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Histopathologic variability in usual and nonspecific interstitial pneumonias
K R Flaherty1, W D Travis, T V Colby
1Department of Radiology, University of Michigan Health System, University of Michigan School of Public Health, Ann Arbor, Michigan 48109-0360, USA.
American Journal of Respiratory and Critical Care Medicine
|November 24, 2001
Summary
Histologic variability is common in surgical lung biopsy (SLB) specimens from patients with idiopathic interstitial pneumonia (IIP). If usual interstitial pneumonia (UIP) is found in any lobe, the patient should be diagnosed with UIP.
Area of Science:
- Pulmonology
- Pathology
- Radiology
Background:
- Surgical lung biopsy (SLB) is crucial for diagnosing idiopathic interstitial pneumonia (IIP).
- Understanding histologic variability across lung lobes is important for accurate IIP classification.
Purpose of the Study:
- To assess the frequency and implications of histologic variability in SLB specimens from multiple lung lobes in IIP patients.
- To determine if lobar distribution of specific IIP patterns (UIP, NSIP) influences patient characteristics and survival.
Main Methods:
- Retrospective review of SLBs from 168 IIP patients, with 109 having multi-lobe biopsies.
- Three pathologists assigned diagnoses to each biopsied lobe.
- Correlation of histologic findings with high-resolution computed tomography (HRCT) and patient survival.
Main Results:
- 26% of patients showed different diagnoses between lung lobes.
- Patients with usual interstitial pneumonia (UIP) in any lobe (discordant UIP) were younger than those with UIP in all lobes (concordant UIP).
- Higher fibrosis profusion on HRCT correlated with UIP diagnoses, particularly concordant UIP.
- Nonspecific interstitial pneumonia (NSIP) patients had better survival than UIP patients.
Conclusions:
- Lobar histologic variability is frequent in IIP.
- A diagnosis of UIP should be assigned if the UIP pattern is present in any biopsied lobe.
- UIP and NSIP have distinct clinical and radiological features and different survival outcomes.