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. 2020 Jul;12(7):3688-3696.
doi: 10.21037/jtd-19-4021.

The interstitial lung disease spectrum under a uniform diagnostic algorithm: a retrospective study of 1,945 individuals

Bingpeng Guo  1 , Lulin Wang  1 , Shu Xia  1 , Mengmeng Mao  1 , Weiping Qian  1 , Xiaomin Peng  1 , Zexuan Zheng  1 , Rongchang Chen  1   2 , Qian Han  1 , Qun Luo  1
Affiliations

The interstitial lung disease spectrum under a uniform diagnostic algorithm: a retrospective study of 1,945 individuals

Bingpeng Guo et al. J Thorac Dis. 2020 Jul.

Abstract

Background: Reported data on the disease spectrum of interstitial lung diseases (ILDs) of China are sparse and varied. We aimed to investigate the spectrum of ILDs and the distribution of diagnostic methods under a uniform diagnosis.

Methods: This retrospective study enrolled ILDs cases from Guangzhou Institute of Respiratory Health (GIRH). All cases were classified into specific subgroups of ILDs according to updated guidelines.

Results: A total of 1,945 subjects were enrolled from January 2012 to December 2017. The mean age was 57.9 years, and 1,080 (55.5%) patients were male. The most common subtype of ILDs was idiopathic pulmonary fibrosis (IPF, 20.3%), followed by interstitial pneumonia with autoimmune features (IPAF, 17.9%), connective tissue disease associated ILD (CTD-ILD, 18.3%) and unclassifiable idiopathic interstitial pneumonia (UIIP, 14.7%). A total of 818 (42.1%) patients underwent lung biopsy in order to obtain a histological diagnose. TBLB was performed in 565 (29.0%) patients, eleven of whom underwent SLB because TBLB failed to obtain lung samples. SLB was performed in 213 (11.0%) patients and TBCB was performed in 51 (2.6%) patients. Among them, histological results were considered clinically helpful in 722 (88.3%) cases, and provided definitive histopathological diagnoses in 368 cases. Surgical lung biopsy (SLB) was performed in 213 (10.9%) subjects, while 115 (54.0%) cases were performed among the idiopathic interstitial pneumonia (IIP). Among SLB cases in IIP, the highest rate of SLB was desquamative interstitial pneumonia/respiratory bronchiolitis-interstitial lung disease (DIP/RB-ILD, 10/10), lymphoid interstitial pneumonia (LIP, 9/9), followed by cryptogenic organizing (COP, 18/26), nonspecific interstitial pneumonia (NSIP, 22/53), IPF (43/395), UIIP (13/285).

Conclusions: IPF was the most common ILDs in our ILD center, followed by IPAF, CTD-ILD and UIIP. Histological information may help to establish diagnostic algorithm in ILD.

Keywords: Interstitial lung disease (ILD); epidemiology; surgical lung biopsy (SLB).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-19-4021). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The diagnosis algorithm for ILDs. ILD, interstitial lung disease. ‡, Serological tests including antinuclear antibody (ANA), anti-cyclic citrullinated peptide antibody (CCP), anti-dsDNA, anti-Ro, anti-La, anti-ribonucleoprotein, anti-Smith, anti-topoisomerase, anti-tRNA synthetase(e.g., Jo-1, PL-7, PL-12, EJ, OJ), anti-PM-Scl, anti-MDA5, anti-rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein, and creatine phosphokinase.
Figure 2
Figure 2
The spectrum of IIP and the number of SLB cases per year. IIP, idiopathic interstitial pneumonia; SLB, surgical lung biopsy.
See this image and copyright information in PMC

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