Chest
Volume 129, Issue 5, May 2006, Pages 1126-1131
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Original Research: Interstitial Lung Disease
Transbronchial Biopsy in Usual Interstitial Pneumonia

https://doi.org/10.1378/chest.129.5.1126Get rights and content

Background

Usual interstitial pneumonia (UIP) is a slowly progressive, usually fatal form of idiopathic interstitial pneumonia for which there is no effective treatment. Transbronchial biopsy (TBB) has been utilized only to exclude other diseases such as sarcoidosis, lymphangitic carcinoma, and infection, for example, but TBB is generally considered to have little role in confirming UIP.

Objective

To determine whether diagnostic changes of UIP can be appreciated on TBB specimens.

Design

Retrospective analysis of TBB specimens from patients with proven UIP.

Setting

Two study sites in the United States.

Participants

Twenty-one patients with UIP confirmed by surgical lung biopsy and/or lung explant, and 1 patient with UIP confirmed by clinical and radiographic findings along with follow-up information.

Measurements and results

Adequate tissue for diagnosis was available in 18 cases; in 7 cases (32% overall), there were varying combinations of interstitial fibrosis in a patchwork pattern along with fibroblast foci and/or honeycomb change. These features were considered diagnostic of UIP. Interstitial fibrosis along with fibroblast foci or honeycomb change were seen in two other cases, but the fibrosis lacked a patchwork pattern, and these features were considered consistent with UIP. Nonspecific interstitial fibrosis alone was found in nine cases.

Conclusions

In summary, characteristic histologic features of UIP can be identified on TBB specimens more often than previously appreciated. TBB may be more useful in confirming UIP than previously recognized.

Section snippets

Materials and Methods

Written informed consent was obtained from each patient or guardian. The protocol was approved by the local Institutional Review Board or Ethics Committee at each institution, and was in accordance with the recommendations found in the Helsinki Declaration of 1975.

Twenty-two patients with UIP who underwent TBB were identified. In 21 patients, the diagnosis was confirmed by SLB and/or explant specimens (19 by SLB, 2 by explant specimens). The histologic diagnosis of UIP was based on accepted

Clinical Features

There were 9 men and 13 women (age range, 31 to 83 years; mean, 51 years). All patients had dyspnea at presentation, and it had been present from 1 to 60 months (mean, 16 months) in 19 patients in whom this information was known. One patient (case 9) was discovered incidentally during a testicular cancer workup to have interstitial lung infiltrates on chest radiographs, and then retrospectively noted that shortness of breath had been present for 6 months. Two patients (cases 11 and 20) had a

Discussion

Our findings suggest that TBB may be more useful than previously recognized in confirming UIP. The fact that 7 of our 22 cases showed changes considered diagnostic of UIP and an additional 2 cases were considered consistent with UIP indicates that significant changes can be recognized even in these small samples. It should be remembered, however, that all patients had clinical and radiographic features compatible with UIP, including chronic dyspnea, restrictive pulmonary function, interstitial

References (8)

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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

This work was funded by NIH-NHLBI P50 HL67665.

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