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

BMC Medicine

David M. Hansell¹  Andrew G. Nicholson⁵  Thomas V. Colby⁷  Samuel A. Yousem²  Jan von der Thüsen³  Anand Devaraj⁶  Nicola Sverzellati⁴  Athol U. Wells⁸  Simon L F Walsh⁹ 

[1] Department of Radiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK;Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA;Medisch Centrum Haaglanden, The Hague Area, Netherlands;Department of Clinical Sciences, Section of Radiology, University of Parma, Via Gramsci 14, Parma, 43126, Italy;Department of Histopathology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK;Department of Radiology, St Georges Hospital, Tooting, London SW17 0QT, UK;Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona, USA;Interstitial Lung Diseases Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK;Department of Radiology, Kings College Hospital Foundation Trust, Denmark Hill, London SE5 9RS, UK

关键词: Survival;    Bronchiectasis;    Fibroblastic foci;    Idiopathic pulmonary fibrosis;    Interstitial lung disease;   

Others  :  1227192
DOI  :  10.1186/s12916-015-0479-0

 received in 2015-04-27, accepted in 2015-09-03,  发布年份 2015

【 摘 要 】

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.

【 授权许可】

   
2015 Walsh et al.

【 图 表 】

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