were assessed on CT and during pathologic analysis. Secondly, the microscopic extension was assessed during pathologic examination. Wilcoxon sign rank tests were used to compare these dimensions. Spearman correlation test and Bland-Altman analysis were used to evaluate the agreement between radiological and pathologic measurements.On CT, the median largest diameter and volume of NSN were 21 mm and 3780 cc, while on pathologic analysis, they were 15 mm and 1800 cc, respectively. Therefore, the largest diameter and volume of the NSN were significantly higher on CT than on pathological analysis. For microscopic extension, the median largest diameter and volume of NSN were 17 mm and 2040 cc, respectively. No significant difference was observed between the macroscopic size and the microscopic extension assessed during pathologic analysis. Moreover, correlation analysis and Bland-Altman plots showed that radiological and pathologic measurements could provide equivalent precision.Our study showed that CT did not underestimate the macroscopic size and microscopic extension of NSN and confirmed that CT can be used for NSN treatment planning.

ObjectiveAntisynthetase syndrome (AS)-related interstitial lung disease (ILD) has a poor prognosis. Intravenous cyclophosphamide (IV CYC) and rituximab (RTX) are the main treatments currently used for moderate to severe ILD. Here, we compare the efficacy of CYC followed by standard immunosuppressive treatment (IST) versus RTX in AS-related ILD.MethodsThis observational retrospective study was conducted between 2003 and 2016 in 3 tertiary care centers. All patients with AS-related ILD and treated with CYC or RTX with at least 6 months of follow-up were included. Pulmonary progression-free survival (PFS), defined according to the American Thoracic Society guidelines, was assessed at 6 months and 2 years. All severe adverse events (AE) were recorded.ResultsSixty-two patients were included. Thirty-four patients received 2–12 monthly IV CYC pulses, followed by standard IST in 30 cases (88%). The RTX group included 28 patients. Following the initial Day 1 to Day 15 infusions, RTX was repeated every 6 months in 26 cases (93%) and 15 patients (54%) concomitantly received another IST. The median steroid dose was similar between both groups. Although RTX and CYC demonstrated similar PFS at 6 months (92% vs 85%, respectively), RTX was superior at 2 years (HR 0.263, 95% CI 0.094–0.732, P = 0.011). Interestingly, lower diffusing lung capacity for carbon monoxide (DLCO) at baseline was independently predictive of poor 2-year PFS [0.965 (0.936–0.995), P = 0.023]. Forced vital capacity and DLCO improved in both groups without significant differences. Serious AE were similar in both groups.ConclusionDespite similar PFS at 6 months, RTX was associated with a better 2-year PFS compared to CYC in patients with AS-related ILD.

Eosinophils have widespread procoagulant effects. Eosinophilic cardiovascular toxicity mostly consists of endomyocardial damage or eosinophilic vasculitis, while reported cases of venous thrombosis (VT) are scarce. We aimed to report on the clinical features and treatment outcomes of patients with unexplained VT and eosinophilia, and to identify predictors of relapse. This retrospective, multicenter, observational study included patients aged over 15 years with VT, concomitant blood eosinophilia ≥ 1G/L and without any other moderate-to-strong contributing factors for VT. Fifty-four patients were included. VT was the initial manifestation of eosinophil-related disease in 29 (54%) patients and included pulmonary embolism (52%), deep venous thrombosis (37%), hepatic (11%) and portal vein (9%) thromboses. The median [IQR] absolute eosinophil count at VT onset was 3.3G/L [1.6–7.4]. Underlying eosinophil-related diseases included FIP1L1-PDGFRA-associated chronic myeloid neoplasm (n = 4), Eosinophilic Granulomatosis with Polyangiitis (n = 9), lymphocytic (n = 1) and idiopathic (n = 29) variants of hypereosinophilic syndrome. After a median [IQR] follow-up of 24 [10–62] months, 7 (13%) patients had a recurrence of VT. In multivariate analysis, persistent eosinophilia was the sole variable associated with a shorter time to VT relapse (HR 7.48; CI95% [1.94–29.47]; p = 0.015). Long-term normalization of eosinophil count could prevent the recurrence of VT in a subset of patients with unexplained VT and eosinophilia ≥ 1G/L.

International audience

Background High levels of serum interleukin-6 (IL-6) correlate with disease severity in COVID-19. We hypothesized that tocilizumab (a recombinant humanized anti-IL-6 receptor) could improve outcomes in selected patients with severe worsening COVID-19 pneumonia and high inflammatory parameters. Methods The TOCICOVID study included a prospective cohort of patients aged 16–80 years with severe (requiring > 6 L/min of oxygen therapy to obtain Sp02 > 94%) rapidly deteriorating (increase by ≥ 3 L/min of oxygen flow within the previous 12 h) COVID-19 pneumonia with ≥ 5 days of symptoms and C-reactive protein levels > 40 mg/L. They entered a compassionate use program of treatment with intravenous tocilizumab (8 mg/kg with a maximum of 800 mg per infusion; and if needed a second infusion 24 to 72 h later). A control group was retrospectively selected with the same inclusion criteria. Outcomes were assessed at D28 using inverse probability of treatment weighted (IPTW) methodology. Results Among the 96 patients included (81% male, mean (SD) age: 60 (12.5) years), underlying conditions, baseline disease severity, and concomitant medications were broadly similar between the tocilizumab (n = 49) and the control (n = 47) groups. In the IPTW analysis, treatment with tocilizumab was associated with a reduced need for overall ventilatory support (49 vs. 89%, wHR: 0.39 [0.25–0.56]; p

Objectives To assess inter-reader agreements and diagnostic accuracy of chest CT to identify COVID-19 pneumonia in patients with intermediate clinical probability during an acute disease outbreak. Methods From March 20 to April 8, 319 patients (mean age 62.3 years old) consecutive patients with an intermediate clinical probability of COVID-19 pneumonia underwent a chest CT scan. Two independent chest radiologists blinded to clinical information and RT-PCR results retrospectively reviewed and classified images on a 1–5 confidence level scale for COVID-19 pneumonia. Agreements between radiologists were assessed with kappa statistics. Diagnostic accuracy of chest CT compared with RT-PCR assay and patient outcomes was measured using receiver operating characteristics (ROC). Positive predictive value (PPV) and negative predictive value (NPV) for COVID-19 pneumonia were calculated. Results Inter-observer agreement for highly probable (kappa: 0.83 [p

Objectives To assess inter-reader agreements and diagnostic accuracy of chest CT to identify COVID-19 pneumonia in patients with intermediate clinical probability during an acute disease outbreak.Methods:From March 20 to April 8, consecutive patients with intermediate clinical probability of COVID-19 pneumonia underwent a chest CT scan. Two independent chest radiologists blinded to clinical information and RT-PCR results retrospectively reviewed and classified images on a 1-5 confidence level scale for COVID-19 pneumonia. Agreements between radiologists were assessed with kappa statistics. Diagnostic accuracy of chest CT compared to RT-PCR assay and patient outcomes was measured using receiver operating characteristics (ROC). Positive predictive value (PPV) and negative predictive value (NPV) for COVID-19 pneumonia were calculated.Results: 319 patients with a mean age of 62.3 yo were included. Inter-observer agreement for highly probable (kappa: 0.83 [p < .001]) and highly probable or probable (kappa: 0.82 [p < .001]) diagnosis of COVID-19 pneumonia was very good. RT-PCR tests performed in 307 patients were positive in 173 and negative in 134. Sixteen patients with negative RT-PCR tests and probable or highly probable CT patterns according to both radiologists were reclassified COVID-19 positive after clinical discussion. The areas under the curve (AUC) were 0.94 and 0.92 respectively. With a disease prevalence of 61.6%, PPV were 96.6 % and 94.4%, and NPV 84.3% and 78.2%.Conclusion :During acute COVID-19 outbreak, chest CT scan may be used for triage of patients with intermediate clinical probability with very good inter-observer agreements and diagnostic accuracy.

Background: High levels of serum Interleukin-6 correlate with disease severity in COVID-19 pneumonia. We hypothesized that tocilizumab (a recombinant humanized anti-IL-6 receptor) could improve outcomes in selected patients with severe worsening COVID-19 pneumonia and high inflammatory parameters. Methods: The TOCICOVID study included a prospective cohort of patients aged 16-80 years with severe (requiring >6L/min of oxygen therapy to obtain Sp02 >94%) rapidly deteriorating (increase by ≥3L/min of oxygen flow within the previous 12 hours) COVID-19 pneumonia with ≥5 days of symptoms and high C-reactive protein levels who entered a compassionate use program of treatment with intravenous tocilizumab (8mg/kg with a maximum of 800mg per infusion; and if needed a second infusion 24 to 72 hours later) and a control group (retrospectively selected with the same inclusion criteria). Outcomes were assessed at D15 using inverse probability of treatment weighted (IPTW) methodology. Findings: Among the 96 patients included (81% male, mean (SD) age: 60 (12.5) years), underlying conditions, disease severity and concomitant medications were well balanced between groups (tocilizumab, n=49; control, n=47). In the IPTW analysis, t reatment with tocilizumab prevented the need for ventilatory support (49 vs. 87%, wHR: 0.42 [0.29–0.60]; p

Background Bronchiectasis is a heterogeneous disease depending on etiology. It represents the most frequent non-infectious pulmonary complication of primary immunodeficiencies (PID). We investigated whether bronchiectasis associated with PID had a distinct course in comparison to bronchiectasis of other causes. Methods Retrospective single-center study of adult patients diagnosed with non-cystic fibrosis bronchiectasis with more than 5 years of follow-up and at least 4 pulmonary functional tests available at one year apart. They were divided into three groups: PID- related bronchiectasis, idiopathic/post infectious-related bronchiectasis and other causes of bronchiectasis. Respiratory functional data and clinical outcomes were compared. Results Of 329 patients with bronchiectasis diagnosed in Foch Hospital (Suresnes, France), 98 patients fulfilled the selected criteria (20 PID-related cases, 39 idiopathic or post-infectious cases, and 39 cases with other causes). Median time of follow-up was 9.5 years. Groups were similar concerning initial characteristics (female 70.4%, never smokers 59.2%, mild severity bronchiectasis according to the FACED score and median FEV1 at diagnosis 73.5% predicted values [Q1–Q3: 53.75–90.5]), except PID patients who were younger (median age of 51.5 vs 62 years, p = 0.02). Eighty-five percent of PID patients received immunoglobulin substitution (median trough level was measured at 10.5 g/dl [10;10.92]). Global median FEV1 annual decline was 25.03 ml/year [8.16;43.9] and 19.82 ml/year [16.08;48.02] in the PID patients group. Forty-five percent of patients had bacterial colonization, pneumoniae occurred in 56% of patients and median exacerbation annual rate was 0.8 [0.3–1.4]. Hemoptysis occurred in 31.6% of patients. Global mortality rate was 11.2%. We did not record any significant difference for all clinical and functional outcomes between patients with PID and other etiologies. The median decline in FEV1 was similar in the three groups. Conclusions The course of PID-related bronchiectasis was similar to bronchiectasis of other causes. Provided that patients receive immunoglobulin replacement, the course of PID-related bronchiectasis seems to be independent of the underlying immune disorder.

The Fleischner Society White Paper and the ATS/ERS/JRS/ALAT guidelines recently redefined the computed tomography (CT) scanning patterns of usual interstitial pneumonia (UIP) [1,2]. Both publications confirmed honeycombing as the cornerstone of UIP pattern diagnosis, and introduced peripheral traction bronchiolectasis (PTB) as a key feature of the new “probable UIP” category. Therefore, improving the distinction between these two features may be critical, especially when the clinical likelihood of IPF is uncertain: a lung biopsy should be discussed for patients with PTB without honeycombing, but is not recommended for patients presenting with clear honeycombing and typical UIP pattern [2]. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr. de Margerie-Mellon reports grants from Institut Servier, grants from Olea Medical, outside the submitted work. Conflict of interest: Dr. Belin has nothing to disclose. Conflict of interest: Dr. Boussouar has nothing to disclose. Conflict of interest: Dr. Khafagy has nothing to disclose. Conflict of interest: Dr. Debray reports personal fees and non-financial support from Boehringer-Ingelheim, personal fees and non-financial support from Roche, outside the submitted work. Conflict of interest: Dr. Levand has nothing to disclose. Conflict of interest: Dr. Chabi has nothing to disclose. Conflict of interest: Dr. KHALIL has nothing to disclose. Conflict of interest: Dr. Benattia has nothing to disclose. Conflict of interest: Dr. Israel-Biet has nothing to disclose. Conflict of interest: Dr. crestani reports personal fees and non-financial support from astra zeneca, grants, personal fees and non-financial support from boehringer ingelheim, grants from MedImmune, grants, personal fees and non-financial support from Roche, personal fees from Sanofi, outside the submitted work. Conflict of interest: Dr. Nunes reports grants and personal fees from Roche/Genentech, grants and personal fees from Boehringer Ingelheim, outside the submitted work. Conflict of interest: Dr. Cadranel has nothing to disclose. Conflict of interest: Dr. GRENIER has nothing to disclose. Conflict of interest: Dr. Valeyre reports personal fees from Boehringer ingelheim, personal fees from Roche, personal fees from Boehringer ingelheim Roche, outside the submitted work. Conflict of interest: Dr. Naccache has nothing to disclose. Conflict of interest: PYB has received personal fees for teaching actions from Boehringer Ingelheim and Roche.

Rationale and Objectives The aim of this study was to evaluate the performance of a computer-aided diagnosis (CAD) system for breast ultrasound to improve the characterization of breast lesions detected on ultrasound by junior and senior radiologists. Materials and Methods One hundred sixty ultrasound breast lesions were randomly reviewed blindly by four radiologists with different levels of expertise (from 20 years [radiologist A] to 4 months [radiologist D]), with and without the help of an ultrasound CAD system (B-CAD version 2). All lesions had been biopsied. Sensitivity and specificity with and without CAD were calculated for each radiologist for the following evaluation criteria: Breast Imaging Reporting and Data System category and the final diagnosis (benign or malignant). Intrinsic sensitivity, specificity, and predictive values of CAD alone were also calculated. Results CAD detected all cancers, and its use increased radiologists’ sensitivity scores when this was possible (with vs without CAD: radiologist A, 99% vs 99%; radiologist B, 96% vs 87%; radiologist C, 95% vs 88%; radiologist D, 91% vs 88%). Seven additional cancers were diagnosed. However, the low specificity of CAD (48%) decreased the specificity of radiologists, especially of the more experienced among them (with vs without CAD: radiologist A, 46% vs 70%; radiologist B, 58% vs 80%; radiologist C, 57% vs 69%; radiologist D, 71% vs 71%). Conclusions CAD for breast ultrasound appears to be a useful tool for improving the diagnosis of malignant lesions for junior radiologists. Nevertheless, its low specificity must be taken into account to limit biopsies of benign lesions.

Little is known about the effectiveness of dose reduction options according to breast thickness. The purpose of this phantom study was to compare the effects on dose and noise of bismuth shielding versus a low kilovoltage for different breast thicknesses.CT acquisitions were performed first at 120 kVp (reference acquisition), then at 120 kVp with shielding and at 100 kVp without shielding on a phantom with three different prosthetic breast thicknesses, corresponding to the minimum, median, and maximum values first measured in a sample of 30 female thoracic CT examinations, which were randomly selected. Breast doses were measured with optically stimulated luminescence dosimeters placed on and beneath the prosthetic breast. For noise evaluation, the CT number SDs were measured within six ROIs at increasing depths.Taking into account all breast thicknesses, the average breast dose was reduced by 42.1% with shielding and by 33.0% at 100 kVp (p=0.009). In-depth noise increased less with shielding (19.0% vs 32.1%, p0.0001). For 1-cm breast thickness, the breast dose fell by 46.5% and 29.7% with shielding and 100 kVp, respectively (p=0.01), and in-depth noise increased by 19.5% and 33.9% (p=0.01). The corresponding values for 2-cm breast thickness were -38.5% and -30.1%, (p=0.02) and 16.5% and 33.5% (p=0.001), whereas those for 4-cm thickness were -40.6% and -40.5% (p=0.95) and 20.7 and 29.2% (p=0.02).Greater breast dose reduction is achieved by shielding for breast thicknesses less than 4 cm. Regardless of breast thickness, shielding leads to a smaller increase in in-depth noise.