Critical reappraisal of underlying histological patterns in patients with suspected idiopathic pulmonary fibrosis

Current Opinion in Pulmonary Medicine
Giulio Rossi, Alberto Cavazza

Abstract

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. 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. 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 repre...Continue Reading

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Citations

Jun 4, 2020·Respiratory Investigation·Daniel S GlassAllison B Reiss
Aug 17, 2021·Current Opinion in Pulmonary Medicine·Claudia Ravaglia, Andrew G Nicholson
May 22, 2020·La Presse médicale·Vincent Cottin, Claudia Valenzuela

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