Aaløkken Trond Mogens, Naalsund Anne, Mynarek Georg, Berstad Audun Elnaes, Solberg Steinar, Strøm Erik H, Scott Helge, Kolbenstvedt Alf, Søyseth Vidar
Department of Radiology, Oslo University Hospital Rikshospitalet, Norway.
Acta Radiol. 2012 Apr 1;53(3):296-302. doi: 10.1258/ar.2011.110482. Epub 2012 Feb 14.
The relative clinical benefit of histopathology and computed tomography (CT) in patients with idiopathic interstitial pneumonia (IIP) is under debate.
To analyze thin-section CT features and histopathologic findings in patients with usual interstitial pneumonia (UIP) in the clinical context of idiopathic pulmonary fibrosis (IPF), and to evaluate and compare diagnostic accuracy of the two methods among patients with an appropriate spectrum of IIP.
The study included 91 patients (49 men; mean age 53.2 years; median follow-up 7.2 years) with clinically suspected interstitial lung disease. All underwent surgical lung biopsy and thin-section CT. Two independent readers retrospectively assessed the CT images for the extent and pattern of abnormality and made a first-choice diagnosis. Two pathologists retrospectively assessed the histopathologic slides. In 64 patients with IIP, a retrospective composite reference standard identified 41 patients with UIP. CT characteristics of UIP and IIPs other than UIP were compared with univariate and multivariate analyses.
There was good agreement between the readers for the correct first-choice CT diagnosis of UIP (κ = 0.79). The sensitivity, specificity, and positive predictive value of the CT diagnosis of UIP were 63%, 96%, and 96%, respectively. The sensitivity, specificity, and positive predictive value of the histological diagnosis of UIP were 73%, 74%, and 83%, respectively. The CT feature that best differentiated UIP from IIPs other than UIP was the extent of reticular pattern (odds ratio, 5.1).
Surgical lung biopsy may not be warranted in patients with thin-section CT diagnosis of UIP.
组织病理学和计算机断层扫描（CT）在特发性间质性肺炎（IIP）患者中的相对临床益处仍存在争议。
在特发性肺纤维化（IPF）的临床背景下，分析普通型间质性肺炎（UIP）患者的薄层CT特征和组织病理学表现，并评估和比较这两种方法在具有适当IIP谱患者中的诊断准确性。
该研究纳入了91例临床疑似间质性肺疾病的患者（49例男性；平均年龄53.2岁；中位随访7.2年）。所有患者均接受了外科肺活检和薄层CT检查。两名独立的阅片者回顾性评估CT图像的异常范围和模式，并做出首选诊断。两名病理学家回顾性评估组织病理学切片。在64例IIP患者中，通过回顾性综合参考标准确定了41例UIP患者。采用单因素和多因素分析比较UIP与非UIP的IIP的CT特征。
阅片者对UIP的正确首选CT诊断之间具有良好的一致性（κ = 0.79）。UIP的CT诊断的敏感性、特异性和阳性预测值分别为63%、96%和96%。UIP的组织学诊断的敏感性、特异性和阳性预测值分别为73%、74%和83%。最能将UIP与非UIP的IIP区分开来的CT特征是网状模式的范围（优势比，5.1）。
对于薄层CT诊断为UIP的患者，可能无需进行外科肺活检。
