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. 2023 Jan;17(1):50-58.
doi: 10.1111/crj.13561. Epub 2022 Nov 17.

Features of transbronchial lung cryobiopsy-diagnosed fibrotic hypersensitivity pneumonitis

Xi Zhan  1 , Yingzhen Du  2 , Jiang Luo  3 , Yifan Que  2 , Chao Hu  3 , Lili Xu  1 , Zhen Wang  1 , Yanbing Wu  1 , Mulan Jin  4 , Chunming Zheng  5 , Yanhong Gao  2 , Christopher Chang  6   7 , Hongxia Li  2 , Zhaohui Tong  1 , Guogang Xu  3
Affiliations

Features of transbronchial lung cryobiopsy-diagnosed fibrotic hypersensitivity pneumonitis

Xi Zhan et al. Clin Respir J. 2023 Jan.

Abstract

Background: Hypersensitivity pneumonitis (HP) is a common type among all the interstitial lung diseases, and transbronchial lung cryobiopsy is an alternative diagnostic technique for interstitial lung diseases. In this study, we describe the clinical and pathological features of fibrotic hypersensitivity pneumonitis diagnosed with transbronchial lung cryobiopsy (TBLC).

Methods: A total of 46 diffused parenchyma lung disease (DPLD) patients received TBLC were included in this study. Medical records including medical history spirometry examinations, 6-min walk test (6MWT) results, high resolution computed tomographic (HRCT) scans, BAL, and histopathology were collected. Results of HRCT and histopathology were compared and classified, especially.

Results: Sixteen patients were diagnosed with fibrotic HP, the mean age of whom was 56.3 ± 12.1 years, and 62.5% of them were male. Three of the 16 patients had been misdiagnosed as tuberculosis and received antituberculosis medications, five patients had been diagnosed as unclassifiable pulmonary fibrosis, and five patients had been diagnosed as idiopathic pulmonary fibrosis (IPF). Thirteen (81.3%) patients had a normal lymphocyte count in BAL. The pathological features of usual interstitial pneumonia (UIP) were detected in 11 (68.8%) of the cases, poor defined granulomatous was detected in nine (56.3%) of the cases, and bronchiolocentric fibrosis was detected in two (12.5%) of the 16 cases.

Conclusions: Fibrotic hypersensitivity pneumonitis should be included in differential diagnosis of pulmonary fibrosis. Pathological characteristics of fibrotic hypersensitivity pneumonitis could be demonstrated from cryobiopsy lung tissue. TBLC is recommended as an alternative diagnostic technique, which may improve the specificity of hypersensitivity pneumonia detection, and UIP is the most frequent pathological finding.

Keywords: fibrotic hypersensitivity pneumonitis; interstitial lung diseases; pulmonary fibrosis; transbronchial lung cryobiopsy; usual interstitial pneumonia.

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Conflict of interest statement

The authors confirm that there are no competing interests.

Figures

FIGURE 1
FIGURE 1
Patient flowchart. DPLD, diffused parenchyma lung disease; HRCT, high‐resolution computed tomography; MDT, multi‐discipline treatment; TBLC, transbronchial lung cryobiopsy; NSIP, nonspecific interstitial pneumonia; OP, organizing pneumonia; UIP, usual interstitial pneumonia; HP, hypersensitivity pneumonitis
FIGURE 2
FIGURE 2
Whole exome sequence for the congenital dyskeratosis patient showed a nonsense mutation (c.844C>T) in TINF2 exon 14.
FIGURE 3
FIGURE 3
HRCT results in patients with fibrotic HP. (A) A male patient with fibrotic HP. HRCT showed reticulation, traction bronchiectasis, and mosaic attenuation. (B) A female patient with fibrotic HP. HRCT showed reticulation and honeycombing. (C) A female patient with chronic fibrotic HP. HRCT showed reticulation and a “three density pattern” (headcheese sign). HRCT, high‐resolution computed tomography; HP, hypersensitivity pneumonitis
FIGURE 4
FIGURE 4
Pathological features in patients with fibrotic HP. (A) A female patient with fibrotic HP. The pathology of the TBLC sample showed patchy fibrosis and fibroblast foci, in accordance with UIP. (Black Arrow HE 40 Χ). (B) A male patient with fibrotic HP. The pathology of the TBLC sample showed poor defined granulomas (black arrows) distributed along with small airways, and fibroblast foci (white arrow). (HE 100 Χ). (C) A male patient with fibrotic HP. The pathology of the TBLC sample showed bronchiolocentric fibrosis (black arrow, HE 100 Χ). TBLC, transbronchial lung cryobiopsy; HP, hypersensitivity pneumonitis
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