title: Usual interstitial pneumonia end-stage features from explants with radiologic and pathological correlations.
abstract: Idiopathic pulmonary fibrosis (IPF) is the most frequent and severe idiopathic interstitial pneumonia, with typical high-resolution computed tomography (HRCT) features and histologic pattern of usual interstitial pneumonia (UIP); its main differential diagnosis is fibrotic nonspecific interstitial pneumonia (F-NSIP). Usual interstitial pneumonia was mainly described from lung biopsies, and little is known on explants. Twenty-two UIP/IPF explants were analyzed histologically and compared with previous open lung biopsies (OLBs; n = 11) and HRCT (n = 19), when available. Temporospatial heterogeneity and subpleural and paraseptal fibrosis were similarly found in UIP/IPF explants and OLB (91%-95%). Fibroblastic foci were found in 82% of OLBs and 100% of explants, with a higher mean score in explants (P = .023). Honeycombing was present in 64% of OLBs and 95% of explants, with a higher mean score in explants (P = .005). Almost 60% of UIP/IPF explants showed NSIP areas and 41% peribronchiolar fibrosis; inflammation, bronchiolar metaplasia, and vascular changes were more frequent in UIP/IPF explants; and Desquamative Interstitial Pneumonia (DIP)-like areas were not common (18%-27%). Numerous large airspace enlargements with fibrosis were frequent in UIP/IPF explants (59%). On HRCT, honeycombing was observed in 95% of the cases and ground-glass opacities in 53%, correlating with NSIP areas or acute exacerbation at histology. Six patients had combined IPF and emphysema. Lesions were more severe in UIP/IPF explants, reflecting the worsening of the disease. Usual interstitial pneumonia/IPF explants more frequently presented with confounding lesions such as NSIP areas, peribronchiolar fibrosis, and airspace enlargements with fibrosis sometimes associated with emphysema.
authors.affiliation: Département de Pathologie, Pôle de Biologie et de Pathologie, Centre Hospitalier Universitaire, Inserm U823, Institut A Bonniot-Université J Fourier, Grenoble, France.
authors.forename: Maud
authors.initials: M
authors.lastname: Rabeyrin
authors.affiliation: Centre de Pathologie Est, Hospices Civils de Lyon, Groupement Hospitalier Est, Université Claude Bernard Lyon I, Inserm UMR 754 and IFR 128, Lyon, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Thivolet
authors.affiliation: Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire, Inserm U823, Institut A Bonniot-Université J Fourier, Grenoble, France.
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Ferretti
authors.affiliation: Centre de Pathologie Est, Hospices Civils de Lyon, Groupement Hospitalier Est, Université Claude Bernard Lyon I, Inserm UMR 754 and IFR 128, Lyon, France.
authors.forename: Lara
authors.initials: L
authors.lastname: Chalabreysse
authors.affiliation: Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire, Inserm U823, Institut A Bonniot-Université J Fourier, Grenoble, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Jankowski
authors.affiliation: Service de Pneumologie, Centre de référence national des maladies pulmonaires rares, Hospices Civils de Lyon, Hôpital Louis Pradel, Université Claude Bernard Lyon I, UMR754 and IFR128, Lyon, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Cottin
authors.affiliation: Clinique Universitaire de Pneumologie, Pôle Oncologie, Médecine Aiguë et Communautaire, Centre Hospitalier Universitaire, Inserm U1055, Université Joseph Fourier, Grenoble, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Pison
authors.affiliation: Service de Pneumologie, Centre de référence national des maladies pulmonaires rares, Hospices Civils de Lyon, Hôpital Louis Pradel, Université Claude Bernard Lyon I, UMR754 and IFR128, Lyon, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Cordier
authors.affiliation: Département de Pathologie, Pôle de Biologie et de Pathologie, Centre Hospitalier Universitaire, Inserm U823, Institut A Bonniot-Université J Fourier, Grenoble, France. Electronic address: SLantuejoul@chu-grenoble.fr.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Lantuejoul
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000473:pathology*; D007249:Inflammation / Q000473:pathology; D016040:Lung Transplantation / Q000379:methods; D008297:Male; D008679:Metaplasia / Q000473:pathology; D008875:Middle Aged; D011658:Pulmonary Fibrosis / Q000601:surgery; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
keywords: Explant; High-resolution computed tomography; Lung transplantation; Nonspecific interstitial pneumonia; Open lung biopsy; Pulmonary fibrosis; Usual interstitial pneumonia