From the Department of Laboratory Medicine and Pathology, Rochester, Minnesota (Eldersveld, Yi).
The Division of Biomedical Statistics and Informatics (Kunze), , Mayo Clinic, Scottsdale, Arizona.
Arch Pathol Lab Med. 2021 Jun 1;145(6):717-727. doi: 10.5858/arpa.2020-0100-OA.
CONTEXT.—: Idiopathic pulmonary fibrosis is a clinical syndrome characterized by the presence of usual interstitial pneumonia (UIP) radiologically and pathologically. Per consensus criteria adopted in 2011, diagnosis of idiopathic pulmonary fibrosis no longer requires a biopsy in an appropriate context if UIP is seen on imaging. As a result, lung biopsies are now typically reserved for patients having indeterminate clinical or imaging findings or suspicion for alternative diagnoses, but the impact of updated guidelines on pathology practice remains unclear.
OBJECTIVE.—: To determine the frequency of histologic UIP before and after 2011.
DESIGN.—: Surgical lung biopsies from adults were studied within two 4-year periods: July 1, 2006 through June 30, 2010 and January 1, 2012 through December 31, 2015. Pathology slides were reviewed in a fashion blinded to clinical information and were classified using current guidelines.
RESULTS.—: Biopsies from 177 and 86 patients (mean [SD] age, 62 [12] and 59 [14] years; 50.3% [89 of 177] and 48.8% [42 of 86] men) before and after 2011, respectively, were reviewed. Probable UIP or UIP was less-frequently encountered after 2011 in all patients with fibrosis (9 of 54 [16.7%] versus 41 of 119 [34.5%] before 2011, P = .02) and also in patients 50 years old and older (8 of 46 [17.4%] versus 39 of 109 [35.8%] before 2011, P = .02), with a concomitant rise in cases indeterminate for UIP or showing alternative diagnoses.
CONCLUSIONS.—: Histology for UIP is less frequently encountered in our contemporary practice compared with the historic era. The pretest probability of a non-UIP diagnosis is now high, even in elderly patients, underscoring the need for pathologists to be familiar with the histologic features of alternative diagnoses.
特发性肺纤维化是一种临床综合征，其特征为放射学和病理学上存在普通型间质性肺炎（UIP）。根据 2011 年采用的共识标准，如果在影像学上看到 UIP，则无需在适当的情况下进行特发性肺纤维化的活检。因此，现在肺活检通常仅保留给临床或影像学表现不确定或怀疑其他诊断的患者，但更新的指南对病理实践的影响尚不清楚。
确定 2011 年前后 UIP 的组织学发生率。
对两个 4 年期间的成人外科肺活检进行了研究：2006 年 7 月 1 日至 2010 年 6 月 30 日和 2012 年 1 月 1 日至 2015 年 12 月 31 日。对病理切片进行了回顾，回顾时不了解临床信息，并使用当前指南进行分类。
分别对 2011 年前后的 177 例和 86 例患者（平均[标准差]年龄分别为 62[12]岁和 59[14]岁；50.3%[89/177]和 48.8%[42/86]为男性）的活检进行了回顾。在所有纤维化患者中（2011 年前为 54 例中的 9 例[16.7%]，2011 年后为 119 例中的 41 例[34.5%]，P=.02），以及在 50 岁及以上的患者中（2011 年前为 46 例中的 8 例[17.4%]，2011 年后为 109 例中的 39 例[35.8%]，P=.02），发现 UIP 或显示其他诊断的不确定病例比例均升高。
与历史时期相比，我们的当代实践中 UIP 的组织学发现较少。即使是老年患者，非 UIP 诊断的术前可能性也很高，这突出表明病理学家需要熟悉替代诊断的组织学特征。
