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ROLE OF SURGICAL LUNG BIOPSY IN SEPARATING CHRONIC HYPERSENSITIVITY PNEUMONIA FROM USUAL INTERSTITIAL PNEUMONIA/IDIOPATHIC PULMONARY FIBROSIS: ANALYSIS OF 31 BIOPSIES FROM 15 PATIENTS

¹Department of Pathology and Cytology, Institute of Pneumology and Cardiology, Laval University, Sainte-Foy, Quebec, Canada ²Division of Pulmonary and Critical Care Medicine, Beth-Israel Deaconess Medical Center, Boston, MA ³Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN ⁴Division of Anatomic Pathology, The University of Michigan, Ann Arbor, Michigan

myerjeff{at}umich.edu

Abstract

Background: Lung biopsy has been proposed as a criterion for diagnosis of chronic hypersensitivity pneumonia (HP), especially in patients without proven antigen exposure. Histological findings in some suspected HP patients overlap with usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP). We reviewed our experience to determine the specificity of histological findings in surgical lung biopsies from patients with clinical diagnoses of HP.

Methods: Surgical lung biopsies from patients with chronic HP, IPF, and idiopathic NSIP were retrospectively reviewed without knowledge of the clinical diagnosis. Each specimen was assigned a histologic diagnosis and selected histologic findings tabulated. Clinical data were abstracted from medical records.

Results: Fifteen patients with clinical diagnoses of chronic HP underwent biopsy of one to three lobes. Ten patients showed features diagnostic of HP in all specimens. Two patients had discordant findings that included HP in one specimen and UIP or nonspecific changes in others. Biopsies from three patients showed only UIP (2) or NSIP (1). Diagnostic features were present in all samples from nine (81.8%) of 11 patients with more than one biopsy site. Three patients died of disease, including both patients from whom biopsies showed only UIP.

Conclusions: Most patients with a clinical diagnosis of chronic HP have supportive histologic findings in surgical lung biopsies. A subset of HP patients has findings indistinguishable from UIP. Sampling from more than one lobe may be helpful in separating HP from IPF.

Key Words: Hypersensitivity pneumonia • Interstitial lung disease • Pulmonary fibrosis