Radiologic Findings Are Strongly Associated with a Pathologic Diagnosis of Usual Interstitial Pneumonia

Gary W. Hunninghake, David A. Lynch, Jeffrey R. Galvin, Barry H. Gross, Nestor Müller, David A. Schwartz, Talmadge E. King, Joseph P. Lynch, Richard Hegele, James Waldron, Thomas V. Colby, James C. Hogg

Research output: Contribution to journalArticle

224 Citations (Scopus)

Abstract

Purpose: To determine which clinical and radiologic findings are independently associated with a pathologic diagnosis of usual interstitial pneumonia (UIP). Methods: We recently reported, using a prospective, multicenter study of patients suspected of having idiopathic interstitial pneumonia (IIP), that a confident diagnosis of UIP made by experienced radiologists was correct in 95% of cases. In the current article, we further analyzed data from this study. Ninety-one patients were entered into the study. Clinical, physiologic, chest radiographic, and CT features were prospectively recorded, and analyzed using univariate and multivariate logistic regression analysis to compare the patients with a histologic diagnosis of UIP with those who received other pathologic diagnoses. Results: Fifty-four of 91 patients (59%) received a pathologic diagnosis of UIP. The following features recorded at the referring clinical centers were associated with a pathologic diagnosis of UIP on multivariate analysis: lower-lobe honeycombing on high-resolution CT (HRCT) [odds ratio, 11.45], radiographic findings consistent with UIP (odds ratio, 5.73), elevated ratio of FEV1 to FVC (odds ratio, 4.8), and absence of smoking history (odds ratio, 0.19). On multivariate analysis of specific HRCT features recorded by four experienced chest radiologists, lower-lung honeycombing (odds ratio, 5.36) and upper-lung irregular lines (odds ratio, 6.28) were the only independent predictors of UIP. Using only these two factors, a diagnosis of UIP could be established with a sensitivity of 74%, a specificity of 81%; and a positive predictive value of 85%. Conclusion: In patients presenting with a clinical syndrome suggestive of IIP, CT findings of lower-lung honeycombing and upper-lung irregular lines are most closely associated with a pathologic diagnosis of UIP.

Original languageEnglish (US)
Pages (from-to)1215-1223
Number of pages9
JournalChest
Volume124
Issue number4
DOIs
StatePublished - Oct 2003
Externally publishedYes

Fingerprint

Idiopathic Pulmonary Fibrosis
Odds Ratio
Idiopathic Interstitial Pneumonias
Lung
Thorax
Multivariate Analysis
Multicenter Studies
Logistic Models
Smoking
History
Regression Analysis
Prospective Studies

Keywords

  • Chest radiograph
  • Idiopathic interstitial pneumonia
  • Idiopathic pulmonary fibrosis
  • Interstitial lung disease
  • Lung
  • Lung CT scans
  • Thorax
  • Usual interstitial pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Hunninghake, G. W., Lynch, D. A., Galvin, J. R., Gross, B. H., Müller, N., Schwartz, D. A., ... Hogg, J. C. (2003). Radiologic Findings Are Strongly Associated with a Pathologic Diagnosis of Usual Interstitial Pneumonia. Chest, 124(4), 1215-1223. https://doi.org/10.1378/chest.124.4.1215

Radiologic Findings Are Strongly Associated with a Pathologic Diagnosis of Usual Interstitial Pneumonia. / Hunninghake, Gary W.; Lynch, David A.; Galvin, Jeffrey R.; Gross, Barry H.; Müller, Nestor; Schwartz, David A.; King, Talmadge E.; Lynch, Joseph P.; Hegele, Richard; Waldron, James; Colby, Thomas V.; Hogg, James C.

In: Chest, Vol. 124, No. 4, 10.2003, p. 1215-1223.

Research output: Contribution to journalArticle

Hunninghake, GW, Lynch, DA, Galvin, JR, Gross, BH, Müller, N, Schwartz, DA, King, TE, Lynch, JP, Hegele, R, Waldron, J, Colby, TV & Hogg, JC 2003, 'Radiologic Findings Are Strongly Associated with a Pathologic Diagnosis of Usual Interstitial Pneumonia', Chest, vol. 124, no. 4, pp. 1215-1223. https://doi.org/10.1378/chest.124.4.1215
Hunninghake GW, Lynch DA, Galvin JR, Gross BH, Müller N, Schwartz DA et al. Radiologic Findings Are Strongly Associated with a Pathologic Diagnosis of Usual Interstitial Pneumonia. Chest. 2003 Oct;124(4):1215-1223. https://doi.org/10.1378/chest.124.4.1215
Hunninghake, Gary W. ; Lynch, David A. ; Galvin, Jeffrey R. ; Gross, Barry H. ; Müller, Nestor ; Schwartz, David A. ; King, Talmadge E. ; Lynch, Joseph P. ; Hegele, Richard ; Waldron, James ; Colby, Thomas V. ; Hogg, James C. / Radiologic Findings Are Strongly Associated with a Pathologic Diagnosis of Usual Interstitial Pneumonia. In: Chest. 2003 ; Vol. 124, No. 4. pp. 1215-1223.
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abstract = "Purpose: To determine which clinical and radiologic findings are independently associated with a pathologic diagnosis of usual interstitial pneumonia (UIP). Methods: We recently reported, using a prospective, multicenter study of patients suspected of having idiopathic interstitial pneumonia (IIP), that a confident diagnosis of UIP made by experienced radiologists was correct in 95{\%} of cases. In the current article, we further analyzed data from this study. Ninety-one patients were entered into the study. Clinical, physiologic, chest radiographic, and CT features were prospectively recorded, and analyzed using univariate and multivariate logistic regression analysis to compare the patients with a histologic diagnosis of UIP with those who received other pathologic diagnoses. Results: Fifty-four of 91 patients (59{\%}) received a pathologic diagnosis of UIP. The following features recorded at the referring clinical centers were associated with a pathologic diagnosis of UIP on multivariate analysis: lower-lobe honeycombing on high-resolution CT (HRCT) [odds ratio, 11.45], radiographic findings consistent with UIP (odds ratio, 5.73), elevated ratio of FEV1 to FVC (odds ratio, 4.8), and absence of smoking history (odds ratio, 0.19). On multivariate analysis of specific HRCT features recorded by four experienced chest radiologists, lower-lung honeycombing (odds ratio, 5.36) and upper-lung irregular lines (odds ratio, 6.28) were the only independent predictors of UIP. Using only these two factors, a diagnosis of UIP could be established with a sensitivity of 74{\%}, a specificity of 81{\%}; and a positive predictive value of 85{\%}. Conclusion: In patients presenting with a clinical syndrome suggestive of IIP, CT findings of lower-lung honeycombing and upper-lung irregular lines are most closely associated with a pathologic diagnosis of UIP.",
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AU - Hunninghake, Gary W.

AU - Lynch, David A.

AU - Galvin, Jeffrey R.

AU - Gross, Barry H.

AU - Müller, Nestor

AU - Schwartz, David A.

AU - King, Talmadge E.

AU - Lynch, Joseph P.

AU - Hegele, Richard

AU - Waldron, James

AU - Colby, Thomas V.

AU - Hogg, James C.

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N2 - Purpose: To determine which clinical and radiologic findings are independently associated with a pathologic diagnosis of usual interstitial pneumonia (UIP). Methods: We recently reported, using a prospective, multicenter study of patients suspected of having idiopathic interstitial pneumonia (IIP), that a confident diagnosis of UIP made by experienced radiologists was correct in 95% of cases. In the current article, we further analyzed data from this study. Ninety-one patients were entered into the study. Clinical, physiologic, chest radiographic, and CT features were prospectively recorded, and analyzed using univariate and multivariate logistic regression analysis to compare the patients with a histologic diagnosis of UIP with those who received other pathologic diagnoses. Results: Fifty-four of 91 patients (59%) received a pathologic diagnosis of UIP. The following features recorded at the referring clinical centers were associated with a pathologic diagnosis of UIP on multivariate analysis: lower-lobe honeycombing on high-resolution CT (HRCT) [odds ratio, 11.45], radiographic findings consistent with UIP (odds ratio, 5.73), elevated ratio of FEV1 to FVC (odds ratio, 4.8), and absence of smoking history (odds ratio, 0.19). On multivariate analysis of specific HRCT features recorded by four experienced chest radiologists, lower-lung honeycombing (odds ratio, 5.36) and upper-lung irregular lines (odds ratio, 6.28) were the only independent predictors of UIP. Using only these two factors, a diagnosis of UIP could be established with a sensitivity of 74%, a specificity of 81%; and a positive predictive value of 85%. Conclusion: In patients presenting with a clinical syndrome suggestive of IIP, CT findings of lower-lung honeycombing and upper-lung irregular lines are most closely associated with a pathologic diagnosis of UIP.

AB - Purpose: To determine which clinical and radiologic findings are independently associated with a pathologic diagnosis of usual interstitial pneumonia (UIP). Methods: We recently reported, using a prospective, multicenter study of patients suspected of having idiopathic interstitial pneumonia (IIP), that a confident diagnosis of UIP made by experienced radiologists was correct in 95% of cases. In the current article, we further analyzed data from this study. Ninety-one patients were entered into the study. Clinical, physiologic, chest radiographic, and CT features were prospectively recorded, and analyzed using univariate and multivariate logistic regression analysis to compare the patients with a histologic diagnosis of UIP with those who received other pathologic diagnoses. Results: Fifty-four of 91 patients (59%) received a pathologic diagnosis of UIP. The following features recorded at the referring clinical centers were associated with a pathologic diagnosis of UIP on multivariate analysis: lower-lobe honeycombing on high-resolution CT (HRCT) [odds ratio, 11.45], radiographic findings consistent with UIP (odds ratio, 5.73), elevated ratio of FEV1 to FVC (odds ratio, 4.8), and absence of smoking history (odds ratio, 0.19). On multivariate analysis of specific HRCT features recorded by four experienced chest radiologists, lower-lung honeycombing (odds ratio, 5.36) and upper-lung irregular lines (odds ratio, 6.28) were the only independent predictors of UIP. Using only these two factors, a diagnosis of UIP could be established with a sensitivity of 74%, a specificity of 81%; and a positive predictive value of 85%. Conclusion: In patients presenting with a clinical syndrome suggestive of IIP, CT findings of lower-lung honeycombing and upper-lung irregular lines are most closely associated with a pathologic diagnosis of UIP.

KW - Chest radiograph

KW - Idiopathic interstitial pneumonia

KW - Idiopathic pulmonary fibrosis

KW - Interstitial lung disease

KW - Lung

KW - Lung CT scans

KW - Thorax

KW - Usual interstitial pneumonia

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