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Diridollou T, Sohier L, Rousseau C, Angibaud A, Chauvin P, Gaignon T, Tas M, Lemerre J, Kerjouan M, Salé A, Lederlin M, Jouneau S. Idiopathic pulmonary fibrosis: Significance of the usual interstitial pneumonia (UIP) CT-scan patterns defined in new international guidelines. Respir Med Res 2020; 77:72-78. [PMID: 32416587 DOI: 10.1016/j.resmer.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The new 2018 international guidelines for diagnosing usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF) by CT scan split the old pattern possible UIP (2011 IPF guidelines) into two new patterns: probable UIP and indeterminate for UIP. However, the proportions and prognoses of these new CT-scan patterns are not clear. METHODS We used a monocentric retrospective cohort of 322 patients suspected of having IPF (University Hospital of Rennes; Competence Center for Rare Lung Diseases; 1 January 2012-31 December 2017). All patients initially diagnosed by CT scan as possible UIP were included. The chest CT-scans were then reclassified according to the new 2018 international guidelines by 3 observers. These data were then subjected to survival analysis with multivariate Cox regression using a composite endpoint of death, lung transplantation, a decline of≥10% in forced vital capacity (FVC), or hospitalization. RESULTS Of the 89 possible UIP patients included, 74 (83%) were reclassified as probable UIP and 15 (17%) as indeterminate for UIP. Probable UIP patients were more likely to meet the composite endpoint (56/74 [75.7%] vs. 5/15 [33%] patients; HR [IC 95%] =3.12 [1.24; 7.83], P=0.015). Multivariate analysis indicated that the probable UIP pattern was associated with significantly increased risk of reaching the composite endpoint (HR [95% CI]=2.85[1.00; 8.10], P=0.049). CONCLUSION The majority of possible UIP diagnoses corresponded to probable UIP, which was associated with a significantly worse prognosis than indeterminate for UIP. This distinction between these two CT patterns emphasizes the relevance of the new international guidelines for the diagnosis of IPF.
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Affiliation(s)
- T Diridollou
- Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France.
| | - L Sohier
- Service de pneumologie, centre hospitalier Lorient, Lorient, France
| | - C Rousseau
- Centre d'investigation clinique, Inserm 1414, Rennes, France
| | - A Angibaud
- Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France
| | - P Chauvin
- Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France
| | - T Gaignon
- Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France
| | - M Tas
- Service de radiologie, CHU de Rennes, France, université de Rennes 1, Rennes, France
| | - J Lemerre
- Service de radiologie, CHU de Rennes, France, université de Rennes 1, Rennes, France
| | - M Kerjouan
- Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France
| | - A Salé
- Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France
| | - M Lederlin
- Service de radiologie, CHU de Rennes, France, université de Rennes 1, Rennes, France
| | - S Jouneau
- Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France; Service de pneumologie, centre hospitalier Lorient, Lorient, France; Centre d'investigation clinique, Inserm 1414, Rennes, France; Service de radiologie, CHU de Rennes, France, université de Rennes 1, Rennes, France; UMR1085, IRSET, université de Rennes 1, Rennes, France.
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