http://hdl.handle.net/2027.42/55486 2013-05-23T03:06:25Z http://hdl.handle.net/2027.42/91977 Radiologic versus Histologic Diagnosis in UIP and NSIP: Survival Implications Flaherty, Kevin R.; Thwaite, E. L.; Kazerooni, Ella A.; Gross, Barry H.; Toews, Galen B.; Colby, Thomas V.; Travis, William D.; Mumford, Jeanette A.; Murray, Susan; Flint, Andrew; Lynch, Joseph P. III; Martinez, Fernando J. Background: High resolution computed tomography (HRCT) has an important diagnostic role in idiopathic interstitial pneumonia (IIP). We hypothesised that the HRCT appearance would have an impact on survival in patients with IIP. Methods: HRCT scans from patients with histological usual interstitial pneumonia (UIP; n=73) or histological non-specific interstitial pneumonia (NSIP; n=23) were characterised as definite UIP, probable UIP, indeterminate, probable NSIP, or definite NSIP. Cox regression analysis examined the relationships between histopathological and radiological diagnoses and mortality, controlling for patient age, sex, and smoking status. Results: All 27 patients with definite or probable UIP on HRCT had histological UIP; 18 of 44 patients with probable or definite NSIP on HRCT had histological NSIP. Patients with HRCT diagnosed definite or probable UIP had a shorter survival than those with indeterminate CT (hazards ratio (HR) 2.43, 95% CI 1.06 to 5.58; median survival 2.08 v 5.76 years) or HRCT diagnosed definite or probable NSIP (HR 3.47, 95% CI 1.58 to 7.63; median survival 2.08 v 5.81 years). Patients with histological UIP with no HRCT diagnosis of probable or definite UIP fared better than patients with histological UIP and an HRCT diagnosis of definite or probable UIP (HR 0.49, 95% CI 0.25 to 0.98; median survival 5.76 v 2.08 years) and worse than those with a histological diagnosis of NSIP (HR 5.42, 95% CI 1.25 to 23.5; median survival 5.76 v >9 years). Conclusions: Patients with a typical HRCT appearance of UIP experience the highest mortality. A surgical lung biopsy is indicated for patients without an HRCT appearance of UIP to differentiate between histological UIP and NSIP. 2003-02-01T00:00:00Z http://hdl.handle.net/2027.42/91976 Thoracic transplantation Grover, Frederick L.; Barr, Mark L.; Edwards, Leah B.; Martinez, Fernando J.; Pierson, Richard N. III; Rosengard, Bruce R.; Murray, Susan Note on Sources: The articles in this supplement are based on the reference tables in the 2002 OPTN/SRTR Annual Report, which are not included in this publication. Many relevant data appear in figures and tables directly referred to in the article; other tables from the Annual Report that serve as the basis for this article include the following: Tables 1.5, 1.6, 1.12, 1.13, 11.1–11.4, 11.8, 11.9, 12.1–12.4, 12.7–12.9, 13.1–13.4, and 13.7–13.9. All of these tables are also available online at http://www.ustransplant.org. 2003-01-01T00:00:00Z http://hdl.handle.net/2027.42/91974 Fibroblastic Foci in Usual Interstitial Pneumonia: Idiopathic versus Collagen Vascular Disease Flaherty, Kevin R.; Colby, Thomas V.; Travis, William D.; Toews, Galen B.; Mumford, Jeanette A.; Murray, Susan; Thannickal, Victor J.; Kazerooni, Ella A.; Gross, Barry H.; Lynch, Joseph P. III; Martinez, Fernando J. 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. 2003-05-15T00:00:00Z http://hdl.handle.net/2027.42/91973 Prognostic implications of physiologic and radiographic changes in idiopathic interstitial pneumonia Flaherty, Kevin R.; Mumford, Jeanette A.; Murray, Susan; Kazerooni, Ella A.; Gross, Barry H.; Colby, Thomas V.; Travis, William D.; Flint, Andrew; Toews, Galen B.; Lynch, Joseph P. III; Martinez, Fernando J. Idiopathic interstitial pneumonias are a diverse group of lung diseases with varied prognoses. We hypothesized that changes in physiologic and radiographic parameters would predict survival. We retrospectively examined 80 patients with usual interstitial pneumonia and 29 patients with nonspecific interstitial pneumonia. Baseline characteristics were examined together with 6-month change in forced vital capacity, diffusing capacity for carbon monoxide, and ground glass infiltrate and fibrosis on high resolution computed tomography. Patients with usual interstitial pneumonia were more likely to have a statistically significant or marginally significant decline in lung volume, diffusing capacity for carbon monoxide, and an increase in ground glass infiltrates (p <= 0.08) compared with patients with nonspecific interstitial pneumonia. For patients with usual interstitial pneumonia, change in forced vital capacity was the best physiologic predictor of mortality (p = 0.05). In a multivariate Cox proportional hazards model controlling for histopathologic diagnosis, gender, smoking history, baseline forced vital capacity, and 6-month change in forced vital capacity, a decrease in forced vital capacity remained an independent risk factor for mortality (decrease > 10%; hazard ratio 2.47; 95% confidence interval 1.29, 4.73; p = 0.006). We conclude that a 6-month change in forced vital capacity gives additional prognostic information to baseline features for patients with idiopathic interstitial pneumonia. 2003-09-01T00:00:00Z