Kim Charissa, Liberman Yuval, Borisovsky Gilad, Litmanovich Diana, VanderLaan Paul, Brook Alexander, Brook Olga R
Beth Israel Deaconess Medical Center, Boston, United States.
Abdom Radiol (NY). 2025 Jun 12. doi: 10.1007/s00261-025-05048-x.
Organizing pneumonia is an inflammatory disorder that may co-exist with malignancy in the lung or elsewhere in the body. We aimed to assess patients with a lung biopsy diagnosis of organizing pneumonia for subsequent pathology confirmation of co-existing malignancy.
In this retrospective IRB-approved, HIPAA-compliant study, 1314 consecutive patients who underwent CT-guided lung biopsy for suspected lung cancer or metastatic disease from 02/2014 to 04/2022 at a single tertiary referral hospital were identified. In 98/1314 (7.5%) patients, biopsies showed organizing pneumonia, which represented our study cohort. Clinical outcomes, including follow-up imaging and repeat tissue sampling if performed, were evaluated through chart review. Descriptive statistics were calculated.
There were 43/98 (44%) females, mean age was 66 ± 14 years, mean lesion size 2.9 ± 2.1 cm, and 11/98 (11.2%) had prior history of malignancy. Of 98 patients initially diagnosed with organizing pneumonia on lung biopsy, 11 (11.2%) were subsequently found to have malignancy. Among these, 6 (54.5%) had pulmonary metastases and 5 (45.5%) had primary lung cancer. Malignancies were confirmed through percutaneous re-biopsy in 3/11 (27%) and bronchoscopic, endoscopic, or surgical procedures in 8/11 (73%).
Malignancy can co-exist with organizing pneumonia in a substantial percentage of initial lung biopsies. Therefore, repeat tissue sampling should be considered when there is high clinical suspicion of malignancy despite an initial histopathological diagnosis of organizing pneumonia. This is especially relevant in lesions that demonstrate FDG avidity on PET/CT or an increase in size on interval imaging, or in instances where the biopsy core sizes are small or where the biopsies have intraprocedural complications.
机化性肺炎是一种炎症性疾病，可能与肺部或身体其他部位的恶性肿瘤共存。我们旨在评估经肺活检诊断为机化性肺炎的患者，以进行后续病理检查以确认是否存在并存的恶性肿瘤。
在这项经机构审查委员会（IRB）批准且符合健康保险流通与责任法案（HIPAA）的回顾性研究中，我们确定了2014年2月至2022年4月期间在一家三级转诊医院因疑似肺癌或转移性疾病接受CT引导下肺活检的1314例连续患者。在1314例患者中的98例（7.5%）活检显示为机化性肺炎，这些患者构成了我们的研究队列。通过查阅病历评估临床结局，包括随访影像学检查以及（如有进行）重复组织采样。计算描述性统计数据。
有43例（44%）女性，平均年龄为66±14岁，平均病变大小为2.9±2.1厘米，11例（11.2%）有恶性肿瘤病史。在最初经肺活检诊断为机化性肺炎的98例患者中，11例（11.2%）随后被发现患有恶性肿瘤。其中，6例（54.5%）有肺转移，5例（45.5%）有原发性肺癌。3例（27%）通过经皮再次活检确诊恶性肿瘤，8例（73%）通过支气管镜、内镜或手术程序确诊。
在相当比例的初始肺活检中，恶性肿瘤可与机化性肺炎共存。因此，尽管最初组织病理学诊断为机化性肺炎，但当临床高度怀疑存在恶性肿瘤时，应考虑重复组织采样。这在PET/CT上显示FDG摄取或在间隔期影像学检查中大小增加的病变中，或在活检组织芯较小或活检过程中出现并发症的情况下尤为重要。
