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Comparative Study
. 2012 Oct 29;13(1):96.
doi: 10.1186/1465-9921-13-96.

Transbronchial biopsy is useful in predicting UIP pattern

Sara Tomassetti  1 , Alberto Cavazza, Thomas V Colby, Jay H Ryu, Oriana Nanni, E Scarpi, Paola Tantalocco, Matteo Buccioli, Alessandra Dubini, Sara Piciucchi, Claudia Ravaglia, Christian Gurioli, Gian Luca Casoni, Carlo Gurioli, Micaela Romagnoli, Venerino Poletti
Affiliations
Comparative Study

Transbronchial biopsy is useful in predicting UIP pattern

Sara Tomassetti et al. Respir Res. .

Abstract

Background: Usual interstitial pneumonia (UIP), is a necessary feature pathologically or radiologically for the diagnosis of idiopathic pulmonary fibrosis (IPF). The predictive value of transbronchial biopsy (TBB) in identifying UIP is currently unknown. The objective of this study is to assess the accuracy with which histopathologic criteria of usual interstitial pneumonia (UIP) can be identified in transbronchial biopsy (TBB) and to assess the usefulness of TBBx in predicting a the diagnosis of UIP pattern. We conducted a retrospective blinded and controlled analysis of TBB specimens from 40 established cases of UIP and 24 non-UIP interstitial lung diseases.

Results: Adequate TBB specimens were available in 34 UIP cases (85% of all UIP cases). TBB contained histopathologic criteria to suggest a UIP pattern (ie. at least one of three pathologic features of UIP present; patchy interstitial fibrosis, fibroblast foci, honeycomb changes) in 12 cases (30% of all UIP cases). Sensitivity, specificity, positive and negative predictive values for the two pathologists were 30% (12/40), 100% (24/24), 100% (12/12), 46% (24/52) and 30% (12/40), 92% (22/24), 86% (12/14), 55% (22/40) respectively. Kappa coefficient of agreement between pathologists was good (0.61, 95% CI 0.31-0.91). The likelihood of identifying UIP on TBB increased with the number and size of the TBB specimens.

Conclusion: Although sensitivity is low our data suggest that even modest amount of patchy interstitial fibrosis, fibroblast foci, honeycomb changes detected on TBB can be highly predictive of a UIP pattern. Conversely, the absence of UIP histopathologic criteria on TBB does not rule out UIP.

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Figures

Figure 1
Figure 1
Transbronchial biopsies in three different patients with a final diagnosis of UIP.A) An area of scarring/honeycombing at the left, showing architectural abnormal lung with fibrosis and enlarged airspaces bordered by bronchiolar epithelium. Mucostasis is frequently present but can be absent, like here. Hematoxylin-Eosin, 100X. B) Higher magnification showing enlarged airspaces with bronchial metaplasia in the absence of mucus. Hematoxylin-Eosin, 20X. C) An area of fibrosis with a patchy character, in which collagen-type interstitial fibrosis is present adjacent to relatively normal alveoli. Hematoxylin-Eosin, 100X. D) A fibroblast focus, consisting in a small, dome-shaped collection of myofibroblasts within myxoid stroma, adjacent to fibrotic lung tissue. Fibroblast foci are frequently covered by hyperplastic pneumocytes, like here. Hematoxylin-Eosin, 200X.
See this image and copyright information in PMC

References

    1. An Official ATS/ERS/JRS/ALAT Statement. Idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183:788–824. doi: 10.1164/rccm.2009-040GL. - DOI - PMC - PubMed
    1. Ley B, Ryerson CJ, Vittinghoff E, Ryu JH, Tomassetti S, Lee JS, Poletti V, Buccioli M, Elicker BM, Jones KD, King TE Jr, Collard HR. A multidimensional index and staging system for idiopathic pulmonary fibrosis. Ann Intern Med. 2012;156(10):684–691. - PubMed
    1. Hunninghake GW, Zimmerman MB, Schwartz DA, King TE Jr, Lynch J, Hegele R, Waldron J, Colby T, Müller N, Lynch D, Galvin J, Gross B, Hogg J, Toews G, Helmers R, Cooper JA Jr, Baughman R, Strange C, Millard M. Utility of a lung biopsy for the diagnosis of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2001;164(2):193–196. - PubMed
    1. Cavazza A, Rossi G, Carbonelli C, Spaggiari L, Paci M, Roggeri A. The role of histology in idiopathic pulmonary fibrosis: an update. Respir Med. 2010;104(Suppl 1):S11–S22. - PubMed
    1. Utz JP, Ryu JH, Douglas WW, Hartman TE, Tazelaar HD, Myers JL, Allen MS, Schroeder DR. High short-term mortality following lung biopsy for usual interstitial pneumonia. Eur Respir J. 2001;17:175–179. doi: 10.1183/09031936.01.17201750. - DOI - PubMed

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