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Radiologic Findings Are Strongly Associated With a Pathologic Diagnosis of Usual Interstitial Pneumonia^*

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

^* From the Departments of Medicine and Radiology, University of Iowa, Iowa City, IA; Departments of Medicine and Radiology, University of Colorado, Denver, CO; Departments of Medicine and Radiology, University of Michigan, Ann Arbor, MI; Department of Pathology, Mayo Clinic, Scottsdale, AZ; Departments of Medicine, Radiology and Pathology, University of British Columbia, Vancouver, BC, Canada; and Department of Pathology, University of Arkansas, Little Rock, AR. Currently at Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC. Currently at Department of Medicine, Pulmonary and Critical Care Division, Duke University Medical Center, Durham, NC. Currently at Department of Internal Medicine, San Francisco General Hospital, San Francisco, CA.

Correspondence to: Gary W. Hunninghake, MD, FCCP, University of Iowa College of Medicine and Veterans Administration Medical Center, Department of Internal Medicine, 200 Hawkins Dr, C33-GH, Iowa City, IA 52242; e-mail: gary-hunninghake{at}uiowa.edu

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.

Key Words: chest radiograph • idiopathic interstitial pneumonia • idiopathic pulmonary fibrosis • interstitial lung disease • lung • lung CT scans • thorax • usual interstitial pneumonia

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