[1935] Histopathologic Comparison of Biopsy with Subsequent Explant/Autopsy in Patients with Interstitial Lung Disease

Anja C Roden, Ronald S Kuzo, David L Levin, Teng Moua, Jay H Ryu, Eunhee S Yi. Mayo Clinic, Rochester, MN

Background: The temporal evolution of histologic features of interstitial lung disease (ILD) is not well characterized. Although literature suggests that for instance cellular non-specific interstitial pneumonia (NSIP) might evolve into fibrotic NSIP, the incidence of that process is unknown. Moreover, sampling might play a role in our ability to correctly diagnose ILD. We studied patients with clinically suspected ILD who underwent biopsy (bx) and subsequent lung transplant or autopsy.
Design: Patients with clinically suspected ILD, a lung bx and a subsequent explant or autopsy were included. Pathology was reviewed by two pulmonary pathologists and a consensus diagnosis was reached. CT scans at the time of bx were reviewed by two thoracic radiologists and a consensus was reached.
Results: 34 patients (19 men, 15 women) with a median age of 56.6 years (range, 25-76) underwent surgical (n=32) or transbronchial bx (n=2) and had a subsequent transplantation (n=21) or autopsy (n=13). Median time between bx and explant/autopsy was 3.8 years (range, 0-24). Tables 1&2 summarize the histologic diagnoses of patients with morphologic progression (n=10, 29.4%) and patients with stable ILD (n=19, 55.9%).

Table 1: Patients with morphologic progression (n=10)
BiopsyExplant/Autopsy# PatientsComments
Hypersensitivity pneumonitis (HP)Chronic HP2 
Focal fibrosisUsual interstitial pneumonia (UIP)2Increase in fibrosis, new honeycomb changes (HC)
EmphysemaUIP1Lower lobe not biopsied
EmphysemaCystic bronchiectasis1 
Organizing pneumonia (OP)Fibrotic NSIP1 
OP, fibroblast fociHC &scarring1 
Thickened pleuraLymphangioleiomyomatosis (LAM)1 
Chronic bronchiolitis &granulomaBronchiolocentric fibrosis &scarring1 

Table 2: Patients with stable ILD (n=19)
Diagnosis Biopsy/Explant/Autopsy# Patients
Chronic HP1

In 5 patients (14.7%), the ILD could not be classified morphologically. In 23 patients, the bx results together with CT (n=31) and clinical workup (n=34) led to a diagnosis at time of bx that matched the diagnosis of the explant/autopsy. The median follow-up (n=34) time after bx was 6.6 years (range, 0.12-24.02). 26 patients died.
Conclusions: Histopathologic differences between bx and explant/autopsy were not uncommon and were due to disease progression and/or limited sampling in bx. However, in the majority of patients, the diagnosis at time of bx matched the diagnosis on explant/transplant when morphologic findings were combined with radiologic and clinical impression.
Category: Pulmonary

Tuesday, March 5, 2013 1:00 PM

Poster Session IV # 287, Tuesday Afternoon


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