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. 2018 Mar 28;13(3):e0193608.
doi: 10.1371/journal.pone.0193608. eCollection 2018.

Clinical spectrum and prognostic factors of possible UIP pattern on high-resolution CT in patients who underwent surgical lung biopsy

Yasuhiro Kondoh  1 , Hiroyuki Taniguchi  1 , Kensuke Kataoka  1 , Taiki Furukawa  2 , Ayumi Shintani  3 , Tomoyuki Fujisawa  4 , Takafumi Suda  4 , Machiko Arita  5 , Tomohisa Baba  6 , Kazuya Ichikado  7 , Yoshikazu Inoue  8 , Kazuma Kishi  9 , Tomoo Kishaba  10 , Osamu Nishiyama  11 , Takashi Ogura  6 , Keisuke Tomii  12 , Sakae Homma  13
Affiliations

Clinical spectrum and prognostic factors of possible UIP pattern on high-resolution CT in patients who underwent surgical lung biopsy

Yasuhiro Kondoh et al. PLoS One. .

Abstract

Background: Few studies have reported the diagnostic variability in patients with a possible usual interstitial pneumonia (UIP) pattern on high-resolution CT (HRCT) who underwent surgical lung biopsy (SLB), and the prognostic factors for these patients have not been fully evaluated. We retrospectively investigated the frequency of idiopathic pulmonary fibrosis (IPF) and prognostic factors in patients with possible UIP pattern on HRCT.

Methods: Consecutive patients who had a possible UIP pattern on HRCT, underwent SLB, and had a diagnosis of IIPs before SLB were retrospectively recruited from 10 hospitals. Diagnoses were made based on multidisciplinary discussion using the criteria for current IPF guidelines and multidisciplinary classification for IIPs in each hospital.

Results: 179 patients who underwent SLB were enrolled. The diagnoses were IPF in 91 patients (51%), unclassifiable IIPs in 47 (26%), idiopathic NSIP in 18 (10%), and chronic hypersensitivity pneumonia in 17 (9%). One-year FVC changes showed significant differences between IPF and non-IPF (-138.6 mL versus 18.2 mL, p = 0.014). Patients with IPF had a worse mortality than those with non-IPF (Logrank test, p = 0.025). Multivariable Cox regression analysis demonstrated that diagnoses of IPF (HR, 2.961; 95% CI, 1.183-7.410; p = 0.02), high modified MRC score (HR, 1.587; 95% CI, 1.003-2.510; p = 0.049), and low %FVC (HR, 0.972; 95% CI, 0.953-0.992; p = 0.005).

Conclusions: About a half of patients with a possible UIP pattern on HRCT had diagnoses other than IPF, and patients with IPF had a worse mortality than those with an alternative diagnosis. We reaffirmed that multidisciplinary discussion is crucial in patients with possible UIP pattern on HRCT.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Survival of IPF and non-IPF patients with possible UIP pattern on HRCT.
Among patients with possible UIP pattern on HRCT, those with IPF had significantly worse survival than those with non-IPF (Log-rank test, p = 0.025).
See this image and copyright information in PMC

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