Critical reappraisal of underlying histological patterns in patients with suspected idiopathic pulmonary fibrosis. Issue 5 (September 2019)

• Record Type: Journal Article
• Authors: Rossi, Giulio; Cavazza, Alberto
• Is Part Of: Current opinion in pulmonary medicine. Volume 25:Issue 5(2019:Sep.)
• Publication Date: 2019-09
• Subjects: genomic -- histology -- hypersensitivity pneumonia -- idiopathic pulmonary fibrosis -- disease -- pattern -- usual interstitial pneumonia; Respiratory organs -- Diseases -- Periodicals; 616.24
• DOI: 10.1097/MCP.0000000000000595
• Languages: English
• ISSNs: 1070-5287

Abstract

Abstract : Purpose of review: Usual interstitial pneumonia (UIP) pattern is the histologic marker of idiopathic pulmonary fibrosis (IPF), but usefulness of ancillary histologic findings may discriminate idiopathic from secondary UIP. Recent findings: Alternative less invasive procedures may identify UIP pattern preventing conventional surgical lung biopsy, whereas genomic analysis may recognize UIP pattern from otherwise poorly diagnostic samples. Summary: High-resolution computed tomography identifies a 'definite' UIP pattern in about half of cases, failing to recognize UIP in the absence of honeycombing or in limited disease. Although radiologic criteria for UIP need redefinition to improve their diagnostic yield, histologic features of UIP did not significantly change from the 1960s but continue to represent a major diagnostic tool, particularly in challenging interstitial lung diseases. A careful recognition of some histologic ancillary findings in UIP (e.g., cellular/follicular bronchiolitis with germinal centers, chronic pleuritis, interstitial granulomas/giant cells, bridging fibrosis) may be helpful in supporting secondary forms (e.g., connective tissue disease, chronic hypersensitivity pneumonia) from IPF. Cryobiopsy and awake-biopsy are promising approaches to obtain representative lung tissue preventing conventional surgical lung biopsy. Genomic techniques have recently demonstrated good-to-high sensitivity and specificity to disclose UIP pattern starting from RNA obtained in transbronchial biopsy, possibly replacing and/or flanking soon traditional histology.