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Fibroblastic Foci in Usual Interstitial Pneumonia

Idiopathic versus Collagen Vascular Disease

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

Correspondence and requests for reprints should be addressed to Fernando J. Martinez, M.D., 3916 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109–0360. E-mail: fmartine{at}umich.edu

A histologic feature of usual interstitial pneumonia is the presence of fibroblastic foci. As some patients with usual interstitial pneumonia and an underlying collagen vascular disease have a better prognosis, we hypothesized that they would have fewer fibroblastic foci. Pathologists reviewed surgical lung biopsies from 108 patients with usual interstitial pneumonia (nine with collagen vascular disease) and assigned a score (absent 0, mild 1, moderate 2, and marked 3) for fibroblastic foci. Patients with idiopathic usual interstitial pneumonia had a higher median profusion of fibroblastic foci (1.75 vs. 1.0, p = 0.003). Baseline characteristics were similar, although patients with a collagen vascular disease were younger, had a shorter duration of symptoms, and had a higher percentage of predicted total lung capacity. Profusion of fibroblastic foci was the most discriminative feature for separating idiopathic from collagen vascular disease–associated usual interstitial pneumonia (odds ratio 8.31; 95% confidence interval, 1.98, 59.42; p = 0.002 for a one-unit increase in fibroblastic foci score). No deaths were noted in the collagen vascular disease–associated usual interstitial pneumonia group; 52 deaths occurred in the idiopathic usual interstitial pneumonia group (log rank; p = 0.005). We conclude that patients with collagen vascular disease–associated usual interstitial pneumonia have fewer fibroblastic foci and improved survival.

Key Words: idiopathic pulmonary fibrosis • usual interstitial pneumonia • nonspecific interstitial pneumonia • fibroblastic focus

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