An Official American Thoracic Society/European Respiratory Society Statement: Update of the International Multidisciplinary Classification of the Idiopathic Interstitial Pneumonias
An Official American Thoracic Society/European Respiratory Society Statement: Update of the International Multidisciplinary Classification of the Idiopathic Interstitial Pneumonias
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DOI：
10.1164/rccm.201308-1483st
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发表时间：
2013-09-15
影响因子：
24.7
通讯作者：
Valeyre, Dominique
中科院分区：
文献类型：
--
作者：
Travis, William D.;Costabel, Ulrich;Valeyre, Dominique
背景资料：2002年，美国胸科学会/欧洲呼吸学会（ATS/ERS）对特发性间质性肺炎（IIP）的分类定义了7种特定的实体，并提供了标准化的术语和诊断标准。此外，组织学诊断的历史“金标准”被多学科方法所取代。自2002年以来，许多出版物提供了关于IIPs.Purpose的新信息：本声明的目的是更新2002年ATS/ERS的IIPs.Methods：一个国际多学科小组成立，并制定了关键问题，通过回顾2000年和2011年之间发表的文献得到解决。非特异性间质性肺炎现在更好地定义。呼吸性细支气管炎-间质性肺病现在通常不需要手术活检就能确诊。特发性肺纤维化和非特异性间质性肺炎的临床过程被认为是异质性的。IIP的急性加重现已得到明确定义。很大比例的IIP患者难以分类，通常是由于混合型肺损伤。对于难以分类的患者或临床过程中具有异质性的实体，提出了基于观察到的疾病行为的分类。一组罕见的实体，包括胸膜实质弹力纤维增生症和罕见的组织学模式，介绍。快速发展的领域的分子标记物进行审查，促进额外的调查，可能有助于确定诊断，并可能预后和treatment.Conclusions的意图：本次更新是对以前的2002年IIP分类文件的补充。它概述了过去十年的进展和未来调查的潜在领域。
Background: In 2002 the American Thoracic Society/European Respiratory Society (ATS/ERS) classification of idiopathic interstitial pneumonias (IIPs) defined seven specific entities, and provided standardized terminology and diagnostic criteria. In addition, the historical "gold standard" of histologic diagnosis was replaced by a multidisciplinary approach. Since 2002 many publications have provided new information about IIPs.Purpose: The objective of this statement is to update the 2002 ATS/ERS classification of IIPs.Methods: An international multidisciplinary panel was formed and developed key questions that were addressed through a review of the literature published between 2000 and 2011.Results: Substantial progress has been made in IIPs since the previous classification. Nonspecific interstitial pneumonia is now better defined. Respiratory bronchiolitis-interstitial lung disease is now commonly diagnosed without surgical biopsy. The clinical course of idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia is recognized to be heterogeneous. Acute exacerbation of IIPs is now well defined. A substantial percentage of patients with IIP are difficult to classify, often due to mixed patterns of lung injury. A classification based on observed disease behavior is proposed for patients who are difficult to classify or for entities with heterogeneity in clinical course. A group of rare entities, including pleuroparenchymal fibroelastosis and rare histologic patterns, is introduced. The rapidly evolving field of molecular markers is reviewed with the intent of promoting additional investigations that may help in determining diagnosis, and potentially prognosis and treatment.Conclusions: This update is a supplement to the previous 2002 IIP classification document. It outlines advances in the past decade and potential areas for future investigation.