Semiquantitative Assessment of Surgical Lung Biopsy: Predictive Value and Impact on Survival of Patients With Diffuse Pulmonary Infiltrate

Abstract

. Semiquantitative assessment of surgical lung biopsy: predictive value and impact on survival of patients with diffuse pulmonary infiltrate. Clinics. 2007; 62(1):23-30.PURPOSE: Surgical lung biopsy has been studied in distinct populations, mostly going beyond clinical issues to impinge upon routine histopathological diagnostic information in diffuse infiltrates; however, detailed tissue analyses have rarely been performed. The present study was designed to investigate the prognostic contribution provided by detailed tissue analysis in diffuse infiltrates. METHODS: Medical records and surgical lung biopsies from the period of 1982 to 2003 of 63 patients older than 18 years with diffuse infiltrates were retrospectively examined. Lung parenchyma was histologically divided into 4 anatomical compartments: interstitium, airways, vessels, and alveolar spaces. Histological changes throughout these anatomical compartments were then evaluated according to their acute or chronic evolutional character. A semiquantitative scoring system was applied to histologic findings to evaluate the intensity and extent of the pathological process. We applied logistic regression to predict the risk of death associated with acute and chronic histological changes and to estimate the odds ratios for each of the independent variables in the model. RESULTS: Impact on survival was found for male gender (P = 0.03), presence of diffuse alveolar damage (P = 0.001), and chronic histological changes (P = 0.0004) on biopsy. Thus, being male was associated with a slightly lower risk (O.R. = 0.18; P=0.03) of dying than being female. Death risk was increased 17 times in the presence of acute histological changes such as diffuse alveolar damage and 2.5 times in the presence of chronic histological changes. CONCLUSION: Detailed analysis of histological specimens can provide more than a nosological diagnosis: this approach can provide valuable information concerning prognosis.

Structural and functional alterations in the rat lung following whole thoracic irradiation with moderate doses: Injury and recovery

“…Sections were stained with hematoxylin and eosin (H & E) for identification. The samples were then scored in a blinded manner according to a semiquantitative scale (Canzian et al 2007). …”

“…Other significant findings included chronic changes such as vessels wall hyalinization, interstitial thickening and mild fibrosis. These changes were scored in a blinded manner using a semiquantitative scale of 0-4, with 4 being the most severe (Canzian et al 2007). These scores were averaged and tabulated to reflect injury at different time points (Table I).…”

Análise semiquantitativa de biópsias cirúrgicas de diferentes lobos pulmonares de pacientes com pneumonia intersticial usual/fibrose pulmonar idiopática

“…(7) In the present study, there was a predominance of males in the group submitted to biopsies on the left side, in which the mean age was also higher, although neither difference was significant. Factors such as age and gender have also been associated with a worse prognosis in IPF, (18,23) and these factors could be the cause of this finding.…”

“…Other research centers in Brazil have published their experience using the same score, confirming previously published findings. (18,19) For the use of this score, three main criteria for quantification were established: a) exudative/inflammatory changes; b) fibrotic/reparative changes; and c) airway changes. These alterations were quantified using a scale ranging from 0 to 5 for criteria a and b, together with a scale ranging from 0 to 2 for criterion c.…”

Modelo experimental de perfusão pulmonar ex vivo em ratos: avaliação histopatológica e de apoptose celular em pulmões preservados com solução de baixo potássio dextrana vs. solução histidina-triptofano-cetoglutarato

“…Each change (event) was separately semi-quantified and received a score ranging from zero to three, as follows: no event (score 0); event occurring in less than 33% of the affected compartments (score 1); event occurring in 33-66% of the affected compartments (score 2); and event occurring in more than 66% of the affected compartments (score 3). (13) Histological examination was performed by a single observer. The parameter "edema" was evaluated in two different compartments, namely the interstitial compartment and the bronchoalveolar compartment.…”