Department of Pulmonary Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Histopathology. 2022 Dec;81(6):724-731. doi: 10.1111/his.14704. Epub 2022 Aug 17.
To improve understanding of the pathology of immune check-point inhibitor (ICI)-related pneumonitis, clinical, radiographic and histopathological features and outcomes were investigated in a cohort of patients who were treatment-naive before receiving ICI inhibition, who underwent lung biopsy, and in whom other potential causes of lung injury were excluded.
Patients were retrospectively identified via searches of institutional pathology and clinical records. Patients treated with other modalities for cancer and patients with lung infections or other aetiologies that could cause pneumonitis were excluded. Clinical records were reviewed by pulmonologists. Imaging studies at presentation and follow-up were reviewed by a thoracic radiologist. Pathology was reviewed by thoracic pathologists.
Six patients with ICI-related pneumonitis were identified. Two patients presented with respiratory failure requiring mechanical ventilation, diffuse ground glass opacities (GGOs) on chest computed tomography (CT) and acute lung injury (ALI) pattern on transbronchial lung biopsies and had fatal outcomes, despite treatment. The remaining four patients presented with less severe symptoms, predominantly consolidations and patchy ground glass and part solid opacities on chest CT, organising pneumonia (OP) or chronic interstitial inflammation histologically, and showed favourable responses to treatment and remission within months.
This study highlights two radiological-pathological patterns of ICI-related pneumonitis with different behaviour: (1) severe respiratory symptoms and diffuse GGOs on imaging correlating with ALI pattern histologically and poor prognosis; and (2) mild respiratory symptoms and consolidations or patchy subsolid opacities on imaging correlating histologically with OP or chronic interstitial inflammation and good outcomes.
为了更好地了解免疫检查点抑制剂（ICI）相关肺炎的病理学，我们对一组在接受 ICI 抑制治疗前未经治疗、接受了肺活检且排除了其他潜在肺损伤原因的患者的临床、影像学和组织病理学特征及结局进行了研究。
通过对机构病理和临床记录的检索，我们对患者进行了回顾性鉴定。我们排除了接受其他癌症治疗的患者以及患有肺部感染或其他可能导致肺炎的病因的患者。由肺病专家对临床记录进行了审查。由胸部放射科医生对患者的影像学表现进行了审查。由胸部病理学家对病理学进行了审查。
共鉴定出 6 例 ICI 相关肺炎患者。2 例患者因呼吸衰竭需要机械通气而就诊，胸部 CT 显示弥漫性磨玻璃影（GGO）和急性肺损伤（ALI）模式的经支气管肺活检，尽管进行了治疗，但仍导致了致命的结局。其余 4 例患者的症状较轻，胸部 CT 主要表现为实变和斑片状磨玻璃影和部分实变影，组织病理学表现为机化性肺炎（OP）或慢性间质性炎症，经治疗后病情得到缓解并在数月内得到缓解。
本研究强调了两种不同行为表现的 ICI 相关肺炎的影像学-病理学模式：（1）影像学上表现为严重的呼吸系统症状和弥漫性 GGO，组织病理学上表现为 ALI 模式，预后较差；（2）影像学上表现为轻微的呼吸系统症状和实变或斑片状亚实性影，组织病理学上表现为 OP 或慢性间质性炎症，结局良好。
