Daily Respiratory Research Analysis
A multicenter randomized trial shows that ultrasound elastography-guided pleural biopsy improves sensitivity for diagnosing malignant pleural effusion without compromising safety. A large population-based cohort quantifies the markedly elevated risk and mortality associated with nontuberculous mycobacterial disease after solid-organ transplantation. Real-world causal analyses indicate that systemic therapies—including glucocorticoids and antifibrotics—significantly slow lung function decline in
Summary
A multicenter randomized trial shows that ultrasound elastography-guided pleural biopsy improves sensitivity for diagnosing malignant pleural effusion without compromising safety. A large population-based cohort quantifies the markedly elevated risk and mortality associated with nontuberculous mycobacterial disease after solid-organ transplantation. Real-world causal analyses indicate that systemic therapies—including glucocorticoids and antifibrotics—significantly slow lung function decline in progressive pulmonary fibrosis, supporting “despite management” criteria for antifibrotic eligibility.
Research Themes
- Diagnostic innovation in pleural disease
- Transplant infectious risk and outcomes
- Real-world effectiveness of antifibrotics in progressive pulmonary fibrosis
Selected Articles
1. Ultrasonic Elastography-guided Pleural Biopsy
In a multicenter randomized trial, elastography-guided pleural biopsy achieved higher sensitivity (85%) for malignant pleural effusion than standard ultrasound-guided biopsy, with similar safety. Elastography targeting likely enriches sampling of stiffer malignant pleura across pleural thickness strata.
Impact: This RCT directly informs diagnostic pathways for pleural effusions by demonstrating superior yield without added harm. It operationalizes tissue stiffness mapping to guide biopsy, an immediately adoptable technique in experienced centers.
Clinical Implications: Consider UEPB when malignancy is suspected to increase diagnostic sensitivity, particularly where initial cytology is nondiagnostic. Training sonographers to integrate elastography into pleural workups could reduce repeat procedures and expedite oncology care.
Key Findings
- UEPB demonstrated higher sensitivity for malignant pleural effusion than standard TUSPB (85.0%).
- Safety profile of UEPB was similar to TUSPB.
- Trial was multicenter and randomized (NCT05781659), supporting generalizability.
Methodological Strengths
- Multicenter randomized design with prospective allocation
- Trial registration with prespecified outcomes
Limitations
- Comparator sensitivity and subgroup performance by pleural thickness not fully detailed in abstract
- Operator experience and learning curve effects not elaborated
Future Directions: Define training standards and learning curves for UEPB; assess cost-effectiveness and impact on time-to-diagnosis; evaluate performance across different pleural thicknesses and tumor histologies.
2. Nontuberculous Mycobacterial Disease in Solid-Organ Transplant Recipients and the General Population.
In a population-based matched cohort of 138,175 individuals, solid-organ transplant recipients—especially lung recipients—had dramatically higher risk of nontuberculous mycobacterial disease (aHR 177 for lung; 8.9 for other organs) versus controls. MAC- and RGM-associated disease conferred increased long-term mortality in both lung and nonlung transplant recipients.
Impact: The study provides robust, generalizable estimates of NTM-D risk and mortality after transplantation, informing screening and prophylaxis strategies across transplant programs.
Clinical Implications: Transplant programs should consider risk-stratified screening for NTM (especially in lung recipients), early diagnostic evaluation of respiratory symptoms, and tailored antimicrobial strategies. Pre- and post-transplant counseling should address NTM risk and surveillance.
Key Findings
- Solid-organ transplantation was associated with markedly increased NTM-D risk vs matched controls (lung aHR 177.34; other organs aHR 8.89).
- NTM-D due to MAC and RGM increased long-term mortality in both lung and nonlung recipients.
- Rigorous, culture-based case definitions and province-wide linkage enhanced validity.
Methodological Strengths
- Population-based design with 1:10 matching by age, sex, and region
- Longitudinal follow-up with Cox models and species-specific analyses
Limitations
- Observational design susceptible to residual confounding
- Potential misclassification of exposure or outcomes inherent to administrative data
Future Directions: Evaluate targeted screening intervals, environmental exposures, and prophylaxis in high-risk subgroups; integrate microbiome and immune profiling to refine risk prediction.
3. Effectiveness of antifibrotic treatment in real-world patients with progressive pulmonary fibrosis.
Across 1,754 non-IPF ILD patients, antifibrotics were associated with improved estimated survival in PF-ILD and in PPF that progressed despite appropriate management, but not in the broader PPF definition. Advanced causal methods (parametric G-formula, time-varying Cox, IPW) yielded consistent findings.
Impact: The study clarifies which PPF definitions identify patients most likely to benefit from antifibrotics in routine care, informing policy and guideline criteria.
Clinical Implications: Antifibrotic initiation may be most justified in PF-ILD and in PPF with documented progression despite appropriate non-antifibrotic management. Programs should operationalize ‘despite management’ criteria and monitor outcomes using causal analytic frameworks.
Key Findings
- Antifibrotics were associated with higher estimated survival in PF-ILD and PPF ‘despite management’.
- No clear survival advantage in the broader PPF group defined by 12-month progression criteria.
- Causal analyses (parametric G-formula, time-varying Cox, IPW) produced consistent results.
Methodological Strengths
- Large multicenter real-world cohort with predefined progression phenotypes
- Use of advanced causal inference methods (parametric G-formula, IPW, time-varying Cox)
Limitations
- Retrospective observational design with potential residual confounding and selection bias
- Heterogeneity of background management and progression ascertainment across centers
Future Directions: Prospective trials to validate ‘despite management’ criteria; harmonize progression definitions and embed pragmatic randomization to confirm survival benefit.