Lesion with morphologic feature of organizing pneumonia (OP) in CT-guided lung biopsy samples for diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP): a retrospective study of 134 cases in a single center

Abstract

Background: Small biopsy samples are generally considered inconclusive for bronchiolitis obliterans organizing pneumonia (BOOP) diagnosis despite their potential to reveal organizing pneumonia (OP) pathologically, necessitating risky invasive tissue biopsy during surgery for reliable confirmation.

Objective: OP by CT-guided lung biopsy was to evaluate the role in the diagnosis of BOOP.

Methods: A retrospective review of 134 cases with the OP feature in the CT-guided lung biopsy samples between 2004 and 2011 at a single center was conducted. Diagnostic accuracy of OP by CT-guided lung biopsy and clinical-radiographic data alone were compared.

Results: After exclusion of 11 cases due to pathology with others besides OP and 15 cases for loss to follow-up, 108 were included. Of these, 95 cases and 13 cases were classified as BOOP and non-BOOP group, respectively. Among BOOP group, only 30 were initially diagnosed as BOOP according to the typical clinical and radiographic features. The other 65 cases with atypical features were diagnosed as BOOP mainly based on OP by CT-guided lung biopsy. Among non-BOOP group, one was misdiagnosed as BOOP, and others were not BOOP according to clinical and radiographic findings. Thus, OP by CT-guided lung biopsy produced a diagnostic accuracy of 87.96% (95/108), much higher than 31.25% (30/96) observed using clinical and radiographic data alone. Combined, these techniques produced diagnostic accuracy of 98.96% (95/96).

Conclusions: OP by CT-guided lung biopsy can be effectively used as the pathological evidence for BOOP diagnosis and reducing unnecessary surgery.

Keywords: Bronchiolitis obliterans organizing pneumonia (BOOP); CT-guided lung biopsy; diagnosis; organizing pneumonia (OP); retrospective study.

Figure 1

organizing pneumonia (OP) identified by CT-guided lung biopsy in a 53-year-old female. (A) Pathological changes were evenly distributed (HE staining, 50×); (B) masson bodies apparent in the alveoli, showing chronic inflammatory cell infiltration in the mesenchyme (HE staining, 100×).

Figure 2

Study profile.

Figure 3

A 45-year-old male with BOOP by CT-guided lung biopsy showing resolution on follow-up computed tomography (CT) scans. (A) Chest CT showing bilateral alveoli filled with consolidation and ground glass opacities; (B) chest CT at the same level after 3 months of glucocorticoid treatment, showing bilateral blotchy consolidation, ground glass opacities absorbed strips and traction bronchiectasis. BOOP, bronchiolitis obliterans organizing pneumonia.

Figure 4

Suspected lung cancer in a 57-year-old female with bilateral multiple lung nodules revealed by CT scanning. Nodules in the lower right lung were diagnosed as OP by CT-guided lung biopsy. The patient voluntarily refused treatment. Follow-up at 32 months revealed that nodules were absorbed, confirming BOOP. Initial chest CT scans showed (A) nodules in the left upper lung with vessel convergence signs; (B) a nodule in the middle lobe of right lung adjacent to the cardiac border; (C) a 2.5 cm nodule in the right lower lung with sentus and strip shadow in the upper lobe of left lung. During follow-up, chest CT scans showed (D) left upper lobe nodule (see in A) was absorbed; (E) the nodule adjacent to the cardiac border (seen in B) was absorbed; and (F) the nodule in the right lower lung and the strip shadow in the left lung were absorbed, with the only remaining strip shadows in the right lower lung. OP, organizing pneumonia.

Figure 5

A 40-year-old male with intracardiac tumor was misdiagnosed as BOOP. (A,B) Initially, bilateral multiple alveoli filling was apparent; (C,D) chest CT after one month of glucocorticoid treatment showed complete absorption of alveoli fillings in the (C) bilateral upper lungs (see in A) and (D) in the bilateral lower lungs (seen in B); (E,F) chest CT after three months glucocorticoid treatment showing symptom deterioration with reduced dosage with (E) alveoli fillings around the bronchus in the upper lobe of right lung and unremarkable left lung combined with (F) alveoli fillings in the right lower lung and unremarkable left lung; (G,H) chest CT following increased glucocorticoid treatment 1 week after symptom deterioration onset showing lesion migration with (G) absorption of alveoli fillings in the right upper lung but not in the left upper lung (seen in E) combined with (H) absorption of lesions in the right lower lung but not in the left lower lung (seen in F); (I,J) chest CT scan during a period of symptomatic chest tightness and shortness of breath following activity, (I) revealing blotchy consolidation and ground glass opacities and (J) multiple blotchy consolidation and ground glass opacities in the upper and lower lobes of the left lung and middle and lower lobes of the right lung. BOOP, bronchiolitis obliterans organizing pneumonia.

Figure 6

A 75-year-old female using clinical manifestation and radiographic imaging was finally diagnosed lung cancer although OP was given by CT-guided lung biopsy. (A) Soft tissue mass located in the bronchus of the right lower lung, indicating potential lung cancer; (B) consolidation and ground glass opacities apparent in the right lower lung. Air bronchogram signs were also apparent in the consolidation. lung biopsy on this region revealed OP pathologically. OP, organizing pneumonia.