The research deals with non-invasive methods for the diagnosis of ILD, aimed at avoiding surgical procedures and reducing medical costs.
We evaluated clinical symptoms, signs, and imaging of 71patients (pts) with ILD (median age 60 years, 42 % males). ILD subgroups included: usual interstitial pneumonia (UIP = 34), non-specific idiopathic pneumonia (NSIP=13), Wegener granulomatosis (WG =14), and extrinsic allergic alveolitis (EAA = 10), all pathologically confirmed. Surgical diagnosis performed by open pulmonary biopsy (n = 31), VATS (n=27) or percutaneous biopsy (n =13). A periodical imaging evaluation has been carried out independently by two radiologists and two respiratory physicians, and a high-resolution CT (HRCT) severity score (degrees = 0-4) has been calculated.
NSIP pts were younger than UIP (p=0.001) or WG (p = 0.01). Cracklers were less common in NSIP than UIP (38% vs 100%; p<0.001), and were absent in WG and EAA. Fever was much more common in EAA than in NSIP (p=0.002), UIP (p=0.001), and WG (p<0.001). All UIP showed Octreoscan uptake index (UI) <10 (normal value ≤10). UI ranging from 10 to 12 UI was indicative of NSIP. It was indicative of WG and EAA when it was higher than 15 UI. A CT score with degree = 4 was indicative of UIP, while 100% of WG and EAA had score degree = 2.
Age, signs (cracklers), fever and Octreoscan may be useful to differentiate among ILD subgroups. The diagnosis of UIP, the commonest ILD subgroup, may be achieved by using these parameters.
Clinical parameters as well as imaging must be considered in assessing ILD. Diagnosis of UIP is possible avoiding surgical procedure and reducing medical costs.
R.G. Carbone, None.