Chest
Volume 125, Issue 2, February 2004, Pages 522-526
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Clinical Investigations
LUNG BIOPSY
Prognostic Implications of Histologic Patterns in Multiple Surgical Lung Biopsies From Patients With Idiopathic Interstitial Pneumonias

https://doi.org/10.1378/chest.125.2.522Get rights and content

Study objectives

To determine the prevalence and prognostic significance of histologic discordance in multiple lung biopsy specimens obtained from patients investigated for suspected cryptogenic fibrosing alveolitis (CFA)/idiopathic pulmonary fibrosis (IPF).

Methods and results

Between 1984 and 2001, 64 patients undergoing investigation for CFA/IPF were identified in whom multiple biopsies were performed that showed either a pattern of usual interstitial pneumonia (UIP) or nonspecific interstitial pneumonia (NSIP). These cases were classified into three groups: concordant UIP-UIP (n = 25, 39.1%), discordant UIP-NSIP (n = 8,12.5%), and concordant NSIP-NSIP (n = 31, 48.4%). The discordant UIP group had survival, clinical, and physiologic features similar to those of the concordant UIP group, and prognosis in both concordant and discordant UIP groups was significantly worse than that of the concordant NSIP group (p = 0.02 and p = 0.04, respectively). The age of the concordant UIP group was higher than that of the concordant NSIP group, with the mean age of the discordant group being intermediate. There were no significant differences among the three groups in smoking history, duration of dyspnea, presence or absence of crackles, FVC, diffusion capacity of the lung for carbon monoxide, or Pao2.

Conclusions

Patients with discordant UIP-NSIP results on multiple biopsies show clinical behavior similar to those with concordant UIP-UIP and should be regarded as having CFA/IPF in the correct clinical context, rather than “idiopathic NSIP” for the purposes of management. Multiple biopsies should be considered in all patients in order to improve the prognostic information provided by lung biopsy.

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

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