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In a recent issue of CHEST (January 2011), Gounant et al 1 showed that dedicated linear echoendoscope endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) needles are able to release metal particles, probably by friction between the stylet and the needle, with a potential risk of injecting particles into nodes. After reading this article, we are a bit confused for several reasons. First, we do not understand the primum movens and the intrinsic aim of designing a study like this. Logically, we should perform similar investigations on all surgical, endoscopic, and radiologic procedures in which metal tools are used. Indeed, a simple blood test with a needle could release metal particles. Therefore, we do not understand the need to focus specifi cally on dedicated EBUS-TBNA needles. Second, the article does not indicate the concentrations of iron, titanium, nickel, and chromium that can be potentially harmful to the body. This is important information, considering how many times a patient may undergo EBUS-TBNA over a lifetime (one, maybe two times). Accordingly, we have some doubts that the concentrations released in the lymph nodes are so high as to be potentially harmful to the body. In conclusion, we completely agree with the authors that transbronchial needle aspiration using a fl exible bronchoscope (conventional transbronchial needle aspiration) or linear echoendoscope (endobronchial ultrasound) allowing real-time guided lymph node aspiration are minimally invasive procedures for the diagnosis of mediastinal lymphadenopathy, with a very high sensitivity, a very low morbidity, and no reported mortality. 2 , 3 Although the release of metal particles by an EBUS-TBNA needle may be reported to the manufacturers of these needles, this must not lead to a reduction in, or questioning of, the use of EBUS-TBNA in the diagnosis of mediastinal lymphadenopathy.

Idiopathic pulmonary fibrosis (IPF) is difficult to diagnose because of numerous interstitial lung diseases with similar symptoms. As serum DNA has proven useful for early lung cancer detection, we aimed to define the relevance of this marker in discriminating IPF from other fibrotic and nonfibrotic/nonmalignant lung diseases. DNA was quantified in 191 subjects: 64 healthy individuals, 58 patients with IPF, 17 patients with nonspecific pulmonary fibrosis (13 idiopathic nonspecific interstitial pneumonia, 4 chronic hypersensitivity pneumonitis), and 52 patients with other diffuse/nonmalignant lung diseases. The median value of free DNA in IPF patients was 61.1 ng/mL (range 7.1–405), which was significantly higher than that of healthy donors (median 6.8, range 2.2–184) (p

Backgrounds: Available data indicate that a large minority of patients with COVID-19 develop ARDS, and pulmonary fibrosis is a recognized sequela of ARDS. However, the long-term pulmonary consequences of COVID-19 remain speculative. The aim of this study is to evaluate risk factors, prevalence and characteristics of POST-COVID-19 interstitial lung changes, with the unique opportunity to evaluate radiologic and pathologic correlations using HRCT and transbronchial lung cryobiopsy specimens.Methods: Here we present the preliminary data on HRCT features of POST-COVID-19 ILD. Data were collected at the time of the first interim analysis (28/11/2020) of the PCOILS trial: a prospective, multicenter national study involving 12 Italian centers (Fig 1). We collected data of consecutively hospitalized patients at baseline and then at 6 (+/-1) months after hospital discharge. HRCT changes at 6 months involving more than 5% of the total lung volume were considered significant. Patients with significant HRCT changes will undergo BAL and/or cryobiopsy and a subsequent follow-up with HRCT and lung function evaluation at 12(+/-1) and 18 (+/-1) months.Results: At the time of the present interim analysis, 524 patients from 9 centers were enrolled (enrollment is still ongoing and will end on January 31st, 2021). Median age was 67 years (range 18-87), 330 were males (62.9%). HRCT changes were detected in 333 participants (63.5%), and in 219 (41.7%) were considered significant. 118 cases (22.5%) showed fibrotic changes including the following HRCT patterns: 7 (1.3%) probable UIP, 45 (8.5%) NSIP (with or without OP), 38 (7.2%) indeterminate, 28 (5.3%) fibrotic consolidations. Among the remaining 101 (19.2%) non fibrotic cases the radiologists described: 11 (2%) NSIP-OP, 15 (2.8%) indeterminate, 67 (12.7%) pure ground glass, 8 (1.5%) consolidations all suspected for lung cancer. Conclusions: This preliminary analysis confirms that after COVID-19 infection a large minority of patients develops interstitial lung changes mostly with NSIP-OP, indeterminate features or ground glass. The hypothesis that post-COVID-19 interstitial changes and interstitial lung diseases may share common risk factors, pathogenetic mechanisms and disease behaviour warrants further evaluations. .