CT-pathologic correlation of major types of pulmonary fibrosis: Insights for revisions to current guidelines

Jonathan H. Chung, Justin Oldham, Steven M. Montner, Rekha Vij, Ayodeji Adegunsoye, Aliya N. Husain, Imre Noth, David A. Lynch, Mary E. Strek

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of this study was to assess the diagnostic significance of CT patterns that cannot be classified according to current idiopathic pulmonary fibrosis (IPF) guidelines and of specific findings of the inconsistent with usual interstitial pneumonitis (UIP) pattern. MATERIALS AND METHODS. Subjects with a multidisciplinary diagnosis of interstitial lung disease who had undergone surgical lung biopsy and chest CT within 1 year of each other were included in the study. The predominant distribution and pattern of disease were scored. Cases were classified as UIP, possible UIP, or inconsistent with UIP at chest CT according to 2011 IPF guidelines. Cases that could not be confidently categorized with current guidelines were annotated as indeterminate. RESULTS. UIP, possible UIP, and inconsistent with UIP CT patterns were associated with pathologic UIP in 89.6%, 81.6%, and 60.0% of subjects. An indeterminate CT pattern (7.7% [20/259]) was associated with a UIP pathologic diagnosis in 55.0% of cases. This finding was not statistically different from the findings in the group with the inconsistent with UIP CT pattern (p = 0.677) but was different from the findings in the UIP (p < 0.001) and possible UIP (p = 0.031) groups. In regard to specific findings of the inconsistent with UIP CT category, ground-glass opacity, air-trapping, consolidation, and axial distribution were associated with a non-UIP pathologic diagnosis; however, there was no significant association with zonal distribution. CONCLUSION. A substantial minority of cases cannot be confidently categorized according to current guidelines for IPF and differ diagnostically from the possible UIP and UIP CT categories. The term “inconsistent with UIP” is misleading and should be renamed.

Original languageEnglish (US)
Pages (from-to)1034-1041
Number of pages8
JournalAmerican Journal of Roentgenology
Volume210
Issue number5
DOIs
StatePublished - May 1 2018

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Idiopathic Pulmonary Fibrosis
Pulmonary Fibrosis
Guidelines
Interstitial Lung Diseases
Thorax

Keywords

  • Connective tissue disease
  • CT
  • Hypersensitivity pneumonitis
  • Idiopathic pulmonary fibrosis
  • Interstitial pneumonia with autoimmune features
  • Pathology
  • Usual interstitial pneumonitis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

CT-pathologic correlation of major types of pulmonary fibrosis : Insights for revisions to current guidelines. / Chung, Jonathan H.; Oldham, Justin; Montner, Steven M.; Vij, Rekha; Adegunsoye, Ayodeji; Husain, Aliya N.; Noth, Imre; Lynch, David A.; Strek, Mary E.

In: American Journal of Roentgenology, Vol. 210, No. 5, 01.05.2018, p. 1034-1041.

Research output: Contribution to journalArticle

Chung, JH, Oldham, J, Montner, SM, Vij, R, Adegunsoye, A, Husain, AN, Noth, I, Lynch, DA & Strek, ME 2018, 'CT-pathologic correlation of major types of pulmonary fibrosis: Insights for revisions to current guidelines', American Journal of Roentgenology, vol. 210, no. 5, pp. 1034-1041. https://doi.org/10.2214/AJR.17.18947
Chung, Jonathan H. ; Oldham, Justin ; Montner, Steven M. ; Vij, Rekha ; Adegunsoye, Ayodeji ; Husain, Aliya N. ; Noth, Imre ; Lynch, David A. ; Strek, Mary E. / CT-pathologic correlation of major types of pulmonary fibrosis : Insights for revisions to current guidelines. In: American Journal of Roentgenology. 2018 ; Vol. 210, No. 5. pp. 1034-1041.
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abstract = "OBJECTIVE. The purpose of this study was to assess the diagnostic significance of CT patterns that cannot be classified according to current idiopathic pulmonary fibrosis (IPF) guidelines and of specific findings of the inconsistent with usual interstitial pneumonitis (UIP) pattern. MATERIALS AND METHODS. Subjects with a multidisciplinary diagnosis of interstitial lung disease who had undergone surgical lung biopsy and chest CT within 1 year of each other were included in the study. The predominant distribution and pattern of disease were scored. Cases were classified as UIP, possible UIP, or inconsistent with UIP at chest CT according to 2011 IPF guidelines. Cases that could not be confidently categorized with current guidelines were annotated as indeterminate. RESULTS. UIP, possible UIP, and inconsistent with UIP CT patterns were associated with pathologic UIP in 89.6{\%}, 81.6{\%}, and 60.0{\%} of subjects. An indeterminate CT pattern (7.7{\%} [20/259]) was associated with a UIP pathologic diagnosis in 55.0{\%} of cases. This finding was not statistically different from the findings in the group with the inconsistent with UIP CT pattern (p = 0.677) but was different from the findings in the UIP (p < 0.001) and possible UIP (p = 0.031) groups. In regard to specific findings of the inconsistent with UIP CT category, ground-glass opacity, air-trapping, consolidation, and axial distribution were associated with a non-UIP pathologic diagnosis; however, there was no significant association with zonal distribution. CONCLUSION. A substantial minority of cases cannot be confidently categorized according to current guidelines for IPF and differ diagnostically from the possible UIP and UIP CT categories. The term “inconsistent with UIP” is misleading and should be renamed.",
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AU - Chung, Jonathan H.

AU - Oldham, Justin

AU - Montner, Steven M.

AU - Vij, Rekha

AU - Adegunsoye, Ayodeji

AU - Husain, Aliya N.

AU - Noth, Imre

AU - Lynch, David A.

AU - Strek, Mary E.

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N2 - OBJECTIVE. The purpose of this study was to assess the diagnostic significance of CT patterns that cannot be classified according to current idiopathic pulmonary fibrosis (IPF) guidelines and of specific findings of the inconsistent with usual interstitial pneumonitis (UIP) pattern. MATERIALS AND METHODS. Subjects with a multidisciplinary diagnosis of interstitial lung disease who had undergone surgical lung biopsy and chest CT within 1 year of each other were included in the study. The predominant distribution and pattern of disease were scored. Cases were classified as UIP, possible UIP, or inconsistent with UIP at chest CT according to 2011 IPF guidelines. Cases that could not be confidently categorized with current guidelines were annotated as indeterminate. RESULTS. UIP, possible UIP, and inconsistent with UIP CT patterns were associated with pathologic UIP in 89.6%, 81.6%, and 60.0% of subjects. An indeterminate CT pattern (7.7% [20/259]) was associated with a UIP pathologic diagnosis in 55.0% of cases. This finding was not statistically different from the findings in the group with the inconsistent with UIP CT pattern (p = 0.677) but was different from the findings in the UIP (p < 0.001) and possible UIP (p = 0.031) groups. In regard to specific findings of the inconsistent with UIP CT category, ground-glass opacity, air-trapping, consolidation, and axial distribution were associated with a non-UIP pathologic diagnosis; however, there was no significant association with zonal distribution. CONCLUSION. A substantial minority of cases cannot be confidently categorized according to current guidelines for IPF and differ diagnostically from the possible UIP and UIP CT categories. The term “inconsistent with UIP” is misleading and should be renamed.

AB - OBJECTIVE. The purpose of this study was to assess the diagnostic significance of CT patterns that cannot be classified according to current idiopathic pulmonary fibrosis (IPF) guidelines and of specific findings of the inconsistent with usual interstitial pneumonitis (UIP) pattern. MATERIALS AND METHODS. Subjects with a multidisciplinary diagnosis of interstitial lung disease who had undergone surgical lung biopsy and chest CT within 1 year of each other were included in the study. The predominant distribution and pattern of disease were scored. Cases were classified as UIP, possible UIP, or inconsistent with UIP at chest CT according to 2011 IPF guidelines. Cases that could not be confidently categorized with current guidelines were annotated as indeterminate. RESULTS. UIP, possible UIP, and inconsistent with UIP CT patterns were associated with pathologic UIP in 89.6%, 81.6%, and 60.0% of subjects. An indeterminate CT pattern (7.7% [20/259]) was associated with a UIP pathologic diagnosis in 55.0% of cases. This finding was not statistically different from the findings in the group with the inconsistent with UIP CT pattern (p = 0.677) but was different from the findings in the UIP (p < 0.001) and possible UIP (p = 0.031) groups. In regard to specific findings of the inconsistent with UIP CT category, ground-glass opacity, air-trapping, consolidation, and axial distribution were associated with a non-UIP pathologic diagnosis; however, there was no significant association with zonal distribution. CONCLUSION. A substantial minority of cases cannot be confidently categorized according to current guidelines for IPF and differ diagnostically from the possible UIP and UIP CT categories. The term “inconsistent with UIP” is misleading and should be renamed.

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KW - CT

KW - Hypersensitivity pneumonitis

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KW - Interstitial pneumonia with autoimmune features

KW - Pathology

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