Pathologic Criteria for the Diagnosis of Usual Interstitial Pneumonia vs Fibrotic Hypersensitivity Pneumonitis in Transbronchial Cryobiopsies.

Autor:	Churg A; Department of Pathology, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada. Electronic address: achurg@mail.ubc.ca., Tazelaar H; Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona., Matej R; Department of Pathology and Molecular Medicine, Third Faculty of Medicine of Charles University and Thomayer University Hospital, Prague, Czech Republic; Department of Pathology, First Faculty of Medicine of Charles University and General University Hospital, Prague, Czech Republic., Vasakova MK; Department of Respiratory Medicine, First Faculty of Medicine of Charles University and Thomayer University Hospital, Prague, Czech Republic., Stewart B; Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida., Patel D; Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida., Duarte E; Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida., Gomez Manjarres DC; Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida., Mehta HJ; Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida., Wright JL; Department of Pathology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada.
Jazyk:	angličtina
Zdroj:	Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc [Mod Pathol] 2023 Sep; Vol. 36 (9), pp. 100221. Date of Electronic Publication: 2023 May 24.
DOI:	10.1016/j.modpat.2023.100221
Abstrakt:	Transbronchial cryobiopsy (TBCB) is increasingly used for the diagnosis of fibrosing interstitial pneumonias, but there are few detailed descriptions of the pathologic findings in such cases. It has been proposed that a combination of patchy fibrosis and fibroblast foci with an absence of alternative features is diagnostic of usual interstitial pneumonia (UIP; ie, idiopathic pulmonary fibrosis [IPF]) in TBCB. In this study, we reviewed 121 TBCB in which a diagnosis of fibrotic hypersensitivity pneumonitis (FHP; n = 83) or IPF (n = 38) was made by multidisciplinary discussion and evaluated a range of pathologic features. Patchy fibrosis was found in 65 of 83 (78%) biopsies from FHP and 32of 38 (84%) biopsies from UIP/IPF cases. Fibroblast foci were present in 47 of 83 (57%) FHP and 27 of 38 (71%) UIP/IPF cases. Fibroblast foci/patchy fibrosis combined did not favor either diagnosis. Architectural distortion was seen in 54 of 83 (65%) FHP and 32 of 38 (84%) UIP/IPF cases (odds ratio [OR] for FHP, 0.35; P = .036) and honeycombing in 18 of 83 (22%) and 17 of 38 (45%), respectively (OR, 0.37; P = .014). Airspace giant cells/granulomas were present in 13 of 83 (20%) FHP and 1 of 38 (2.6%) UIP/IPF cases (OR for FHP, 6.87; P = .068), and interstitial giant cells/granulomas in 20 of 83 (24%) FHP and 0 of 38 (0%) UIP/IPF (OR, 6.7 x 10 6 ; P = .000). We conclude that patchy fibrosis plus fibroblast foci can be found in TBCB from both FHP and UIP/IPF. The complete absence of architectural distortion/honeycombing favors a diagnosis of FHP, as does the presence of airspace or interstitial giant cells/granulomas, but these measures are insensitive, and many cases of FHP cannot be separated from UIP/IPF on TBCB. (Copyright © 2023 United States & Canadian Academy of Pathology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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