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Clinicopathologic features associated with relapse in cryptogenic organizing pneumonia
Michiya Nishino1, Susan K Mathai2, David Schoenfeld3
1Department of Pathology, Massachusetts General Hospital, Boston, MA 02114.
Human Pathology
|December 18, 2013
Summary
High levels of fibrin in lung biopsies and widespread disease on imaging predict relapse in patients with cryptogenic organizing pneumonia (COP). This finding may guide intensive steroid therapy decisions for COP patients.
Area of Science:
- Pulmonology
- Pathology
- Radiology
Background:
- Organizing pneumonia (OP) is a histopathologic pattern indicating lung injury.
- Intraalveolar fibrin, a marker of microvascular injury, is present in OP, but its clinical significance is uncertain.
- Cryptogenic organizing pneumonia (COP) is an idiopathic form of OP.
Purpose of the Study:
- To investigate the association between intraalveolar fibrin levels and clinical outcomes in COP.
- To correlate fibrin deposition and radiographic disease extent with the risk of COP relapse.
Main Methods:
- Analysis of lung wedge biopsies from 26 COP patients to quantify fibrin.
- Correlation of fibrin levels and radiographic findings (lung zone involvement) with disease relapse rates.
- Assessment of predictive values for relapse based on combined pathologic and radiographic markers.
Main Results:
- Patients with high fibrin (multifocal deposits or acute fibrinous and organizing pneumonia) had a significantly higher relapse rate (60% vs 6%, P < .05).
- Widespread radiographic disease (three lung zones) was associated with a higher relapse rate (41% vs 0%, P = .055).
- Combined high fibrin and three-zone radiographic disease predicted relapse with 86% sensitivity and 84% specificity.
Conclusions:
- Elevated intraalveolar fibrin and extensive radiographic disease predict an increased risk of COP relapse.
- These findings may help identify COP patients who could benefit from more aggressive steroid treatment.
- Pathologic and radiographic markers offer valuable prognostic information in COP management.
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