CT Scan Findings of Probable Usual Interstitial Pneumonitis Have a High Predictive Value for Histologic Usual Interstitial Pneumonitis
CT Scan Findings of Probable Usual Interstitial Pneumonitis Have a High Predictive Value for Histologic Usual Interstitial Pneumonitis
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DOI：
10.1378/chest.14-0976
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发表时间：
2015-02-01
期刊：
影响因子：
9.6
通讯作者：
Lynch, David A.
中科院分区：
文献类型：
--
作者：
Chung, Jonathan H.;Chawla, Ashish;Lynch, David A.
背景：目前常见的间质性肺炎(UIP)/特发性肺纤维化CT扫描分类系统排除了可能的UIP作为诊断类别。我们试图确定可能的UIP在CT扫描对组织学的预测作用，以及MUC5B （rs35705950）启动子多态性对组织学和CT扫描UIP诊断的影响。方法：该队列包括201例肺纤维化患者，他们在胸部CT扫描后1年内获得肺组织样本。2 - 3名肺部放射科医生将CT扫描的UIP诊断分为不一致、不确定、可能或明确UIP。组织切片由两名肺病理学专家评分。所有具有可用DNA的受试者（N = 200）对rs35705950进行基因分型。结果：CT扫描诊断的比例为：与UIP不一致（69例，34.3%），不确定（72例，35.8%），可能（34例，16.9%），明确（26例，12.9%）。CT扫描上可能存在UIP的患者比CT扫描上不确定存在UIP的患者更容易出现组织学上可能/明确的UIP （82.4% [34 / 28] vs 54.2% [72 / 39]; P = 0.01）。CT扫描与显微蜂窝状扫描无相关性（P = 0.76）。MUC5B多态性的次要(T)等位基因与一致性CT扫描和组织学UIP诊断相关（P = 0.03）。结论：CT扫描上可能的UIP比CT扫描上不确定的UIP与更高的组织学UIP率相关，这表明它们是不同的组，不应像目前指南推荐的那样合并为单一的CT扫描分类。CT扫描和显微镜下的蜂窝可能是不同的实体。T等位基因rs35705950可通过胸部CT扫描和组织学预测UIP诊断。
BACKGROUND: The current usual interstitial pneumonitis (UIP)/idiopathic pulmonary fibrosis CT scan classification system excludes probable UIP as a diagnostic category. We sought to determine the predictive effect of probable UIP on CT scan on histology and the effect of the promoter polymorphism in MUC5B (rs35705950) on histologic and CT scan UIP diagnosis.METHODS: The cohort included 201 subjects with pulmonary fibrosis who had lung tissue samples obtained within 1 year of chest CT scan. UIP diagnosis on CT scan was categorized as inconsistent with, indeterminate, probable, or definite UIP by two to three pulmonary radiologists. Tissue slides were scored by two expert pulmonary pathologists. All subjects with available DNA (N = 200) were genotyped for rs35705950.RESULTS: The proportion of CT scan diagnoses were as follows: inconsistent with (69 of 201, 34.3%), indeterminate (72 of 201, 35.8%), probable (34 of 201, 16.9%), and definite (26 of 201, 12.9%) UIP. Subjects with probable UIP on CT scan were more likely to have histologic probable/definite UIP than subjects with indeterminate UIP on CT scan (82.4% [28 of 34] vs 54.2% [ 39 of 72]; P = .01). CT scan and microscopic honeycombing were not associated with each other (P = .76). The minor (T) allele of the MUC5B polymorphism was associated with concordant CT scan and histologic UIP diagnosis (P = .03).CONCLUSIONS: Probable UIP on CT scan is associated with a higher rate of histologic UIP than indeterminate UIP on CT scan suggesting that they are distinct groups and should not be combined into a single CT scan category as currently recommended by guidelines. CT scan and microscopic honeycombing may be dissimilar entities. The T allele at rs35705950 predicts a UIP diagnosis by both chest CT scan and histology.