Pulmonary Department, Federal University of Sao Paulo, R. Botucatu, 740 - Vila Clementino, São Paulo, SP, 04023-062, Brazil.
Imaging Department, Fleury Group, Sao Paulo, Brazil.
BMC Pulm Med. 2020 Nov 16;20(1):299. doi: 10.1186/s12890-020-01339-9.
Usual interstitial pneumonia can present with a probable pattern on high-resolution computed tomography (HRCT), but the probability of identifying usual interstitial pneumonia by surgical lung biopsy in such cases remains controversial. We aimed to determine the final clinical diagnosis in patients with a probable usual interstitial pneumonia pattern on HRCT who were subjected to surgical lung biopsy.
HRCT images were assessed and categorized by three radiologists, and tissue slides were evaluated by two pathologists, all of whom were blinded to the clinical findings. The final clinical diagnosis was accomplished via a multidisciplinary discussion. Patients with a single layer of honeycombing located outside of the lower lobes on HRCT were not excluded.
A total of 50 patients were evaluated. The most common final clinical diagnosis was fibrotic hypersensitivity pneumonitis (38.0%) followed by idiopathic pulmonary fibrosis (24.0%), interstitial lung disease ascribed to gastroesophageal reflux disease (12.0%) and familial interstitial lung disease (10.0%). In the group without environmental exposure (n = 22), 10 patients had a final clinical diagnosis of idiopathic pulmonary fibrosis (45.5%). Irrespective of the final clinical diagnosis, by multivariate Cox analysis, patients with honeycombing, dyspnoea and fibroblastic foci on surgical lung biopsy had a high risk of death.
The most common disease associated with a probable usual interstitial pneumonia pattern on HRCT is fibrotic hypersensitivity pneumonitis followed by idiopathic pulmonary fibrosis and interstitial lung disease ascribed to gastroesophageal reflux disease. In patients without environmental exposure, the frequencies of usual interstitial pneumonia and a final clinical diagnosis of idiopathic pulmonary fibrosis are not sufficiently high to obviate the indications for surgical lung biopsy.
高分辨率计算机断层扫描（HRCT）上可能表现为寻常型间质性肺炎（UIP）模式，但在这种情况下通过外科肺活检确定 UIP 的可能性仍存在争议。我们旨在确定接受外科肺活检的 HRCT 上具有可能的 UIP 模式的患者的最终临床诊断。
由三位放射科医生评估 HRCT 图像并进行分类，由两位病理学家评估组织切片，所有医生均对临床发现不知情。最终的临床诊断是通过多学科讨论得出的。HRCT 上仅存在单层蜂窝肺且位于下叶以外的患者不被排除。
共评估了 50 名患者。最常见的最终临床诊断是纤维化型过敏性肺炎（38.0%），其次是特发性肺纤维化（24.0%）、胃食管反流病相关性间质性肺病（12.0%）和家族性间质性肺病（10.0%）。在无环境暴露组（n=22）中，10 名患者的最终临床诊断为特发性肺纤维化（45.5%）。无论最终临床诊断如何，多变量 Cox 分析显示，外科肺活检中存在蜂窝肺、呼吸困难和纤维母细胞灶的患者死亡风险较高。
与 HRCT 上可能的 UIP 模式相关的最常见疾病是纤维化型过敏性肺炎，其次是特发性肺纤维化和胃食管反流病相关性间质性肺病。在无环境暴露的患者中，UIP 和特发性肺纤维化的最终临床诊断的频率不足以排除外科肺活检的适应证。
