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Regina Tibana
Universidade Federal de Sao Paulo Escola Paulista de Medicina
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9410-8455
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Background: Usual interstitial pneumonia (UIP) can present with a probable pattern on high-resolution computed tomography (HRCT), but the probability of UIP by surgical lung biopsy in such cases remains controversial. We aimed to determine the final clinical diagnosis in patients with a probable UIP pattern on HRCT subjected to surgical lung biopsy.
Methods: HRCT images were assessed and categorized by three radiologists, and tissue slides were evaluated by two pathologists, all of whom were blinded to the clinical findings. The final clinical diagnosis was accomplished via a multidisciplinary discussion. Patients with a single layer of honeycombing located outside of the lower lobes on HRCT were not excluded.
Results: A total of 50 patients were evaluated. The most common final clinical diagnosis was fibrotic hypersensitivity pneumonitis (38.0%; 95% CI: 24.7% to 52.8%), followed by idiopathic pulmonary fibrosis (24.0%; 95% CI: 13.1% to 38.2%) and interstitial lung disease ascribed to gastroesophageal reflux disease (12.0%; 95% CI: 4.5% to 24.3%) and familial interstitial lung disease (10.0%; 95% CI: 3.3% to 21.8%). In the group without environmental exposure (n = 22), 10 patients had a final clinical diagnosis of idiopathic pulmonary fibrosis (45.5%; 95% CI: 24.4% to 67.8%). Irrespective of the final clinical diagnosis, by multivariate Cox analysis, patients with honeycombing, dyspnoea and the presence of fibroblastic foci on surgical lung biopsy had a high risk of death.
Conclusions: The most common disease associated with a probable UIP pattern on HRCT is fibrotic hypersensitivity pneumonitis, followed by idiopathic pulmonary fibrosis and interstitial lung disease ascribed to gastroesophageal reflux disease. In patients without environmental exposure, the frequency of UIP and a final clinical diagnosis of idiopathic pulmonary fibrosis are not sufficiently high to obviate the indication for surgical lung biopsy.
Keywords
Idiopathic pulmonary fibrosis, Hypersensitivity pneumonia, Usual interstitial pneumonia, Interstitial lung disease, Surgical lung biopsy, High-resolution computed tomography
This is a list of supplementary files associated with this preprint. Click to download.
- SupplementarymaterialRR.docx
Additional file 1: Figure S1. Inclusion criteria diagram. Supplementary Figure S2. Chest high resolution computed tomography (HRCT) in a 60 years-old female patient with probable usual interstitial pneumonia pattern on HRCT and histological bronchiolocentric fibrosis. Supplementary Figure S3. Fibrotic hypersensitivity pneumonitis with probable usual interstitial pneumonia pattern on high resolution computed tomography and the classical histological triad of HP. Supplementary Figure S4. Idiopathic pulmonary fibrosis with probable usual interstitial pneumonia (UIP) pattern on high resolution computed tomography and histological UIP pattern. Supplementary Figure S5. Interstitial lung disease ascribed to gastroesophageal reflux disease with a probable usual interstitial pneumonia pattern on high resolution computed tomography and histological bronchiolocentric fibrosis (BF) pattern. Figure S6. Survival in the patients with probable UIP on HRCT according to the diagnostic groups. Table S1. Clinical characteristics, functional characteristics, and HRCT findings of 50 patients with fibrotic chronic hypersensitivity pneumonia, idiopathic pulmonary fibrosis, and other diagnoses and a probable UIP HRCT pattern.
- SupplementarymaterialRR.docx
Additional file 1: Figure S1. Inclusion criteria diagram. Supplementary Figure S2. Chest high resolution computed tomography (HRCT) in a 60 years-old female patient with probable usual interstitial pneumonia pattern on HRCT and histological bronchiolocentric fibrosis. Supplementary Figure S3. Fibrotic hypersensitivity pneumonitis with probable usual interstitial pneumonia pattern on high resolution computed tomography and the classical histological triad of HP. Supplementary Figure S4. Idiopathic pulmonary fibrosis with probable usual interstitial pneumonia (UIP) pattern on high resolution computed tomography and histological UIP pattern. Supplementary Figure S5. Interstitial lung disease ascribed to gastroesophageal reflux disease with a probable usual interstitial pneumonia pattern on high resolution computed tomography and histological bronchiolocentric fibrosis (BF) pattern. Figure S6. Survival in the patients with probable UIP on HRCT according to the diagnostic groups. Table S1. Clinical characteristics, functional characteristics, and HRCT findings of 50 patients with fibrotic chronic hypersensitivity pneumonia, idiopathic pulmonary fibrosis, and other diagnoses and a probable UIP HRCT pattern.
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research
Regina Tibana
Universidade Federal de Sao Paulo Escola Paulista de Medicina
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9410-8455
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
View the published article at BMC Pulmonary Medicine.
Version 1
Posted 24 Jul, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pulmonology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Pulmonary Medicine.
Background: Usual interstitial pneumonia (UIP) can present with a probable pattern on high-resolution computed tomography (HRCT), but the probability of UIP by surgical lung biopsy in such cases remains controversial. We aimed to determine the final clinical diagnosis in patients with a probable UIP pattern on HRCT subjected to surgical lung biopsy.
Methods: HRCT images were assessed and categorized by three radiologists, and tissue slides were evaluated by two pathologists, all of whom were blinded to the clinical findings. The final clinical diagnosis was accomplished via a multidisciplinary discussion. Patients with a single layer of honeycombing located outside of the lower lobes on HRCT were not excluded.
Results: A total of 50 patients were evaluated. The most common final clinical diagnosis was fibrotic hypersensitivity pneumonitis (38.0%; 95% CI: 24.7% to 52.8%), followed by idiopathic pulmonary fibrosis (24.0%; 95% CI: 13.1% to 38.2%) and interstitial lung disease ascribed to gastroesophageal reflux disease (12.0%; 95% CI: 4.5% to 24.3%) and familial interstitial lung disease (10.0%; 95% CI: 3.3% to 21.8%). In the group without environmental exposure (n = 22), 10 patients had a final clinical diagnosis of idiopathic pulmonary fibrosis (45.5%; 95% CI: 24.4% to 67.8%). Irrespective of the final clinical diagnosis, by multivariate Cox analysis, patients with honeycombing, dyspnoea and the presence of fibroblastic foci on surgical lung biopsy had a high risk of death.
Conclusions: The most common disease associated with a probable UIP pattern on HRCT is fibrotic hypersensitivity pneumonitis, followed by idiopathic pulmonary fibrosis and interstitial lung disease ascribed to gastroesophageal reflux disease. In patients without environmental exposure, the frequency of UIP and a final clinical diagnosis of idiopathic pulmonary fibrosis are not sufficiently high to obviate the indication for surgical lung biopsy.
This is a list of supplementary files associated with this preprint. Click to download.
- SupplementarymaterialRR.docx
Additional file 1: Figure S1. Inclusion criteria diagram. Supplementary Figure S2. Chest high resolution computed tomography (HRCT) in a 60 years-old female patient with probable usual interstitial pneumonia pattern on HRCT and histological bronchiolocentric fibrosis. Supplementary Figure S3. Fibrotic hypersensitivity pneumonitis with probable usual interstitial pneumonia pattern on high resolution computed tomography and the classical histological triad of HP. Supplementary Figure S4. Idiopathic pulmonary fibrosis with probable usual interstitial pneumonia (UIP) pattern on high resolution computed tomography and histological UIP pattern. Supplementary Figure S5. Interstitial lung disease ascribed to gastroesophageal reflux disease with a probable usual interstitial pneumonia pattern on high resolution computed tomography and histological bronchiolocentric fibrosis (BF) pattern. Figure S6. Survival in the patients with probable UIP on HRCT according to the diagnostic groups. Table S1. Clinical characteristics, functional characteristics, and HRCT findings of 50 patients with fibrotic chronic hypersensitivity pneumonia, idiopathic pulmonary fibrosis, and other diagnoses and a probable UIP HRCT pattern.
- SupplementarymaterialRR.docx
Additional file 1: Figure S1. Inclusion criteria diagram. Supplementary Figure S2. Chest high resolution computed tomography (HRCT) in a 60 years-old female patient with probable usual interstitial pneumonia pattern on HRCT and histological bronchiolocentric fibrosis. Supplementary Figure S3. Fibrotic hypersensitivity pneumonitis with probable usual interstitial pneumonia pattern on high resolution computed tomography and the classical histological triad of HP. Supplementary Figure S4. Idiopathic pulmonary fibrosis with probable usual interstitial pneumonia (UIP) pattern on high resolution computed tomography and histological UIP pattern. Supplementary Figure S5. Interstitial lung disease ascribed to gastroesophageal reflux disease with a probable usual interstitial pneumonia pattern on high resolution computed tomography and histological bronchiolocentric fibrosis (BF) pattern. Figure S6. Survival in the patients with probable UIP on HRCT according to the diagnostic groups. Table S1. Clinical characteristics, functional characteristics, and HRCT findings of 50 patients with fibrotic chronic hypersensitivity pneumonia, idiopathic pulmonary fibrosis, and other diagnoses and a probable UIP HRCT pattern.
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