Ravaglia Claudia, Bosi Marcello, Wells Athol U, Gurioli Carlo, Gurioli Christian, Dubini Alessandra, Piciucchi Sara, Puglisi Silvia, Mascetti Susanna, Arcadu Antonella, Tomassetti Sara, Poletti Venerino
1Department of Thoracic Diseases, G.B. Morgagni - L. Pierantoni Hospital, Via C. Forlanini 34, 47121 Forlì, FC Italy.
2Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK.
Multidiscip Respir Med. 2019 Feb 8;14:3. doi: 10.1186/s40248-019-0170-y. eCollection 2019.
Prognostic evaluation in idiopathic pulmonary fibrosis (IPF) may be important as it can guide management decisions, but the potential role of honeycomb changes in providing information about outcome and survival of patients with IPF, particularly if diagnosed using cryobiopsy, has not been evaluated. Aim of this study was to determinate whether a relationship exists between honeycombing on cryobiopsy and clinical/radiological picture and outcome in patients with IPF and to assess whether the same pathologic criteria that have been used to define the UIP pattern (usual interstitial pneumonia) for surgical biopsy can also be applied to cryobiopsy.
Sixty-three subjects with a multidisciplinary diagnosis of IPF and a UIP pattern on cryobiopsy were evaluated. Patients were classified into two sub-groups depending on the presence of honeycombing on histology.
The presence of honeycombing on cryobiopsy did not identify a specific phenotype of patients as it did not correlate with radiological and clinical picture and it was not associated neither with the risk of death ( = 0.1192) or with the event-free survival ( = 0.827); a higher number of samples and the presence of pleura on biopsy were instead associated with an increase in the finding of honeycombing.
The same pathologic criteria that have been used to define the UIP pattern in surgical biopsies (with honeycombing changes considered as non-mandatory for the definition of the pattern itself) can be applied to cryobiopsy samples, as the presence of these changes do not define different clinical or radiological phenotypes of patients with IPF.
特发性肺纤维化（IPF）的预后评估可能很重要，因为它可以指导管理决策，但蜂窝状改变在提供IPF患者的预后和生存信息方面的潜在作用，尤其是在使用冷冻活检诊断时，尚未得到评估。本研究的目的是确定IPF患者冷冻活检中的蜂窝状改变与临床/放射学表现及预后之间是否存在关联，并评估用于定义外科活检的UIP模式（普通间质性肺炎）的相同病理标准是否也可应用于冷冻活检。
对63例经多学科诊断为IPF且冷冻活检显示UIP模式的受试者进行评估。根据组织学上是否存在蜂窝状改变将患者分为两个亚组。
冷冻活检中蜂窝状改变的存在并未识别出特定的患者表型，因为它与放射学和临床表型无关，也与死亡风险（=0.1192）或无事件生存期（=0.827）无关；相反，活检时样本数量增加和胸膜的存在与蜂窝状改变的发现增加有关。
用于定义外科活检中UIP模式的相同病理标准（蜂窝状改变对于模式本身的定义并非必需）可应用于冷冻活检样本，因为这些改变的存在并未定义IPF患者不同的临床或放射学表型。
