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Hariri LP, Sharma A, Nandy S, Berigei SR, Yamamoto S, Raphaely RA, Flashner BM, Muniappan A, Auchincloss HG, Lanuti M, Hallowell RW, Shea BS, Keyes CM. Endobronchial Optical Coherence Tomography as a Novel Method for In Vivo Microscopic Assessment of Interstitial Lung Abnormalities. Am J Respir Crit Care Med 2024. [PMID: 38207094 DOI: 10.1164/rccm.202310-1871le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/10/2024] [Indexed: 01/13/2024] Open
Affiliation(s)
- Lida P Hariri
- Massachusetts General Hospital, Pathology, Boston, Massachusetts, United States;
| | - Amita Sharma
- Massachusetts General Hospital, Radiology, Boston, Massachusetts, United States
| | - Sreyankar Nandy
- Massachusetts General Hospital, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Sarita R Berigei
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States
| | - Satomi Yamamoto
- Massachusetts General Hospital, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Rebecca A Raphaely
- University of Washington, 7284, Division of Pulmonary and Critical Care Medicine, Seattle, Washington, United States
| | - Bess M Flashner
- Beth Israel Deaconess Medical Center, 1859, Internal Medicine, Boston, Massachusetts, United States
| | - Ashok Muniappan
- Massachusetts General Hospital, Thoracic Surgery, Boston, Massachusetts, United States
| | - Hugh G Auchincloss
- Massachusetts General Hospital, Thoracic Surgery, Boston, Massachusetts, United States
| | - Michael Lanuti
- Massachusetts General Hospital, Thoracic Surgery, Boston, Massachusetts, United States
| | - Robert W Hallowell
- Massachusetts General Hospital, 2348, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Barry S Shea
- Massachusetts General Hospital, 2348, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Colleen M Keyes
- Massachusetts General Hospital, Interventional Pulmonology, Boston, Massachusetts, United States
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Nandy S, Berigei SR, Keyes CM, Muniappan A, Auchincloss HG, Lanuti M, Roop BW, Shih AR, Colby TV, Medoff BD, Suter MJ, Villiger M, Hariri LP. Polarization-Sensitive Endobronchial Optical Coherence Tomography for Microscopic Imaging of Fibrosis in Interstitial Lung Disease. Am J Respir Crit Care Med 2022; 206:905-910. [PMID: 35675552 DOI: 10.1164/rccm.202112-2832le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sreyankar Nandy
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | | | - Colleen M Keyes
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Ashok Muniappan
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Hugh G Auchincloss
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Michael Lanuti
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | | | - Angela R Shih
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | | | - Benjamin D Medoff
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Melissa J Suter
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Martin Villiger
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
| | - Lida P Hariri
- Massachusetts General Hospital Boston, Massachusetts.,Harvard Medical School Boston, Massachusetts
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Hariri LP, Flashner BM, Kanarek DJ, O'Donnell WJ, Soskis A, Ziehr DR, Frank A, Nandy S, Berigei SR, Sharma A, Mathisen D, Keyes CM, Lanuti M, Muniappan A, Shepard JAO, Mino-Kenudson M, Ly A, Hung YP, Castelino FV, Ott HC, Medoff BD, Christiani DC. E-Cigarette Use, Small Airway Fibrosis, and Constrictive Bronchiolitis. NEJM Evid 2022; 1:10.1056/evidoa2100051. [PMID: 37122361 PMCID: PMC10137322 DOI: 10.1056/evidoa2100051] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Vaping, including the use of electronic cigarettes (e-cigarettes), has become increasingly prevalent, yet the associated long-term health risks are largely unknown. Given the prevalence of use, particularly among adolescents early in their lifespan, it is vital to understand the potential chronic pathologic sequelae of vaping. METHODS We present the cases of four patients with chronic lung disease associated with e-cigarette use characterized by clinical evaluation, with pulmonary function tests (PFTs), chest high-resolution computed tomography (HRCT), endobronchial optical coherence tomography (EB-OCT) imaging, and histopathologic assessment. RESULTS Each patient presented with shortness of breath and chest pain in association with a 3- to 8-year history of e-cigarette use, with mild progressive airway obstruction on PFTs and/or chest HRCT findings demonstrating evidence of air trapping and bronchial wall thickening. EB-OCT imaging performed in two patients showed small airway–centered fibrosis with bronchiolar narrowing and lumen irregularities. The predominant histopathologic feature on surgical lung biopsy was small airway–centered fibrosis, including constrictive bronchiolitis and MUC5AC overexpression in all patients. Patients who ceased vaping had a partial, but not complete, reversal of disease over 1 to 4 years. CONCLUSIONS After thorough evaluation for other potential etiologies, vaping was considered to be the most likely common causal etiology for all patients due to the temporal association of symptomatic chronic lung disease with e-cigarette use and partial improvement in symptoms after e-cigarette cessation. In this series, we associate the histopathologic pattern of small airway–centered fibrosis, including constrictive bronchiolitis, with vaping, potentially defining a clinical and pathologic entity associated with e-cigarette use. (Funded in part by the National Institutes of Health.)
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Affiliation(s)
- Lida P Hariri
- Department of Pathology, Massachusetts General Hospital, Boston
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Bess M Flashner
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - David J Kanarek
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Walter J O'Donnell
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Alyssa Soskis
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
- Division of Pulmonary and Critical Care Medicine, Duke University Hospital, Durham, NC
| | - David R Ziehr
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Angela Frank
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Sreyankar Nandy
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Sarita R Berigei
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Amita Sharma
- Harvard Medical School, Boston
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Douglas Mathisen
- Harvard Medical School, Boston
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston
| | - Colleen M Keyes
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Michael Lanuti
- Harvard Medical School, Boston
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston
| | - Ashok Muniappan
- Harvard Medical School, Boston
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston
| | | | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Flavia V Castelino
- Harvard Medical School, Boston
- Division of Rheumatology, Massachusetts General Hospital, Boston
| | - Harald C Ott
- Harvard Medical School, Boston
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - David C Christiani
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
- Harvard T.H. Chan School of Public Health, Boston
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4
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Nandy S, Raphaely RA, Muniappan A, Shih A, Roop BW, Sharma A, Keyes CM, Colby TV, Auchincloss HG, Gaissert HA, Lanuti M, Morse CR, Ott HC, Wain JC, Wright CD, Garcia-Moliner ML, Smith ML, VanderLaan PA, Berigei SR, Mino-Kenudson M, Horick NK, Liang LL, Davies DL, Szabari MV, Caravan P, Medoff BD, Tager AM, Suter MJ, Hariri LP. Reply to Kalverda et al.: Endobronchial Optical Coherence Tomography: Shining New Light on Diagnosing Usual Interstitial Pneumonitis? Am J Respir Crit Care Med 2022; 205:968-971. [PMID: 35148493 PMCID: PMC9838623 DOI: 10.1164/rccm.202112-2737le] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Sreyankar Nandy
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Rebecca A. Raphaely
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Ashok Muniappan
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Angela Shih
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | | | - Amita Sharma
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Colleen M. Keyes
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | | | - Hugh G. Auchincloss
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Henning A. Gaissert
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Michael Lanuti
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Christopher R. Morse
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Harald C. Ott
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - John C. Wain
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts,St. Elizabeth’s Medical CenterBoston, Massachusetts
| | - Cameron D. Wright
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | | | | | - Paul A. VanderLaan
- Harvard Medical SchoolBoston, Massachusetts,Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | | | - Mari Mino-Kenudson
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Nora K. Horick
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | | | | | - Margit V. Szabari
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Peter Caravan
- Harvard Medical SchoolBoston, Massachusetts,Athinoula A. Martinos Center for Biomedical ImagingCharlestown, Massachusetts,Massachusetts General HospitalCharlestown, Massachusetts
| | - Benjamin D. Medoff
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Andrew M. Tager
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Melissa J. Suter
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Lida P. Hariri
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts,Corresponding author (e-mail: )
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5
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Nandy S, Raphaely RA, Muniappan A, Shih A, Roop BW, Sharma A, Keyes CM, Colby TV, Auchincloss HG, Gaissert HA, Lanuti M, Morse CR, Ott HC, Wain JC, Wright CD, Garcia-Moliner ML, Smith ML, VanderLaan PA, Berigei SR, Mino-Kenudson M, Horick NK, Liang LL, Davies DL, Szabari MV, Caravan P, Medoff BD, Tager AM, Suter MJ, Hariri LP. Diagnostic Accuracy of Endobronchial Optical Coherence Tomography for the Microscopic Diagnosis of Usual Interstitial Pneumonia. Am J Respir Crit Care Med 2021; 204:1164-1179. [PMID: 34375171 PMCID: PMC8759308 DOI: 10.1164/rccm.202104-0847oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022] Open
Abstract
Rationale: Early, accurate diagnosis of interstitial lung disease (ILD) informs prognosis and therapy, especially in idiopathic pulmonary fibrosis (IPF). Current diagnostic methods are imperfect. High-resolution computed tomography has limited resolution, and surgical lung biopsy (SLB) carries risks of morbidity and mortality. Endobronchial optical coherence tomography (EB-OCT) is a low-risk, bronchoscope-compatible modality that images large lung volumes in vivo with microscopic resolution, including subpleural lung, and has the potential to improve the diagnostic accuracy of bronchoscopy for ILD diagnosis. Objectives: We performed a prospective diagnostic accuracy study of EB-OCT in patients with ILD with a low-confidence diagnosis undergoing SLB. The primary endpoints were EB-OCT sensitivity/specificity for diagnosis of the histopathologic pattern of usual interstitial pneumonia (UIP) and clinical IPF. The secondary endpoint was agreement between EB-OCT and SLB for diagnosis of the ILD fibrosis pattern. Methods: EB-OCT was performed immediately before SLB. The resulting EB-OCT images and histopathology were interpreted by blinded, independent pathologists. Clinical diagnosis was obtained from the treating pulmonologists after SLB, blinded to EB-OCT. Measurements and Main Results: We enrolled 31 patients, and 4 were excluded because of inconclusive histopathology or lack of EB-OCT data. Twenty-seven patients were included in the analysis (16 men, average age: 65.0 yr): 12 were diagnosed with UIP and 15 with non-UIP ILD. Average FVC and DlCO were 75.3% (SD, 18.5) and 53.5% (SD, 16.4), respectively. Sensitivity and specificity of EB-OCT was 100% (95% confidence interval, 75.8-100.0%) and 100% (79.6-100%), respectively, for both histopathologic UIP and clinical diagnosis of IPF. There was high agreement between EB-OCT and histopathology for diagnosis of ILD fibrosis pattern (weighted κ: 0.87 [0.72-1.0]). Conclusions: EB-OCT is a safe, accurate method for microscopic ILD diagnosis, as a complement to high-resolution computed tomography and an alternative to SLB.
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Affiliation(s)
- Sreyankar Nandy
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Rebecca A. Raphaely
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Ashok Muniappan
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Angela Shih
- Department of Pathology
- Harvard Medical School, Boston, Massachusetts
| | - Benjamin W. Roop
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
| | - Amita Sharma
- Department of Radiology, and
- Harvard Medical School, Boston, Massachusetts
| | - Colleen M. Keyes
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Thomas V. Colby
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | | | - Michael Lanuti
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | | | - Harald C. Ott
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - John C. Wain
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
- St. Elizabeth’s Medical Center, Boston, Massachusetts
| | - Cameron D. Wright
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Maria L. Garcia-Moliner
- Department of Pathology, Rhode Island Hospital and Alpert Medical School, Providence, Rhode Island
| | - Maxwell L. Smith
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Paul A. VanderLaan
- Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sarita R. Berigei
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
| | | | - Nora K. Horick
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | - Margit V. Szabari
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Peter Caravan
- Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts; and
- Institute for Innovation in Imaging (i), Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Benjamin D. Medoff
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Andrew M. Tager
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Melissa J. Suter
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Lida P. Hariri
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Department of Pathology
- Harvard Medical School, Boston, Massachusetts
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6
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Nandy S, Helland TL, Roop BW, Raphaely RA, Ly A, Lew M, Berigei SR, Villiger M, Sorokina A, Szabari MV, Fintelmann FJ, Suter MJ, Hariri LP. Rapid non-destructive volumetric tumor yield assessment in fresh lung core needle biopsies using polarization sensitive optical coherence tomography. Biomed Opt Express 2021; 12:5597-5613. [PMID: 34692203 PMCID: PMC8515979 DOI: 10.1364/boe.433346] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 05/28/2023]
Abstract
Adequate tumor yield in core-needle biopsy (CNB) specimens is essential in lung cancer for accurate histological diagnosis, molecular testing for therapeutic decision-making, and tumor biobanking for research. Insufficient tumor sampling in CNB is common, primarily due to inadvertent sampling of tumor-associated fibrosis or atelectatic lung, leading to repeat procedures and delayed diagnosis. Currently, there is no method for rapid, non-destructive intraprocedural assessment of CNBs. Polarization-sensitive optical coherence tomography (PS-OCT) is a high-resolution, volumetric imaging technique that has the potential to meet this clinical need. PS-OCT detects endogenous tissue properties, including birefringence from collagen, and degree of polarization uniformity (DOPU) indicative of tissue depolarization. Here, PS-OCT birefringence and DOPU measurements were used to quantify the amount of tumor, fibrosis, and normal lung parenchyma in 42 fresh, intact lung CNB specimens. PS-OCT results were compared to and validated against matched histology in a blinded assessment. Linear regression analysis showed strong correlations between PS-OCT and matched histology for quantification of tumors, fibrosis, and normal lung parenchyma in CNBs. PS-OCT distinguished CNBs with low tumor content from those with higher tumor content with high sensitivity and specificity. This study demonstrates the potential of PS-OCT as a method for rapid, non-destructive, label-free intra-procedural tumor yield assessment.
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Affiliation(s)
- Sreyankar Nandy
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Harvard Medical School, Boston, MA 02110, USA
| | - Timothy L. Helland
- Harvard Medical School, Boston, MA 02110, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02110, USA
| | - Benjamin W. Roop
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02110, USA
| | - Rebecca A. Raphaely
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Harvard Medical School, Boston, MA 02110, USA
| | - Amy Ly
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Harvard Medical School, Boston, MA 02110, USA
| | - Madelyn Lew
- Department of Pathology, University of Michigan, Ann Arbor, MI 48104, USA
| | - Sarita R. Berigei
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02110, USA
| | - Martin Villiger
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Harvard Medical School, Boston, MA 02110, USA
| | - Anastasia Sorokina
- Department of Pathology, University of Illinois at Chicago, Chicago, IL 60131, USA
- Department of Pathology, Research Institute of Human Morphology, Moscow 103132, Russia
| | - Margit V. Szabari
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Harvard Medical School, Boston, MA 02110, USA
| | - Florian J. Fintelmann
- Harvard Medical School, Boston, MA 02110, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02110, USA
| | - Melissa J. Suter
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Harvard Medical School, Boston, MA 02110, USA
| | - Lida P. Hariri
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Harvard Medical School, Boston, MA 02110, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02110, USA
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7
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Shih AR, Nitiwarangkul C, Little BP, Roop BW, Nandy S, Szabari MV, Mercaldo N, Mercaldo S, Montesi SB, Muniappan A, Berigei SR, Lynch DA, Sharma A, Hariri LP. Practical application and validation of the 2018 ATS/ERS/JRS/ALAT and Fleischner Society guidelines for the diagnosis of idiopathic pulmonary fibrosis. Respir Res 2021; 22:124. [PMID: 33902572 PMCID: PMC8074481 DOI: 10.1186/s12931-021-01670-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/22/2021] [Indexed: 12/21/2022] Open
Abstract
Background Accurate diagnosis of idiopathic pulmonary fibrosis (IPF) is essential to inform prognosis and treatment. In 2018, the ATS/ERS/JRS/ALAT and Fleischner Society released new diagnostic guidelines for usual interstitial pneumonitis (UIP)/IPF, adding Probable UIP as a CT category based on prior studies demonstrating this category had relatively high positive predictive value (PPV) for histopathologic UIP/Probable UIP. This study applies the 2018 ATS/ERS/JRS/ALAT and Fleischner Society guidelines to determine test characteristics of CT categories in academic clinical practice. Methods CT and histopathology were evaluated by three thoracic radiologists and two thoracic pathologists. Comparison of consensus categorization by the 2018 ATS and Fleischner Society guidelines by CT and histopathology was performed. Results Of patients with CT UIP, 87% (PPV, 95% CI: 60–98%) had histopathologic UIP with 97% (CI: 90–100%) specificity. Of patients with CT Probable UIP, 38% (PPV, CI: 14–68%) had histopathologic UIP and 46% (PPV, CI: 19–75%) had either histopathologic UIP or Probable UIP, with 88% (CI: 77–95%) specificity. Patients with CT Indeterminate and Alternative Diagnosis had histopathologic UIP in 27% (PPV, CI: 6–61%) and 21% (PPV, CI: 11–33%) of cases with specificities of 90% (CI: 80–96%) and 25% (CI: 16–37%). Interobserver variability (kappa) between radiologists ranged 0.32–0.81. Conclusions CT UIP and Probable UIP have high specificity for histopathologic UIP, and CT UIP has high PPV for histopathologic UIP. PPV of CT Probable UIP was 46% for combined histopathologic UIP/Probable UIP. Our results indicate that additional studies are needed to further assess and refine the guideline criteria to improve classification performance. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01670-7.
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Affiliation(s)
- Angela R Shih
- Department of Pathology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, USA
| | - Chayanin Nitiwarangkul
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Brent P Little
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Benjamin W Roop
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sreyankar Nandy
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Margit V Szabari
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Nathaniel Mercaldo
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sarah Mercaldo
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sydney B Montesi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ashok Muniappan
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sarita R Berigei
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - Amita Sharma
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Lida P Hariri
- Department of Pathology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA. .,Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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