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Histopathologic variability in usual and nonspecific interstitial pneumonias.
Am J Respir Crit Care Med. 2001 Nov 01; 164(9):1722-7.AJ

Abstract

Findings of surgical lung biopsy (SLB) are important in categorizing patients with idiopathic interstitial pneumonia (IIP). We investigated whether histologic variability would be evident in SLB specimens from multiple lobes in patients with IIP. SLBs from 168 patients, 109 of whom had multiple lobes biopsied, were reviewed by three pathologists. A diagnosis was assigned to each lobe. A different diagnosis was found between lobes in 26% of the patients. Patients with usual interstitial pneumonia (UIP) in all lobes were categorized as concordant for UIP (n = 51) and those with UIP in at least one lobe were categorized as discordant for UIP (n = 28). Patients with nonspecific interstitial pneumonia (NSIP) in all lobes were categorized as having fibrotic (n = 25) or cellular NSIP (n = 5). No consistent distribution of lobar histology was noted. Patients concordant for UIP were older (63 +/- 9 [mean +/- SD] yr; p < 0.05 as compared with all other groups) than those discordant for UIP (57 +/- 12 yr) or with fibrotic NSIP (56 +/- 11 yr) or cellular NSIP (50 +/- 9 yr). Semiquantitative high-resolution computed tomography demonstrated a varied profusion of fibrosis (p < 0.05 for all group comparisons), with more fibrosis in concordant UIP (2.13 +/- 0.62) than in discordant UIP (1.42 +/- 0.73), fibrotic NSIP (0.83 +/- 0.58), or cellular NSIP (0.44 +/- 0.42). Survival was better for patients with NSIP than for those in both UIP groups (p < 0.001), although survival in the two UIP groups was comparable (p = 0.16). Lobar histologic variability is frequent in patients with IIP, patients with a histologic pattern of UIP in any lobe should be classified as having UIP.

Authors+Show Affiliations

Department of Radiology, University of Michigan Health System, University of Michigan School of Public Health, Ann Arbor, Michigan 48109-0360, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

11719316

Citation

Flaherty, K R., et al. "Histopathologic Variability in Usual and Nonspecific Interstitial Pneumonias." American Journal of Respiratory and Critical Care Medicine, vol. 164, no. 9, 2001, pp. 1722-7.
Flaherty KR, Travis WD, Colby TV, et al. Histopathologic variability in usual and nonspecific interstitial pneumonias. Am J Respir Crit Care Med. 2001;164(9):1722-7.
Flaherty, K. R., Travis, W. D., Colby, T. V., Toews, G. B., Kazerooni, E. A., Gross, B. H., Jain, A., Strawderman, R. L., Flint, A., Lynch, J. P., & Martinez, F. J. (2001). Histopathologic variability in usual and nonspecific interstitial pneumonias. American Journal of Respiratory and Critical Care Medicine, 164(9), 1722-7.
Flaherty KR, et al. Histopathologic Variability in Usual and Nonspecific Interstitial Pneumonias. Am J Respir Crit Care Med. 2001 Nov 1;164(9):1722-7. PubMed PMID: 11719316.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Histopathologic variability in usual and nonspecific interstitial pneumonias. AU - Flaherty,K R, AU - Travis,W D, AU - Colby,T V, AU - Toews,G B, AU - Kazerooni,E A, AU - Gross,B H, AU - Jain,A, AU - Strawderman,R L, AU - Flint,A, AU - Lynch,J P, AU - Martinez,F J, PY - 2001/11/24/pubmed PY - 2002/6/20/medline PY - 2001/11/24/entrez SP - 1722 EP - 7 JF - American journal of respiratory and critical care medicine JO - Am J Respir Crit Care Med VL - 164 IS - 9 N2 - Findings of surgical lung biopsy (SLB) are important in categorizing patients with idiopathic interstitial pneumonia (IIP). We investigated whether histologic variability would be evident in SLB specimens from multiple lobes in patients with IIP. SLBs from 168 patients, 109 of whom had multiple lobes biopsied, were reviewed by three pathologists. A diagnosis was assigned to each lobe. A different diagnosis was found between lobes in 26% of the patients. Patients with usual interstitial pneumonia (UIP) in all lobes were categorized as concordant for UIP (n = 51) and those with UIP in at least one lobe were categorized as discordant for UIP (n = 28). Patients with nonspecific interstitial pneumonia (NSIP) in all lobes were categorized as having fibrotic (n = 25) or cellular NSIP (n = 5). No consistent distribution of lobar histology was noted. Patients concordant for UIP were older (63 +/- 9 [mean +/- SD] yr; p < 0.05 as compared with all other groups) than those discordant for UIP (57 +/- 12 yr) or with fibrotic NSIP (56 +/- 11 yr) or cellular NSIP (50 +/- 9 yr). Semiquantitative high-resolution computed tomography demonstrated a varied profusion of fibrosis (p < 0.05 for all group comparisons), with more fibrosis in concordant UIP (2.13 +/- 0.62) than in discordant UIP (1.42 +/- 0.73), fibrotic NSIP (0.83 +/- 0.58), or cellular NSIP (0.44 +/- 0.42). Survival was better for patients with NSIP than for those in both UIP groups (p < 0.001), although survival in the two UIP groups was comparable (p = 0.16). Lobar histologic variability is frequent in patients with IIP, patients with a histologic pattern of UIP in any lobe should be classified as having UIP. SN - 1073-449X UR - https://www.unboundmedicine.com/medline/citation/11719316/Histopathologic_variability_in_usual_and_nonspecific_interstitial_pneumonias_ L2 - https://www.atsjournals.org/doi/10.1164/ajrccm.164.9.2103074?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -