Update for Pathologists on Idiopathic Interstitial Pneumonias
Update for Pathologists on Idiopathic Interstitial Pneumonias
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DOI：
10.5858/arpa.2012-0225-ra
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发表时间：
2012-10-01
影响因子：
4.6
通讯作者：
Colby, Thomas V.
中科院分区：
文献类型：
--
作者：
Larsen, Brandon T.;Colby, Thomas V.
背景。-特发性间质性肺炎是弥漫性肺间质性疾病的一个子集，2002年国际共识将其分类为特发性肺纤维化、非特异性间质性肺炎、隐源性机化性肺炎、急性间质性肺炎、呼吸性细支气管炎间质性肺病、脱屑性间质性肺炎和淋巴间质性肺炎。每一种都与一种特征性的组织病理学模式有关。2011年，发布了特发性肺纤维化诊断和管理的最新共识指南。整个特发性间质性肺炎组目前正在进行完善，预计在即将达成共识的分类中会有更新。许多这些最近和预期的变化是相关的病理学家。回顾特发性肺纤维化和其他特发性间质性肺炎诊断的国际共识指南，并讨论最近和预期的未来分类更新。已发表的同行评审文献和作者的个人经验。结论。特发性间质性肺炎的诊断，由临床医生，放射科医生和病理学家之间的多学科讨论，现在强烈鼓励。特发性肺纤维化的诊断不再需要手术肺活检;高分辨率计算机断层扫描是一个可接受的替代方法。在临床试验的背景下，病理学家被要求分配特发性肺纤维化患者常见间质性肺炎组织学诊断的置信水平。特发性肺纤维化急性加重现在已被接受，当急性肺损伤叠加在普通间质性肺炎的背景上时，应考虑到特发性肺纤维化急性加重。特发性间质性肺炎的更新分类将包括罕见实体的单独类别，包括淋巴样间质性肺炎和特发性胸膜实质纤维弹性组织增生症。(Arch Pathol Lab Med. 2012; 136：1234-1241; doi：10.5858/arpa.2012-0225-RA）
Context.-Idiopathic interstitial pneumonias are a subset of diffuse pulmonary interstitial diseases classified by international consensus in 2002 as idiopathic pulmonary fibrosis, nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, acute interstitial pneumonia, respiratory bronchiolitis interstitial lung disease, desquamative interstitial pneumonia, and lymphoid interstitial pneumonia. Each is associated with a characteristic histopathologic pattern. In 2011, updated consensus guidelines were released for diagnosis and management of idiopathic pulmonary fibrosis. The entire group of idiopathic interstitial pneumonias is currently undergoing refinement, with updates expected in a forthcoming consensus classification. Many of these recent and anticipated changes are relevant to pathologists.Objectives.-To review international consensus guidelines for diagnosis of idiopathic pulmonary fibrosis and other idiopathic interstitial pneumonias and to discuss recent and expected future classification updates.Data Sources.-Published peer-reviewed literature and personal experience of the authors.Conclusions.-Diagnosis of idiopathic interstitial pneumonias by multidisciplinary discussion among clinicians, radiologists, and pathologists is now strongly encouraged. Diagnosis of idiopathic pulmonary fibrosis no longer requires surgical lung biopsy; high-resolution computed tomography is an acceptable surrogate. In the context of clinical trials, pathologists are being asked to assign levels of confidence for histologic diagnosis of usual interstitial pneumonia in patients with idiopathic pulmonary fibrosis. Acute exacerbation of idiopathic pulmonary fibrosis is now accepted and should be considered when acute lung injury is superimposed on a background of usual interstitial pneumonia. The updated classification of idiopathic interstitial pneumonias will include a separate category for rare entities, including lymphoid interstitial pneumonia and idiopathic pleuroparenchymal fibroelastosis. (Arch Pathol Lab Med. 2012; 136: 1234-1241; doi: 10.5858/arpa.2012-0225-RA)