Histopathologic Variability in Usual and Nonspecific Interstitial Pneumonias

作者：KEVIN R. FLAHERTY, William David Travis, Thomas Vail Colby, Galen B. Toews, Ella Annabelle Kazerooni, Barry H. Gross, Arvind Kumar Jain, Robert L. Strawderman, Andrew Flint, Joseph P. Lynch, Fernando J. Martínez · 发表于：American Journal of Respiratory and Critical Care Medicine · 年份：2001 · DOI：10.1164/ajrccm.164.9.2103074 · 被引用次数：668 · 研究领域：Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis、Inhalation and Respiratory Drug Delivery、Occupational and environmental lung diseases

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 group...