Chest
Clinical InvestigationsLUNG BIOPSYPrognostic Implications of Histologic Patterns in Multiple Surgical Lung Biopsies From Patients With Idiopathic Interstitial Pneumonias
Section snippets
Histology
Surgical lung biopsy specimens from patients who underwent multiple biopsies for the investigation of subsequently proven CFA/IPF between 1984 and 2001 were reviewed by two pathologists, independently and without access to clinical data. Some cases are parts of cohorts reviewed in previous studies2412 on the prognostic significance of interstitial pneumonias. In patients presenting before 1987, clinical criteria comprised the following: (1) bilateral predominantly basal crackles; (2) evidence
Results
Of 64 patients with patterns of UIP and NSIP, 25 patients showed concordant UIP (group 1), 8 showed discordant UIP (group 2), and 31 showed concordant NSIP (group 3). Three patients with concordant NSIP were of cellular subtype, and 28 patients were of fibrotic subtype. In the discordant UIP group, two of eight patients with NSIP were of cellular subtype and six of eight were of fibrotic subtype. Table 1 shows the lobar distribution of these biopsies and indicates the percentage of biopsies
Discussion
Although biopsy rates vary between countries and institutions in the investigation of idiopathic interstitial pneumonias, assignment of histologic pattern of interstitial pneumonia still provides significant prognostic and diagnostic data in patients undergoing biopsy. Increasingly, multiple biopsies are being undertaken in an effort to reduce sampling error,11 but there is only one published study6 that considers the implications of such data, the methodology of which was adopted for our own
References (20)
- et al.
Prognostic significance of histopathological subsets in idiopathic pulmonary fibrosis
Am J Respir Crit Care Med
(1998) - et al.
A histologic pattern of nonspecific interstitial pneumonia is associated with a better prognosis than usual interstitial pneumonia in patients with cryptogenic fibrosing alveolitis
Am J Respir Crit Care Med
(1999) - et al.
Idiopathic nonspecific interstitial pneumonia/fibrosis: comparison with idiopathic pulmonary fibrosis and BOOP
Eur Respir J
(1998) - et al.
The prognostic significance of the histologic pattern of interstitial pneumonia in patients presenting with the clinical entity of cryptogenic fibrosing alveolitis
Am J Respir Crit Care Med
(2000) - et al.
Idiopathic nonspecific interstitial pneumonia: prognostic significance of cellular and fibrosing patterns; survival comparison with usual interstitial pneumonia and desquamative interstitial pneumonia
Am J Surg Pathol
(2000) - et al.
Histopathologic variability in usual and nonspecific interstitial pneumonias
Am J Respir Crit Care Med
(2001) - et al.
Clinical significance of histological classification of idiopathic interstitial pneumonia
Eur Respir J
(2002) - et al.
ATS/ERS consensus statement of idiopathic interstitial pneumonias
Am J Respir Crit Care Med
(2002) - et al.
British Thoracic Society study of cryptogenic fibrosing alveolitis: current presentation and initial management
Thorax
(1997) - et al.
Nonspecific interstitial pneumonia: nobody said it's perfect
Am J Respir Crit Care Med
(2001)