Histopathologic variability in usual and nonspecific interstitial pneumonias
Histopathologic variability in usual and nonspecific interstitial pneumonias
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DOI：
10.1164/ajrccm.164.9.2103074
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发表时间：
2001-11-01
影响因子：
24.7
通讯作者：
Martinez, FJ
中科院分区：
文献类型：
--
作者：
Flaherty, KR;Travis, WD;Martinez, FJ
外科肺活检（SLB）的结果在特发性间质性肺炎（IIP）患者的分类中很重要。我们研究了IIP患者多叶SLB标本的组织学变异性是否明显。来自168名患者的SLB，其中109人有。多叶活检，由三位病理学家审查。对每个肺叶进行诊断。在26%的患者中发现了不同的诊断。所有肺叶中存在普通型间质性肺炎（UIP）的患者被归类为UIP一致（n = 51），至少一个肺叶中存在UIP的患者被归类为UIP不一致（n = 28）。所有肺叶中的非特异性间质性肺炎（NSIP）患者被分类为纤维化（n = 25）或细胞性NSIP（n = 5）。未观察到肺叶组织学的一致分布。UIP一致的患者年龄（63 +/- 9 [平均值+/- SD]岁;与所有其他组相比，p < 0.05）比UIP不一致的患者（57 +/- 12岁）或纤维化NSIP（56 +/- 11岁）或细胞NSIP（50 +/- 9岁）。半定量高分辨率计算机断层扫描显示不同程度的纤维化（所有组比较p < 0.05），一致性UIP（2.13 ± 0.62）的纤维化程度高于不一致性UIP（1.42 ± 0.73）、纤维化NSIP（0.83 ± 0.58）或细胞性NSIP（0.44 ± 0.42）。NSIP患者的生存率优于两个UIP组（p < 0.001），尽管两个UIP组的生存率相当（p = 0.16）。肺叶组织学变异在IIP患者中很常见，任何肺叶具有UIP组织学模式的患者应归类为UIP。
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 groups was comparable (p = 0.16). Lobar histologic variability is frequent in patients with IIP, patients with a histologic pattern of UIP in any lobe should be classified as having UIP.