Overview of Diagnostic Modalities Used for Screening and Monitoring Systemic Sclerosis-related Interstitial Lung Disease
DOI:
https://doi.org/10.52340/GBMN.2024.01.01.79Keywords:
Bronchoalveolar lavage, chest radiography, DLCO, HRCT, interstitial lung disease, lung ultrasound, mean pulmonary arterial pressure, pulmonary function tests, systemic sclerosis, 6-minute walk testAbstract
Background: Systemic sclerosis-associated interstitial lung disease (SSc-ILD) presents a significant challenge in clinical practice due to its high morbidity and mortality rates. This review evaluates various diagnostic modalities essential for screening and monitoring SSc-ILD, emphasizing their clinical utility and limitations. Pulmonary function tests (PFTs), including spirometry and diffusion capacity for carbon monoxide (DLCO), are primary tools for initial assessment and longitudinal monitoring. While DLCO demonstrates higher sensitivity, serial changes in forced vital capacity (FVC) predict disease progression and mortality more reliably. High-resolution chest CT (HRCT) scans provide superior sensitivity in detecting early structural abnormalities and guiding therapeutic decisions despite concerns over radiation exposure. Although widely used, the 6-minute walk test (6MWT) lacks specificity compared to advanced assessments like DLCO during exercise. Lung ultrasound (LUS) emerges as a promising, radiation-free alternative for early ILD detection, correlating well with HRCT findings. Mean pulmonary arterial pressure (MPAP), assessed via echocardiography and right heart catheterization, aids in identifying pulmonary hypertension complications in SSc-ILD patients. Bronchoalveolar lavage (BAL) and surgical lung biopsy offer additional insights in challenging cases, yet their routine use remains contentious due to invasiveness and limited impact on clinical outcomes. Integrating these diagnostic approaches optimizes screening accuracy and facilitates timely intervention in SSc-ILD management. Future research should focus on standardizing protocols and exploring novel biomarkers to enhance diagnostic precision and therapeutic efficacy.References
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