title: Clinicopathologic features associated with relapse in cryptogenic organizing pneumonia.
abstract: Organizing pneumonia (OP) is a histopathologic pattern of response to lung injury. Fibrin is a marker of acute microvascular injury, and variable amounts of intraalveolar fibrin are seen in OP; however, its relevance to clinical outcomes is unclear. We examined lung wedge biopsies of 26 patients with cryptogenic organizing pneumonia (COP), assessed the amount of fibrin associated with airspace organization, and correlated fibrin levels with other histologic, clinical, and radiographic findings. Seven patients with COP had disease relapse. Patients with multifocal fibrin deposits or acute fibrinous and organizing pneumonia (collectively, "high fibrin") showed a higher rate of OP relapse compared to those with no or focal fibrin (60% versus 6%, P < .05). Patients with radiographic evidence of disease involving all three lung zones (upper, middle, and lower) also showed higher rates of relapse compared to those in whom disease was limited to one or two zones (41% versus 0%, P = .055). In patients with both pathologic evidence of high fibrin and radiographic evidence of three-zone disease, OP relapse could be predicted with a sensitivity of 86% and specificity of 84% (positive predictive value of 67% and negative predictive value of 94%). The presence of high levels of intraalveolar fibrin in lung biopsies and radiographic evidence of disease involving all three lung zones is associated with increased risk of relapse in patients with COP, and these features may help identify patients who may benefit from more intensive steroid therapy.
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, MA 02114.
authors.forename: Michiya
authors.initials: M
authors.lastname: Nishino
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, MA 02114.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Mathai
authors.affiliation: Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114.
authors.forename: David
authors.initials: D
authors.lastname: Schoenfeld
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, MA 02114.
authors.forename: Subba R
authors.initials: SR
authors.lastname: Digumarthy
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, MA 02114; Department of Medicine, Massachusetts General Hospital, Boston, MA 02114; Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, MA 02114. Electronic address: rkradin@partners.org.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kradin
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D018549:Cryptogenic Organizing Pneumonia / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005337:Fibrin / Q000032:analysis*; D006801:Humans; D008168:Lung / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005337:Fibrin
keywords: Acute fibrinous and organizing pneumonia; Cryptogenic organizing pneumonia; Fibrin; Lung