Interstitial pneumonia with autoimmune features value of histopathology

Ayodeji Adegunsoye, Justin Oldham, Eleanor Valenzi, Cathryn Lee, Leah J. Witt, Lena Chen, Steven Montner, Jonathan H. Chung, Imre Noth, Rekha Vij, Mary E. Strek, Aliya N. Husain

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Context.-Patients with idiopathic interstitial pneumonia may display evidence of autoimmunity without meeting criteria for a defined connective tissue disease. A recent European Respiratory Society/American Thoracic Society statement proposed research criteria for interstitial pneumonia with autoimmune features (IPAF), which includes findings from the clinical, serologic, and morphologic domains. Objectives.-To investigate the importance of histopathologic criteria within the morphologic domain and to report our methodology for identifying these features. Design.-Patients with idiopathic interstitial pneumonia at the University of Chicago who underwent surgical lung biopsy or lung transplantation were assessed for IPAF histopathologic features, using the initial pathology interpretation in the electronic records. A focused rereview of available slides by a pulmonary pathologist was then performed for patients who failed to meet IPAF criteria on initial pathology assessment. Results.-Of 422 patients with idiopathic interstitial pneumonia, 176 (41.7%) underwent surgical lung biopsy or lung transplant. Forty-six of those 176 patients (26.1%) met IPAF criteria by initial pathology interpretation and a positive clinical or serologic feature. Of the remaining 130 patients, 73 (56.2%) met either the clinical or serologic domains without meeting the morphologic domain, whereas 36 (27.7%) had slides available for pathology rereview. This rereview demonstrated nonspecific interstitial pneumonia in 8 of 36 patients (22.2%) and lympho-plasmacytic infiltrates in 6 of 36 patients (16.7%), resulting in an additional 7 of 36 patients (19.4%) with idiopathic interstitial pneumonia that met the IPAF criteria. In IPAF, pulmonary vasculopathy was the most prevalent finding (45 of 84; 53.6%) and predicted increased mortality (hazard ratio, 2.5; P =.04). Conclusions.-Using a methodological approach to identifying IPAF pathology, we demonstrate a significant increase in the number of patients meeting IPAF criteria because of focused pathologic review and highlight the prognostic value of the IPAF pathologic findings.

Original languageEnglish (US)
Pages (from-to)960-969
Number of pages10
JournalArchives of Pathology and Laboratory Medicine
Volume141
Issue number7
DOIs
StatePublished - Jul 1 2017

Fingerprint

Interstitial Lung Diseases
Idiopathic Interstitial Pneumonias
Pathology
Lung
Biopsy
Connective Tissue Diseases
Lung Transplantation
Autoimmunity
Transplants
Mortality

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

Cite this

Interstitial pneumonia with autoimmune features value of histopathology. / Adegunsoye, Ayodeji; Oldham, Justin; Valenzi, Eleanor; Lee, Cathryn; Witt, Leah J.; Chen, Lena; Montner, Steven; Chung, Jonathan H.; Noth, Imre; Vij, Rekha; Strek, Mary E.; Husain, Aliya N.

In: Archives of Pathology and Laboratory Medicine, Vol. 141, No. 7, 01.07.2017, p. 960-969.

Research output: Contribution to journalArticle

Adegunsoye, A, Oldham, J, Valenzi, E, Lee, C, Witt, LJ, Chen, L, Montner, S, Chung, JH, Noth, I, Vij, R, Strek, ME & Husain, AN 2017, 'Interstitial pneumonia with autoimmune features value of histopathology', Archives of Pathology and Laboratory Medicine, vol. 141, no. 7, pp. 960-969. https://doi.org/10.5858/arpa.2016-0427-OA
Adegunsoye, Ayodeji ; Oldham, Justin ; Valenzi, Eleanor ; Lee, Cathryn ; Witt, Leah J. ; Chen, Lena ; Montner, Steven ; Chung, Jonathan H. ; Noth, Imre ; Vij, Rekha ; Strek, Mary E. ; Husain, Aliya N. / Interstitial pneumonia with autoimmune features value of histopathology. In: Archives of Pathology and Laboratory Medicine. 2017 ; Vol. 141, No. 7. pp. 960-969.
@article{26d29b056fbc43b1994f4bd77d0d7815,
title = "Interstitial pneumonia with autoimmune features value of histopathology",
abstract = "Context.-Patients with idiopathic interstitial pneumonia may display evidence of autoimmunity without meeting criteria for a defined connective tissue disease. A recent European Respiratory Society/American Thoracic Society statement proposed research criteria for interstitial pneumonia with autoimmune features (IPAF), which includes findings from the clinical, serologic, and morphologic domains. Objectives.-To investigate the importance of histopathologic criteria within the morphologic domain and to report our methodology for identifying these features. Design.-Patients with idiopathic interstitial pneumonia at the University of Chicago who underwent surgical lung biopsy or lung transplantation were assessed for IPAF histopathologic features, using the initial pathology interpretation in the electronic records. A focused rereview of available slides by a pulmonary pathologist was then performed for patients who failed to meet IPAF criteria on initial pathology assessment. Results.-Of 422 patients with idiopathic interstitial pneumonia, 176 (41.7{\%}) underwent surgical lung biopsy or lung transplant. Forty-six of those 176 patients (26.1{\%}) met IPAF criteria by initial pathology interpretation and a positive clinical or serologic feature. Of the remaining 130 patients, 73 (56.2{\%}) met either the clinical or serologic domains without meeting the morphologic domain, whereas 36 (27.7{\%}) had slides available for pathology rereview. This rereview demonstrated nonspecific interstitial pneumonia in 8 of 36 patients (22.2{\%}) and lympho-plasmacytic infiltrates in 6 of 36 patients (16.7{\%}), resulting in an additional 7 of 36 patients (19.4{\%}) with idiopathic interstitial pneumonia that met the IPAF criteria. In IPAF, pulmonary vasculopathy was the most prevalent finding (45 of 84; 53.6{\%}) and predicted increased mortality (hazard ratio, 2.5; P =.04). Conclusions.-Using a methodological approach to identifying IPAF pathology, we demonstrate a significant increase in the number of patients meeting IPAF criteria because of focused pathologic review and highlight the prognostic value of the IPAF pathologic findings.",
author = "Ayodeji Adegunsoye and Justin Oldham and Eleanor Valenzi and Cathryn Lee and Witt, {Leah J.} and Lena Chen and Steven Montner and Chung, {Jonathan H.} and Imre Noth and Rekha Vij and Strek, {Mary E.} and Husain, {Aliya N.}",
year = "2017",
month = "7",
day = "1",
doi = "10.5858/arpa.2016-0427-OA",
language = "English (US)",
volume = "141",
pages = "960--969",
journal = "Archives of Pathology and Laboratory Medicine",
issn = "0003-9985",
publisher = "College of American Pathologists",
number = "7",

}

TY - JOUR

T1 - Interstitial pneumonia with autoimmune features value of histopathology

AU - Adegunsoye, Ayodeji

AU - Oldham, Justin

AU - Valenzi, Eleanor

AU - Lee, Cathryn

AU - Witt, Leah J.

AU - Chen, Lena

AU - Montner, Steven

AU - Chung, Jonathan H.

AU - Noth, Imre

AU - Vij, Rekha

AU - Strek, Mary E.

AU - Husain, Aliya N.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Context.-Patients with idiopathic interstitial pneumonia may display evidence of autoimmunity without meeting criteria for a defined connective tissue disease. A recent European Respiratory Society/American Thoracic Society statement proposed research criteria for interstitial pneumonia with autoimmune features (IPAF), which includes findings from the clinical, serologic, and morphologic domains. Objectives.-To investigate the importance of histopathologic criteria within the morphologic domain and to report our methodology for identifying these features. Design.-Patients with idiopathic interstitial pneumonia at the University of Chicago who underwent surgical lung biopsy or lung transplantation were assessed for IPAF histopathologic features, using the initial pathology interpretation in the electronic records. A focused rereview of available slides by a pulmonary pathologist was then performed for patients who failed to meet IPAF criteria on initial pathology assessment. Results.-Of 422 patients with idiopathic interstitial pneumonia, 176 (41.7%) underwent surgical lung biopsy or lung transplant. Forty-six of those 176 patients (26.1%) met IPAF criteria by initial pathology interpretation and a positive clinical or serologic feature. Of the remaining 130 patients, 73 (56.2%) met either the clinical or serologic domains without meeting the morphologic domain, whereas 36 (27.7%) had slides available for pathology rereview. This rereview demonstrated nonspecific interstitial pneumonia in 8 of 36 patients (22.2%) and lympho-plasmacytic infiltrates in 6 of 36 patients (16.7%), resulting in an additional 7 of 36 patients (19.4%) with idiopathic interstitial pneumonia that met the IPAF criteria. In IPAF, pulmonary vasculopathy was the most prevalent finding (45 of 84; 53.6%) and predicted increased mortality (hazard ratio, 2.5; P =.04). Conclusions.-Using a methodological approach to identifying IPAF pathology, we demonstrate a significant increase in the number of patients meeting IPAF criteria because of focused pathologic review and highlight the prognostic value of the IPAF pathologic findings.

AB - Context.-Patients with idiopathic interstitial pneumonia may display evidence of autoimmunity without meeting criteria for a defined connective tissue disease. A recent European Respiratory Society/American Thoracic Society statement proposed research criteria for interstitial pneumonia with autoimmune features (IPAF), which includes findings from the clinical, serologic, and morphologic domains. Objectives.-To investigate the importance of histopathologic criteria within the morphologic domain and to report our methodology for identifying these features. Design.-Patients with idiopathic interstitial pneumonia at the University of Chicago who underwent surgical lung biopsy or lung transplantation were assessed for IPAF histopathologic features, using the initial pathology interpretation in the electronic records. A focused rereview of available slides by a pulmonary pathologist was then performed for patients who failed to meet IPAF criteria on initial pathology assessment. Results.-Of 422 patients with idiopathic interstitial pneumonia, 176 (41.7%) underwent surgical lung biopsy or lung transplant. Forty-six of those 176 patients (26.1%) met IPAF criteria by initial pathology interpretation and a positive clinical or serologic feature. Of the remaining 130 patients, 73 (56.2%) met either the clinical or serologic domains without meeting the morphologic domain, whereas 36 (27.7%) had slides available for pathology rereview. This rereview demonstrated nonspecific interstitial pneumonia in 8 of 36 patients (22.2%) and lympho-plasmacytic infiltrates in 6 of 36 patients (16.7%), resulting in an additional 7 of 36 patients (19.4%) with idiopathic interstitial pneumonia that met the IPAF criteria. In IPAF, pulmonary vasculopathy was the most prevalent finding (45 of 84; 53.6%) and predicted increased mortality (hazard ratio, 2.5; P =.04). Conclusions.-Using a methodological approach to identifying IPAF pathology, we demonstrate a significant increase in the number of patients meeting IPAF criteria because of focused pathologic review and highlight the prognostic value of the IPAF pathologic findings.

UR - http://www.scopus.com/inward/record.url?scp=85021774951&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021774951&partnerID=8YFLogxK

U2 - 10.5858/arpa.2016-0427-OA

DO - 10.5858/arpa.2016-0427-OA

M3 - Article

C2 - 28467213

AN - SCOPUS:85021774951

VL - 141

SP - 960

EP - 969

JO - Archives of Pathology and Laboratory Medicine

JF - Archives of Pathology and Laboratory Medicine

SN - 0003-9985

IS - 7

ER -