title: Fibroblastic foci in usual interstitial pneumonia: idiopathic versus collagen vascular disease.
abstract: A histologic feature of usual interstitial pneumonia is the presence of fibroblastic foci. As some patients with usual interstitial pneumonia and an underlying collagen vascular disease have a better prognosis, we hypothesized that they would have fewer fibroblastic foci. Pathologists reviewed surgical lung biopsies from 108 patients with usual interstitial pneumonia (nine with collagen vascular disease) and assigned a score (absent 0, mild 1, moderate 2, and marked 3) for fibroblastic foci. Patients with idiopathic usual interstitial pneumonia had a higher median profusion of fibroblastic foci (1.75 vs. 1.0, p = 0.003). Baseline characteristics were similar, although patients with a collagen vascular disease were younger, had a shorter duration of symptoms, and had a higher percentage of predicted total lung capacity. Profusion of fibroblastic foci was the most discriminative feature for separating idiopathic from collagen vascular disease-associated usual interstitial pneumonia (odds ratio 8.31; 95% confidence interval, 1.98, 59.42; p = 0.002 for a one-unit increase in fibroblastic foci score). No deaths were noted in the collagen vascular disease-associated usual interstitial pneumonia group; 52 deaths occurred in the idiopathic usual interstitial pneumonia group (log rank; p = 0.005). We conclude that patients with collagen vascular disease-associated usual interstitial pneumonia have fewer fibroblastic foci and improved survival.
authors.affiliation: Department of Radiology, University of Michigan Health System, Ann Arbor, USA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Flaherty
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Colby
authors.forename: William D
authors.initials: WD
authors.lastname: Travis
authors.forename: Galen B
authors.initials: GB
authors.lastname: Toews
authors.forename: Jeanette
authors.initials: J
authors.lastname: Mumford
authors.forename: Susan
authors.initials: S
authors.lastname: Murray
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Thannickal
authors.forename: Ella A
authors.initials: EA
authors.lastname: Kazerooni
authors.forename: Barry H
authors.initials: BH
authors.lastname: Gross
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Lynch
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Martinez
mesh_terms: D000704:Analysis of Variance; D001707:Biopsy, Needle; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D015331:Cohort Studies; D003095:Collagen Diseases / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology*; D005260:Female; D005347:Fibroblasts / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology*; D008297:Male; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging / Q000473:pathology; D012129:Respiratory Function Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed