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Original Research: Diffuse Lung Disease |

CT Scan Findings of Probable Usual Interstitial Pneumonitis Have a High Predictive Value for Histologic Usual Interstitial PneumonitisUsual Interstitial Pneumonitis on Chest CT Scan

Jonathan H. Chung, MD; Ashish Chawla, MD; Anna L. Peljto, PhD; Carlyne D. Cool, MD; Steve D. Groshong, MD; Janet L. Talbert, MS; David F. McKean, BS; Kevin K. Brown, MD, FCCP; Tasha E. Fingerlin, PhD; Marvin I. Schwarz, MD, FCCP; David A. Schwartz, MD; David A. Lynch, MBBS
Author and Funding Information

From the Department of Radiology (Drs Chung, Chawla, and Lynch) and Department of Medicine (Drs Cool, Groshong, Brown, and D. A. Schwartz and Ms Talbert), National Jewish Health, Denver; and the Department of Medicine (Drs Peljto, Cool, M. I. Schwarz, and D. A. Schwartz and Mr McKean), Department of Epidemiology (Dr Fingerlin), and Department of Immunology (Dr D. A. Schwartz), University of Colorado, Aurora, CO.

CORRESPONDENCE TO: Jonathan H. Chung, MD, Department of Radiology, National Jewish Health, 1400 Jackson St, Denver, CO 80206; e-mail: ChungJ@NJHealth.org


This article was presented at the Radiological Society of North America Annual Meeting, December 4, 2013, Chicago, IL.

FUNDING/SUPPORT: The research presented here was supported by the following grants: National Institutes of Health (NIH) R01 HL097163 (Dr D. A. Schwartz), VA-Merit 1I01BX001534 (Dr D. A. Schwartz), NIH P01 HL092870 (Dr D. A. Schwartz), and NIH R01 HL095393 (Dr D. A. Schwartz).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(2):450-459. doi:10.1378/chest.14-0976
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BACKGROUND:  The current usual interstitial pneumonitis (UIP)/idiopathic pulmonary fibrosis CT scan classification system excludes probable UIP as a diagnostic category. We sought to determine the predictive effect of probable UIP on CT scan on histology and the effect of the promoter polymorphism in MUC5B (rs35705950) on histologic and CT scan UIP diagnosis.

METHODS:  The cohort included 201 subjects with pulmonary fibrosis who had lung tissue samples obtained within 1 year of chest CT scan. UIP diagnosis on CT scan was categorized as inconsistent with, indeterminate, probable, or definite UIP by two to three pulmonary radiologists. Tissue slides were scored by two expert pulmonary pathologists. All subjects with available DNA (N = 200) were genotyped for rs35705950.

RESULTS:  The proportion of CT scan diagnoses were as follows: inconsistent with (69 of 201, 34.3%), indeterminate (72 of 201, 35.8%), probable (34 of 201, 16.9%), and definite (26 of 201, 12.9%) UIP. Subjects with probable UIP on CT scan were more likely to have histologic probable/definite UIP than subjects with indeterminate UIP on CT scan (82.4% [28 of 34] vs 54.2% [39 of 72]; P = .01). CT scan and microscopic honeycombing were not associated with each other (P = .76). The minor (T) allele of the MUC5B polymorphism was associated with concordant CT scan and histologic UIP diagnosis (P = .03).

CONCLUSIONS:  Probable UIP on CT scan is associated with a higher rate of histologic UIP than indeterminate UIP on CT scan suggesting that they are distinct groups and should not be combined into a single CT scan category as currently recommended by guidelines. CT scan and microscopic honeycombing may be dissimilar entities. The T allele at rs35705950 predicts a UIP diagnosis by both chest CT scan and histology.

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