LUNG ULTRASOUND FOR THE SCREENING OF INTERSTITIAL LUNG DISEASE IN VERY EARLY SYSTEMIC SCLEROSIS

Background: Many systemic sclerosis (SSc) patients develop interstitial lung disease (ILD) during the course of the disease. Promising data have recently shown that lung ultrasound (LUS) is able to detect ILD by the evaluation of B-lines, the sonographic sign of lung interstitial syndrome. Objectives: To evaluate whether B-lines assessed by LUS are reliable in the screening of ILD in patients with SSc. Methods: Fifty consecutive SSc patients (47 females) who underwent a clinically-driven chest high resolution computed tomography (HRCT) were evaluated by LUS for detection of B-lines. Among them, 27 patients fulfilled the criteria for a Very Early Diagnosis Of SSc (VEDOSS). Results: At least mild ILD was present at HRCT in 76% of the total population and in 70% of the VEDOSS population. A significant difference in B-lines number was found in patients with and without ILD on HRCT (62±54 vs 11±10; p<.0001), with a concordance rate of 88%. All discordant cases were false positive at LUS. When considering only the VEDOSS population, the concordance rate between the two exams was 89%, with a sensitivity of 100%, a negative predictive value of 100%, specificity of 50% and positive predictive value of 87.5%. Conclusions: ILD appears very early in SSc patients. Presence of B-lines at LUS examination correlates with ILD at HRCT. LUS is very sensitive to detect early ILD even in patients with very early diagnosis of SSc. The use of LUS as a screening tool for ILD seems feasible to guide further investigation with HRCT.