Probable usual interstitial pneumonia pattern on chest CT: is it sufficient for a diagnosis of idiopathic pulmonary fibrosis?
Probable usual interstitial pneumonia pattern on chest CT: is it sufficient for a diagnosis of idiopathic pulmonary fibrosis?
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DOI：
10.1183/13993003.02465-2018
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发表时间：
2020-04-01
影响因子：
24.3
通讯作者：
Hasegawa, Yoshinori
中科院分区：
文献类型：
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作者：
Fukihara, Jun;Kondoh, Yasuhiro;Hasegawa, Yoshinori
最近的研究表明，在特发性间质性肺炎（IIP）患者中，胸部计算机断层扫描（CT）上可能的通常间质性肺炎（UIP）模式足以诊断特发性肺纤维化（IPF）而无需组织病理学。我们回顾性比较了IIP患者的预后和首次急性发作（AE）的时间，这些患者在初始胸部CT上有UIP和可能的UIP模式。160例IIP患者有UIP模式，242例患者可能有UIP模式。可能的UIP模式与较长的生存时间（校正风险比0.713,95% CI 0.536-0.950, p=0.021）和发生首次AE的时间（校正风险比0.580,95% CI 0.389-0.866, p=0.008）独立相关。在可能存在UIP模式的受试者中，接受外科肺活检的组织病理学UIP模式的概率为83%。经过多学科的讨论和纵向行为的纳入，在66%的病例中诊断为IPF。在IPF患者中，生存时间和首次AE时间与CT表现无关。在可能存在UIP模式的受试者中，与非IPF患者相比，IPF患者的生存时间和首次AE的时间更短。综上所述，早期胸部CT显示可能为UIP型的IIP患者预后较好，到首次AE的时间较UIP型患者长。然而，当基线数据和纵向行为提供IPF的最终诊断时，CT模式与这些结果无关。这表明在可能的UIP模式的患者中存在诊断异质性。
Recent studies have suggested that in patients with an idiopathic interstitial pneumonia (IIP), a probable usual interstitial pneumonia (UIP) pattern on chest computed tomography (CT) is sufficient to diagnose idiopathic pulmonary fibrosis (IPF) without histopathology.We retrospectively compared the prognosis and time to first acute exacerbation (AE) in IIP patients with a UIP and a probable UIP pattern on initial chest CT.One hundred and sixty IIP patients with a UIP pattern and 242 with a probable UIP pattern were identified. Probable UIP pattern was independently associated with longer survival time (adjusted hazard ratio 0.713, 95% CI 0.536-0.950; p=0.021) and time to first AE (adjusted hazard ratio 0.580, 95% CI 0.389-0.866; p=0.008). In subjects with a probable UIP pattern who underwent surgical lung biopsy, the probability of a histopathological UIP pattern was 83%. After multidisciplinary discussion and the inclusion of longitudinal behaviour, a diagnosis of IPF was made in 66% of cases. In IPF patients, survival time and time to first AE were not associated with CT pattern. Among subjects with a probable UIP pattern, compared to non-IPF patients, survival time and time to first AE were shorter in IPF patients.In conclusion, IIP patients with a probable UIP pattern on initial chest CT had a better prognosis and longer time to first AE than those with a UIP pattern. However, when baseline data and longitudinal behaviour provided a final diagnosis of IPF, CT pattern was not associated with these outcomes. This suggests diagnostic heterogeneity among patients with a probable UIP pattern.