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Updated: Jul 29, 2025
Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
Correlation between high-resolution computed tomography appearance and histopathological features in the diagnosis of
Paraskevas Lyberis1, Giulia Verri2, Paolo Solidoro3
1Unit of Thoracic Surgery, Cardio-Vascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy.
Insights
High-resolution computed tomography (HRCT) for interstitial lung disease (ILD) has limitations. Surgical lung biopsy (SLB) provides more accurate pathological diagnoses, improving tailored treatment strategies for patients with diffuse lung pathologies.
Area of Science:
- Pulmonology
- Radiology
- Pathology
Background:
- Current guidelines suggest surgical biopsy is rarely needed for high-confidence radiologic interstitial lung disease (ILD) diagnoses on high-resolution computed tomography (HRCT).
- However, discrepancies between HRCT diagnoses and biopsy findings are more common than presumed.
- Surgical lung biopsy (SLB) is recommended for newly detected ILDs of unknown cause.
Purpose of the Study:
- To determine the concordance rate between HRCT scans and pathological diagnoses of ILDs obtained via surgical biopsy.
- To evaluate the diagnostic accuracy of HRCT in identifying ILDs.
Main Methods:
- Analysis of 104 patients who underwent mini-invasive surgical biopsies for interstitial lung diseases between January 2018 and August 2022.
- HRCT scans were reviewed by an observer blinded to clinical information.
- Assessment of concordance between histological and HRCT findings.
Main Results:
- Data from 104 patients with uncertain HRCT diagnoses were analyzed; 65% were male.
- Common HRCT patterns included alternative diagnoses (44.23%) and probable usual interstitial pneumonia (UIP) (40.38%).
- Histological diagnoses varied, with definite UIP (28.84%) and hypersensitivity pneumonia (19%) being most frequent. Pathological findings contradicted HRCT diagnoses in 7 (20%) cases, showing moderate agreement (kappa index: 0.428).
Conclusions:
- HRCT has limitations in accurately diagnosing interstitial lung diseases.
- Pathological assessment via surgical lung biopsy is crucial for accurate diagnosis and tailored treatment strategies, avoiding delays in managing progressive pulmonary fibrosis.
- While traditional video-assisted surgical lung biopsy (VASLB) carries risks, awake-VASLB under local anesthesia offers a safer alternative for obtaining confident diagnoses in diffuse lung pathologies.
Background:
According to current guidelines, a surgical biopsy is rarely required when a high-confidence radiologic interstitial lung disease (ILD) diagnosis is made on thin-section high-resolution computed tomography (HRCT). Nevertheless, disowning HRCT scans diagnosed by biopsy are more common than presumed. Our study aimed to describe the concordance rate between HRCT scans and pathological diagnoses of ILDs obtained by surgical biopsy. The current guideline suggests the use of surgical lung biopsy (SLB) in patients with newly detected ILD of unknown cause.
Methods:
Patients who underwent mini-invasive surgical biopsies for interstitial lung diseases from January 2018 to August 2022 were analyzed. The HRCT scans were reviewed by an observer blinded to the patient's clinical information. The concordance between histological and HRCT-scan were assessed.
Results:
Data from 104 patients with uncertain low confidence diagnosis of interstitial lung diseases at HRCT were analyzed. Most of the patients are male (65; 62.5%). The more frequent HRCT pattern were: alternative diagnoses (46; 44.23%), UIP probable (42; 40.38%), UIP indeterminate (7; 6.73%), and non-specific interstitial pneumonia (NSIP) (9, 8.65%). The more common histological diagnosis was UIP definite (30; 28.84%), hypersensitivity pneumonia [HP](19; 18.44%), NSIP (15; 14.42%), sarcoidosis (10; 9.60%). In 7 (20%) cases, the final pathological finding denies HRCT-scans diagnoses; indeed, a moderate agreement was observed between HRCT-scan findings and the definitive histological diagnosis (kappa index: 0.428).
Conclusions:
HRCT-scan has limitations if the objective is to define interstitial lung diseases accurately. Consequently, pathological assessment should be taken into account in order to provide more accurate tailored treatment strategies because the risk is to wait from 12 to 24 months to ascertain if the ILD will be treatable as progressive pulmonary fibrosis (PPF). Undeniably true, video-assisted surgical lung biopsy (VASLB) with endotracheal intubation and mechanical ventilation is associated with a risk of mortality and morbidity that is far from nil. Nevertheless, in recent years a VASLB approach performed in awake subjects under loco-regional anesthesia (awake-VASLB) has been suggested as an effective method to obtain a highly confident diagnosis in patients with diffuse pathologies of the lung parenchyma.
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