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Am. J. Respir. Crit. Care Med., Volume 164, Number 9, November 2001, 1722-1727

Histopathologic Variability in Usual and Nonspecific Interstitial Pneumonias

KEVIN R. FLAHERTY, WILLIAM D. TRAVIS, THOMAS V. COLBY, GALEN B. TOEWS, ELLA A. KAZEROONI, BARRY H. GROSS, ARVIND JAIN, ROBERT L. STRAWDERMAN III, ANDREW FLINT, JOSEPH P. LYNCH III, and FERNANDO J. MARTINEZ

Division of Pulmonary and Critical Care Medicine, and Departments of Radiology and Pathology, University of Michigan Health System, and Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, Washington, D.C.; Department of Pathology, Mayo Clinic, Scottsdale, Arizona

Findings of surgical lung biopsy (SLB) are important in categorizing patients with idiopathic interstitial pneumonia (IIP). We investigated whether histologic variability would be evident in SLB specimens from multiple lobes in patients with IIP. SLBs from 168 patients, 109 of whom had multiple lobes biopsied, were reviewed by three pathologists. A diagnosis was assigned to each lobe. A different diagnosis was found between lobes in 26% of the patients. Patients with usual interstitial pneumonia (UIP) in all lobes were categorized as concordant for UIP (n = 51) and those with UIP in at least one lobe were categorized as discordant for UIP (n = 28). Patients with nonspecific interstitial pneumonia (NSIP) in all lobes were categorized as having fibrotic (n = 25) or cellular NSIP (n = 5). No consistent distribution of lobar histology was noted. Patients concordant for UIP were older (63 ± 9 [mean ± SD] yr; p < 0.05 as compared with all other groups) than those discordant for UIP (57 ± 12 yr) or with fibrotic NSIP (56 ± 11 yr) or cellular NSIP (50 ± 9 yr). Semiquantitative high-resolution computed tomography demonstrated a varied profusion of fibrosis (p < 0.05 for all group comparisons), with more fibrosis in concordant UIP (2.13 ± 0.62) than in discordant UIP (1.42 ± 0.73), fibrotic NSIP (0.83 ± 0.58), or cellular NSIP (0.44 ± 0.42). Survival was better for patients with NSIP than for those in both UIP groups (p < 0.001), although survival in the two UIP groups was comparable (p = 0.16). Lobar histologic variability is frequent in patients with IIP, patients with a histologic pattern of UIP in any lobe should be classified as having UIP.




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Angiogenesis and Pulmonary Fibrosis: Feast or Famine?
Am. J. Respir. Crit. Care Med., August 1, 2004; 170(3): 207 - 209.
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 ThoraxHome page
N R Simler, P E Brenchley, A W Horrocks, S M Greaves, P S Hasleton, and J J Egan
Angiogenic cytokines in patients with idiopathic interstitial pneumonia
Thorax, July 1, 2004; 59(7): 581 - 585.
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 ChestHome page
H. R. Collard, J. H. Ryu, W. W. Douglas, M. I. Schwarz, D. Curran-Everett, T. E. King Jr., and K. K. Brown
Combined Corticosteroid and Cyclophosphamide Therapy Does Not Alter Survival in Idiopathic Pulmonary Fibrosis
Chest, June 1, 2004; 125(6): 2169 - 2174.
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 ChestHome page
K. Williams, D. Malarkey, L. Cohn, D. Patrick, J. Dye, and G. Toews
Identification of Spontaneous Feline Idiopathic Pulmonary Fibrosis: Morphology and Ultrastructural Evidence for a Type II Pneumocyte Defect
Chest, June 1, 2004; 125(6): 2278 - 2288.
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 ThoraxHome page
A G Nicholson, B J Addis, H Bharucha, C A Clelland, B Corrin, A R Gibbs, P S Hasleton, K M Kerr, N B N Ibrahim, S Stewart, et al.
Inter-observer variation between pathologists in diffuse parenchymal lung disease
Thorax, June 1, 2004; 59(6): 500 - 505.
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 Am. J. Pathol.Home page
C. Jakubzick, E. S. Choi, K. J. Carpenter, S. L. Kunkel, H. Evanoff, F. J. Martinez, K. R. Flaherty, G. B. Toews, T. V. Colby, W. D. Travis, et al.
Human Pulmonary Fibroblasts Exhibit Altered Interleukin-4 and Interleukin-13 Receptor Subunit Expression in Idiopathic Interstitial Pneumonia
Am. J. Pathol., June 1, 2004; 164(6): 1989 - 2001.
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 J. Clin. Pathol.Home page
C Jakubzick, E S Choi, S L Kunkel, H Evanoff, F J Martinez, R K Puri, K R Flaherty, G B Toews, T V Colby, E A Kazerooni, et al.
Augmented pulmonary IL-4 and IL-13 receptor subunit expression in idiopathic interstitial pneumonia
J. Clin. Pathol., May 1, 2004; 57(5): 477 - 486.
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 ChestHome page
D. S. Zander
Idiopathic Interstitial Pneumonias and the Concept of the Trump Card
Chest, February 1, 2004; 125(2): 359 - 360.
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 ChestHome page
H. Monaghan, A. U. Wells, T. V. Colby, R. M. du Bois, D. M. Hansell, and A. G. Nicholson
Prognostic Implications of Histologic Patterns in Multiple Surgical Lung Biopsies From Patients With Idiopathic Interstitial Pneumonias
Chest, February 1, 2004; 125(2): 522 - 526.
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 Am. J. Respir. Crit. Care Med.Home page
V. N. Lama, K. R. Flaherty, G. B. Toews, T. V. Colby, W. D. Travis, Q. Long, S. Murray, E. A. Kazerooni, B. H. Gross, J. P. Lynch III, et al.
Prognostic Value of Desaturation during a 6-Minute Walk Test in Idiopathic Interstitial Pneumonia
Am. J. Respir. Crit. Care Med., November 1, 2003; 168(9): 1084 - 1090.
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 ChestHome page
D. W. Kamp
Idiopathic Pulmonary Fibrosis: The Inflammation Hypothesis Revisited
Chest, October 1, 2003; 124(4): 1187 - 1190.
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 ChestHome page
R. Vassallo, E. A. Jensen, T. V. Colby, J. H. Ryu, W. W. Douglas, T. E. Hartman, and A. H. Limper
The Overlap Between Respiratory Bronchiolitis and Desquamative Interstitial Pneumonia in Pulmonary Langerhans Cell Histiocytosis: High-Resolution CT, Histologic, and Functional Correlations
Chest, October 1, 2003; 124(4): 1199 - 1205.
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 Am. J. Respir. Cell Mol. Bio.Home page
N. Kaminski, J. A. Belperio, P. B. Bitterman, L. Chen, S. W. Chensue, A. M.K. Choi, S. Dacic, J. H. Dauber, R. M. du Bois, J. J. Enghild, et al.
Idiopathic Pulmonary Fibrosis
Am. J. Respir. Cell Mol. Biol., September 1, 2003; 29(3): S1 - 105.
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 Am. J. Respir. Crit. Care Med.Home page
K. R. Flaherty, J. A. Mumford, S. Murray, E. A. Kazerooni, B. H. Gross, T. V. Colby, W. D. Travis, A. Flint, G. B. Toews, J. P. Lynch III, et al.
Prognostic Implications of Physiologic and Radiographic Changes in Idiopathic Interstitial Pneumonia
Am. J. Respir. Crit. Care Med., September 1, 2003; 168(5): 543 - 548.
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 Am. J. Respir. Crit. Care Med.Home page
P. I. Latsi, R. M. du Bois, A. G. Nicholson, T. V. Colby, D. Bisirtzoglou, A. Nikolakopoulou, S. Veeraraghavan, D. M. Hansell, and A. U. Wells
Fibrotic Idiopathic Interstitial Pneumonia: The Prognostic Value of Longitudinal Functional Trends
Am. J. Respir. Crit. Care Med., September 1, 2003; 168(5): 531 - 537.
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 Mayo Clin Proc.Home page
K. C. Meyer
Interferon Gamma-1b Therapy for Idiopathic Pulmonary Fibrosis: Is the Cart Before the Horse?
Mayo Clin. Proc., September 1, 2003; 78(9): 1073 - 1075.
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 Eur Respir JHome page
C. Vogelmeier
IPF or NSIP? That is the question
Eur. Respir. J., August 1, 2003; 22(2): 191 - 192.
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 Eur Respir JHome page
S. Veeraraghavan, P.I. Latsi, A.U. Wells, P. Pantelidis, A.G. Nicholson, T.V. Colby, P.L. Haslam, E.A. Renzoni, and R.M. du Bois
BAL findings in idiopathic nonspecific interstitial pneumonia and usual interstitial pneumonia
Eur. Respir. J., August 1, 2003; 22(2): 239 - 244.
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 J. Clin. Microbiol.Home page
Y.-W. Tang, J. E. Johnson, P. J. Browning, R. A. Cruz-Gervis, A. Davis, B. S. Graham, K. L. Brigham, J. A. Oates Jr., J. E. Loyd, and A. A. Stecenko
Herpesvirus DNA Is Consistently Detected in Lungs of Patients with Idiopathic Pulmonary Fibrosis
J. Clin. Microbiol., June 1, 2003; 41(6): 2633 - 2640.
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 Am. J. Respir. Crit. Care Med.Home page
K. R. Flaherty, T. V. Colby, W. D. Travis, G. B. Toews, J. Mumford, S. Murray, V. J. Thannickal, E. A. Kazerooni, B. H. Gross, J. P. Lynch III, et al.
Fibroblastic Foci in Usual Interstitial Pneumonia: Idiopathic versus Collagen Vascular Disease
Am. J. Respir. Crit. Care Med., May 15, 2003; 167(10): 1410 - 1415.
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 Eur Respir JHome page
O. Ghekiere, B. Weynand, P. Collard, and E. Coche
Progressive dyspnoea in a 40-yr-old female
Eur. Respir. J., April 1, 2003; 21(4): 728 - 731.
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 Am. J. Respir. Crit. Care Med.Home page
A. U. Wells, S. R. Desai, M. B. Rubens, N. S. L. Goh, D. Cramer, A. G. Nicholson, T. V. Colby, R. M. du Bois, and D. M. Hansell
Idiopathic Pulmonary Fibrosis: A Composite Physiologic Index Derived from Disease Extent Observed by Computed Tomography
Am. J. Respir. Crit. Care Med., April 1, 2003; 167(7): 962 - 969.
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 ThoraxHome page
K R Flaherty, E L Thwaite, E A Kazerooni, B H Gross, G B Toews, T V Colby, W D Travis, J A Mumford, S Murray, A Flint, et al.
Radiological versus histological diagnosis in UIP and NSIP: survival implications
Thorax, February 1, 2003; 58(2): 143 - 148.
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 Am. J. Respir. Crit. Care Med.Home page
M. J. Tobin
Compliance (COMmunicate PLease wIth Less Abbreviations, Noun Clusters, and Exclusiveness)
Am. J. Respir. Crit. Care Med., December 15, 2002; 166(12): 1534 - 1536.
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 Am. J. Respir. Crit. Care Med.Home page
A. G. Nicholson, L. G. Fulford, T. V. Colby, R. M. du Bois, D. M. Hansell, and A. U. Wells
The Relationship between Individual Histologic Features and Disease Progression in Idiopathic Pulmonary Fibrosis
Am. J. Respir. Crit. Care Med., July 15, 2002; 166(2): 173 - 177.
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 Am. J. Respir. Crit. Care Med.Home page
T. E. King Jr.
Nonspecific Interstitial Pneumonia and Systemic Sclerosis
Am. J. Respir. Crit. Care Med., June 15, 2002; 165(12): 1578 - 1579.
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 Am. J. Respir. Crit. Care Med.Home page
D. Bouros, A. U. Wells, A. G. Nicholson, T. V. Colby, V. Polychronopoulos, P. Pantelidis, P. L. Haslam, D. A. Vassilakis, C. M. Black, and R. M. du Bois
Histopathologic Subsets of Fibrosing Alveolitis in Patients with Systemic Sclerosis and Their Relationship to Outcome
Am. J. Respir. Crit. Care Med., June 15, 2002; 165(12): 1581 - 1586.
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 Eur Respir JHome page
M. Demedts and U. Costabel
ATS/ERS international multidisciplinary consensus classification of the idiopathic interstitial pneumonias
Eur. Respir. J., May 1, 2002; 19(5): 794 - 796.
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 Am. J. Respir. Crit. Care Med.Home page
R. M. Strieter
Inflammatory Mechanisms Are Not a Minor Component of the Pathogenesis of Idiopathic Pulmonary Fibrosis
Am. J. Respir. Crit. Care Med., May 1, 2002; 165(9): 1206 - 1207.
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 Am. J. Respir. Crit. Care Med.Home page
R. M. Strieter
Rebuttal from Dr. Strieter
Am. J. Respir. Crit. Care Med., May 1, 2002; 165(9): 1208 - 1208.
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