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Relationship between fibroblastic foci profusion and high resolution CT morphology in fibrotic lung disease.

Walsh SL, Wells AU, Sverzellati N, Devaraj A, von der Thüsen J, Yousem SA, Colby TV, Nicholson AG, Hansell DM - BMC Med (2015)

Bottom Line: Increasing extent of reticulation (P < 0.0001) and increasing severity of traction bronchiectasis (P < 0.0001) were independently associated with increasing FF score within the entire cohort.Within individual multidisciplinary team diagnosis subgroups, the only significant independent association with FF score was severity of traction bronchiectasis in patients with idiopathic pulmonary fibrosis (IPF)/UIP (n = 66, r(2) = 0.19, P < 0.0001) and patients with chronic hypersensitivity pneumonitis (CHP) (n = 49, r(2) = 0.45, P < 0.0001).This may explain the growing evidence that traction bronchiectasis is a predictor of mortality in several fibrotic lung diseases.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK. slfwalsh@gmail.com.

ABSTRACT

Background: Fibroblastic foci profusion on histopathology and severity of traction bronchiectasis on highresolution computed tomography (HRCT) have been shown to be predictors of mortality in patients with idiopathic pulmonary fibrosis (IPF). The aim of this study was to investigate the relationship between fibroblastic foci (FF) profusion and HRCT patterns in patients with a histopathologic diagnosis of usual interstitial pneumonia (UIP), fibrotic non-specific interstitial pneumonia (NSIP) and chronic hypersensitivity pneumonitis (CHP).

Methods: The HRCT scans of 162 patients with a histopathologic diagnosis of UIP or fibrotic NSIP (n = 162) were scored on extent of groundglass opacification, reticulation, honeycombing, emphysema and severity of traction bronchiectasis. For each patient, a fibroblastic foci profusion score based on histopathologic appearances was assigned. Relationships between extent of fibroblastic foci and individual HRCT patterns were investigated using univariate correlation analysis and multivariate linear regression.

Results: Increasing extent of reticulation (P < 0.0001) and increasing severity of traction bronchiectasis (P < 0.0001) were independently associated with increasing FF score within the entire cohort. Within individual multidisciplinary team diagnosis subgroups, the only significant independent association with FF score was severity of traction bronchiectasis in patients with idiopathic pulmonary fibrosis (IPF)/UIP (n = 66, r(2) = 0.19, P < 0.0001) and patients with chronic hypersensitivity pneumonitis (CHP) (n = 49, r(2) = 0.45, P < 0.0001). Furthermore, FF score had the strongest association with severity of traction bronchiectasis in patients with IPF (r(2) = 0.34, P < 0.0001) and CHP (r(2) = 0.35, P < 0.0001). There was no correlation between FF score and severity of traction bronchiectasis in patients with fibrotic NSIP. Global disease extent had the strongest association with severity of traction bronchiectasis in patients with fibrotic NSIP (r(2) = 0.58, P < 0.0001).

Conclusion: In patients with fibrotic lung disease, profusion of fibroblastic foci is strikingly related to the severity of traction bronchiectasis, particularly in IPF and CHP. This may explain the growing evidence that traction bronchiectasis is a predictor of mortality in several fibrotic lung diseases.

No MeSH data available.


Related in: MedlinePlus

Biopsy proven fibrotic NSIP. MDT diagnosis: idiopathic fibrotic NSIP. Total disease extent at this level: 40 %. Ground glass opacification: 30 %, extent of reticulation 10 %, extent of consolidation 10 %. Traction bronchiectasis score in ground glass opacification: 0. Traction bronchiectasis score in consolidation: 1. Consensed FF score: 0.5
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Fig1: Biopsy proven fibrotic NSIP. MDT diagnosis: idiopathic fibrotic NSIP. Total disease extent at this level: 40 %. Ground glass opacification: 30 %, extent of reticulation 10 %, extent of consolidation 10 %. Traction bronchiectasis score in ground glass opacification: 0. Traction bronchiectasis score in consolidation: 1. Consensed FF score: 0.5

Mentions: A semiquantitative evaluation of fibroblastic foci profusion (FF score) was performed using a scale of 0–6. All cases were scored by one pathologist (AN), and the second score was undertaken by an experienced pulmonary pathologist in relation to previous and current cohort studies (TC, SY, JvdT) [8]. A consensus diagnosis of histologic pattern was made for each case. Semiquantitative evaluation of fibroblastic foci profusion has been shown to correlate well with objective fibroblastic foci counts [8]. Absence of fibroblastic foci was scored as 0, and the most profuse score was 6 after the method described by Nicholson et al. ([8], see Fig. 1). In cases with biopsies from two different sites, an average score was taken. The average of each pathologist’s FF score was calculated to give an overall FF score for each patient.Fig. 1


Relationship between fibroblastic foci profusion and high resolution CT morphology in fibrotic lung disease.

Walsh SL, Wells AU, Sverzellati N, Devaraj A, von der Thüsen J, Yousem SA, Colby TV, Nicholson AG, Hansell DM - BMC Med (2015)

Biopsy proven fibrotic NSIP. MDT diagnosis: idiopathic fibrotic NSIP. Total disease extent at this level: 40 %. Ground glass opacification: 30 %, extent of reticulation 10 %, extent of consolidation 10 %. Traction bronchiectasis score in ground glass opacification: 0. Traction bronchiectasis score in consolidation: 1. Consensed FF score: 0.5
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4581474&req=5

Fig1: Biopsy proven fibrotic NSIP. MDT diagnosis: idiopathic fibrotic NSIP. Total disease extent at this level: 40 %. Ground glass opacification: 30 %, extent of reticulation 10 %, extent of consolidation 10 %. Traction bronchiectasis score in ground glass opacification: 0. Traction bronchiectasis score in consolidation: 1. Consensed FF score: 0.5
Mentions: A semiquantitative evaluation of fibroblastic foci profusion (FF score) was performed using a scale of 0–6. All cases were scored by one pathologist (AN), and the second score was undertaken by an experienced pulmonary pathologist in relation to previous and current cohort studies (TC, SY, JvdT) [8]. A consensus diagnosis of histologic pattern was made for each case. Semiquantitative evaluation of fibroblastic foci profusion has been shown to correlate well with objective fibroblastic foci counts [8]. Absence of fibroblastic foci was scored as 0, and the most profuse score was 6 after the method described by Nicholson et al. ([8], see Fig. 1). In cases with biopsies from two different sites, an average score was taken. The average of each pathologist’s FF score was calculated to give an overall FF score for each patient.Fig. 1

Bottom Line: Increasing extent of reticulation (P < 0.0001) and increasing severity of traction bronchiectasis (P < 0.0001) were independently associated with increasing FF score within the entire cohort.Within individual multidisciplinary team diagnosis subgroups, the only significant independent association with FF score was severity of traction bronchiectasis in patients with idiopathic pulmonary fibrosis (IPF)/UIP (n = 66, r(2) = 0.19, P < 0.0001) and patients with chronic hypersensitivity pneumonitis (CHP) (n = 49, r(2) = 0.45, P < 0.0001).This may explain the growing evidence that traction bronchiectasis is a predictor of mortality in several fibrotic lung diseases.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK. slfwalsh@gmail.com.

ABSTRACT

Background: Fibroblastic foci profusion on histopathology and severity of traction bronchiectasis on highresolution computed tomography (HRCT) have been shown to be predictors of mortality in patients with idiopathic pulmonary fibrosis (IPF). The aim of this study was to investigate the relationship between fibroblastic foci (FF) profusion and HRCT patterns in patients with a histopathologic diagnosis of usual interstitial pneumonia (UIP), fibrotic non-specific interstitial pneumonia (NSIP) and chronic hypersensitivity pneumonitis (CHP).

Methods: The HRCT scans of 162 patients with a histopathologic diagnosis of UIP or fibrotic NSIP (n = 162) were scored on extent of groundglass opacification, reticulation, honeycombing, emphysema and severity of traction bronchiectasis. For each patient, a fibroblastic foci profusion score based on histopathologic appearances was assigned. Relationships between extent of fibroblastic foci and individual HRCT patterns were investigated using univariate correlation analysis and multivariate linear regression.

Results: Increasing extent of reticulation (P < 0.0001) and increasing severity of traction bronchiectasis (P < 0.0001) were independently associated with increasing FF score within the entire cohort. Within individual multidisciplinary team diagnosis subgroups, the only significant independent association with FF score was severity of traction bronchiectasis in patients with idiopathic pulmonary fibrosis (IPF)/UIP (n = 66, r(2) = 0.19, P < 0.0001) and patients with chronic hypersensitivity pneumonitis (CHP) (n = 49, r(2) = 0.45, P < 0.0001). Furthermore, FF score had the strongest association with severity of traction bronchiectasis in patients with IPF (r(2) = 0.34, P < 0.0001) and CHP (r(2) = 0.35, P < 0.0001). There was no correlation between FF score and severity of traction bronchiectasis in patients with fibrotic NSIP. Global disease extent had the strongest association with severity of traction bronchiectasis in patients with fibrotic NSIP (r(2) = 0.58, P < 0.0001).

Conclusion: In patients with fibrotic lung disease, profusion of fibroblastic foci is strikingly related to the severity of traction bronchiectasis, particularly in IPF and CHP. This may explain the growing evidence that traction bronchiectasis is a predictor of mortality in several fibrotic lung diseases.

No MeSH data available.


Related in: MedlinePlus