PMID- 34900002
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20211215
IS  - 1759-720X (Print)
IS  - 1759-7218 (Electronic)
IS  - 1759-720X (Linking)
VI  - 13
DP  - 2021
TI  - Bronchoalveolar lavage and lung biopsy in connective tissue diseases, to do or 
      not to do?
PG  - 1759720X211059605
LID - 10.1177/1759720X211059605 [doi]
LID - 1759720X211059605
AB  - Bronchoalveolar lavage and lung biopsy (LBx) are helpful in patients with 
      connective tissue diseases (CTD) and interstitial lung diseases (ILD) regardless 
      of cause, including infectious, noninfectious, immunologic, or malignant. The 
      decision whether to perform only bronchoalveolar lavage (BAL), and eventually a 
      subsequent LBx in case of a nondiagnostic lavage, or one single bronchoscopy 
      combining both sampling methods depends on the clinical suspicion, on patient's 
      characteristics (e.g. increased biopsy risk) and preferences, and on the 
      resources and biopsy techniques available locally (e.g. regular forceps versus 
      cryobiopsy). In CTD-ILD, BAL has major clinical utility in excluding infections 
      and in the diagnosis of specific patterns of acute lung damage (e.g. alveolar 
      hemorrhage, diffuse alveolar damage, and organizing pneumonia). LBx is indicated 
      to exclude neoplasm or diagnose lymphoproliferative lung disorders that in CTD 
      patients are more common than in the general population. Defining BAL cellularity 
      and characterizing the CTD-ILD histopathologic pattern by LBx can be helpful in 
      the differential diagnosis of cases without established CTD [e.g. ILD preceding 
      full-blown CTD, interstitial pneumonia with autoimmune features (IPAF)], but the 
      prognostic and theragnostic role of those findings remains unclear. Few studies 
      in the pretranscriptomics era have investigated the diagnostic and prognostic 
      role of BAL and LBx in CTD-ILD, and it is reasonable to hypothesize that future 
      studies conducted applying innovative techniques on BAL and LBx might open new 
      and unexpected avenues in pathogenesis, diagnosis, and treatment approach to 
      CTD-ILD. This is particularly desirable now that a new drug treatment era is 
      emerging, in which we have more than one therapeutic choice (immunosuppressive 
      agents, antifibrotic drugs, and biological agents). We hope that future research 
      will pave the path toward precision medicine providing data for a more accurate 
      ILD-CTD endotyping that will guide the physicians through targeted therapeutic 
      choices, rather than to the approximative approach 'one drug fits them all'.
CI  - (c) The Author(s), 2021.
FAU - Tomassetti, Sara
AU  - Tomassetti S
AUID- ORCID: 0000-0002-4781-6539
AD  - Department of Experimental and Clinical Medicine, Careggi University Hospital and 
      University of Florence, 50121 Florence, Italy.
FAU - Colby, Thomas V
AU  - Colby TV
AD  - Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, 
      USA.
FAU - Wells, Athol U
AU  - Wells AU
AD  - ILD Unit, Pulmonary Medicine, Royal Brompton Hospital, London, UK.
FAU - Poletti, Venerino
AU  - Poletti V
AD  - Department of Diseases of the Thorax, GB Morgagni Hospital, Forli, Italy.
FAU - Costabel, Ulrich
AU  - Costabel U
AD  - Center for Interstitial and Rare Lung Diseases, Pneumology Department, 
      Ruhrlandklinik, University Medicine Essen, Essen, Germany.
FAU - Matucci-Cerinic, Marco
AU  - Matucci-Cerinic M
AD  - Department of Experimental and Clinical Medicine, Careggi University Hospital, 
      Florence, ItalyUnit of Immunology, Rheumatology, Allergy and Rare diseases 
      (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20211208
PL  - England
TA  - Ther Adv Musculoskelet Dis
JT  - Therapeutic advances in musculoskeletal disease
JID - 101517322
PMC - PMC8664307
OTO - NOTNLM
OT  - autoimmune diseases
OT  - bronchoalveolar lavage
OT  - connective tissue diseases
OT  - interstitial lung diseases
OT  - lung biopsy
COIS- Conflict of interest: The authors declared no potential conflicts of interest 
      with respect to the research, authorship, and/or publication of this article.
EDAT- 2021/12/14 06:00
MHDA- 2021/12/14 06:01
PMCR- 2021/12/08
CRDT- 2021/12/13 17:59
PHST- 2021/06/16 00:00 [received]
PHST- 2021/10/26 00:00 [accepted]
PHST- 2021/12/13 17:59 [entrez]
PHST- 2021/12/14 06:00 [pubmed]
PHST- 2021/12/14 06:01 [medline]
PHST- 2021/12/08 00:00 [pmc-release]
AID - 10.1177_1759720X211059605 [pii]
AID - 10.1177/1759720X211059605 [doi]
PST - epublish
SO  - Ther Adv Musculoskelet Dis. 2021 Dec 8;13:1759720X211059605. doi: 
      10.1177/1759720X211059605. eCollection 2021.