Clinical diagnosis of patients subjected to surgical lung biopsy with a probable usual interstitial pneumonia pattern on
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RESEARCH ARTICLE
Open Access
Clinical diagnosis of patients subjected to surgical lung biopsy with a probable usual interstitial pneumonia pattern on highresolution computed tomography Regina Celia Carlos Tibana1* , Maria Raquel Soares1, Karin Mueller Storrer1, Gustavo de Souza Portes Meirelles2, Katia Hidemi Nishiyama3, Israel Missrie3, Ester Nei Aparecida Martins Coletta4, Rimarcs Gomes Ferreira4 and Carlos Alberto de Castro Pereira1
Abstract Background: 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. Methods: 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. Results: 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. Conclusions: 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. Keywords: Idiopathic pulmonary fibrosis, Hypersensitivity pneumonia, Usual interstitial pneumonia, Interstitial lung disease, Surgical lung biopsy, High-resolution computed tomography
* Correspondence: [email protected] 1 Pulmonary Department, Federal University of Sao Paulo, R. Botucatu, 740 Vila Clementino, São Paulo, SP 04023-062, Brazil Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original
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