Radiological versus histological diagnosis in UIP and NSIP: survival implications
Radiological versus histological diagnosis in UIP and NSIP: survival implications
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DOI：
10.1136/thorax.58.2.143
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发表时间：
2003-02-01
期刊：
影响因子：
10
通讯作者：
Martinez, FJ
中科院分区：
文献类型：
--
作者：
Flaherty, KR;Thwaite, EL;Martinez, FJ
背景：高分辨率计算机断层扫描（HRCT）在特发性间质性肺炎（IIP）中具有重要的诊断作用。我们假设，HRCT的外观将有一个生存的患者IIP.Methods的影响：HRCT扫描与组织学普通间质性肺炎（UIP; n=73）或组织学非特异性间质性肺炎（NSIP; n=23）患者的特点是明确的UIP，可能的UIP，不确定，可能的NSIP，或明确的NSIP。考克斯回归分析检查组织病理学和放射学诊断和死亡率之间的关系，控制患者的年龄，性别和吸烟status.Results：所有27例明确或可能的UIP的HRCT有组织学UIP; 18 44例可能或明确的NSIP的HRCT有组织学NSIP。HRCT诊断为明确或可能的UIP患者的生存期短于CT不确定患者（风险比（HR）2.43，95% CI 1.06 - 5.58;中位生存期2.08 v5.76年）或HRCT诊断为明确或可能的NSIP患者（HR 3.47，95% CI 1.58 - 7.63;中位生存期2.08 v5.81年）。HRCT诊断为可能或明确UIP的组织学UIP患者比HRCT诊断为明确或可能UIP的组织学UIP患者表现更好（HR 0.49，95%CI 0.25 - 0.98;中位生存期5.76 v2.08年），且比组织学诊断为NSIP的患者更差（HR 5.42，95%CI 1.25 - 23.5;中位生存期5.76 v >9年）。结论：具有典型HRCT表现的UIP患者死亡率最高。对于HRCT上无UP表现的患者，手术肺活检可用于区分组织学UIP和NSIP。
Background: High resolution computed tomography (HRCT) has an important diagnostic role in idiopathic interstitial pneumonia (IIP). We hypothesised that the HRCT appearance would have an impact on survival in patients with IIP.Methods: HRCT scans from patients with histological usual interstitial pneumonia (UIP; n=73) or histological non-specific interstitial pneumonia (NSIP; n=23) were characterised as definite UIP, probable UIP, indeterminate, probable NSIP, or definite NSIP. Cox regression analysis examined the relationships between histopathological and radiological diagnoses and mortality, controlling for patient age, sex, and smoking status.Results: All 27 patients with definite or probable UIP on HRCT had histological UIP; 18 of 44 patients with probable or definite NSIP on HRCT had histological NSIP. Patients with HRCT diagnosed definite or probable UIP had a shorter survival than those with indeterminate CT (hazards ratio (HR) 2.43, 95% Cl 1.06 to 5.58; median survival 2.08 v 5.76 years) or HRCT diagnosed definite or probable NSIP (HR 3.47, 95% Cl 1.58 to 7.63; median survival 2.08 v 5.81 years). Patients with histological UIP with no HRCT diagnosis of probable or definite UIP fared better than patients with histological UIP and an HRCT diagnosis of definite or probable UIP (HR 0.49, 95% Cl 0.25 to 0.98; median survival 5.76 v 2.08 years) and worse than those with a histological diagnosis of NSIP (HR 5.42, 95% Cl 1.25 to 23.5; median survival 5.76 v >9 years).Conclusions: Patients with a typical HRCT appearance of UIP experience the highest mortality. A surgical lung biopsy is indicated for patients without an HRCT appearance of UP to differentiate between histological UIP and NSIP.