Smoking-related interstitial fibrosis combined with pulmonary emphysema: computed tomography-pathologic correlative study using lobectomy specimens

Abstract

PurposeTo evaluate the incidence and pathologic correlation of thin-section computed tomography (TSCT) findings in smoking-related interstitial fibrosis (SRIF) with pulmonary emphysema.Patients and methodsOur study included 172 consecutive patients who underwent TSCT and subsequent lobectomy. TSCT findings including clustered cysts with visible walls (CCVW) and ground-glass attenuation with/without reticulation (GGAR) were evaluated and compared in nonsmokers and smokers and among lung locations. TSCT findings, especially CCVW, were also compared with histological findings using lobectomy specimens.ResultsThe incidence of CCVW and GGAR was significantly higher in smokers than in nonsmokers (34.1% and 40.7%, respectively, vs 2.0% and 12.2%). CCVW and GGAR were frequently found in the lower and peripheral zones. Histologically, CCVW corresponded more often with SRIF with emphysema than usual interstitial pneumonia (UIP, 63.3% vs 30%). CCVW of irregular size and shape were seen in 19 of 20 SRIF with emphysema and in seven of nine UIP-manifested areas with similar round cysts. A less-involved subpleural parenchyma was observed more frequently in SRIF with emphysema.ConclusionSRIF with emphysema is a more frequent pathological finding than UIP in patients with CCVW on TSCT. The irregular size and shape of CCVW and a less-involved subpleural parenchyma may be a clue suggesting the presence of SRIF with emphysema.

Interstitial lung abnormalities and interstitial lung diseases associated with cigarette smoking in a rural cohort undergoing surgical resection

“…Our study assessed ILA/ILD patterns on visual inspection of pre-surgical resection CT chest while others have relied on quantitative high attenuation areas (HAAs) to define ILAs [ 22 , 23 ]. Pathological investigation which utilized tissue resected for lung cancer reported a similarly high prevalence of radiographic interstitial changes [ 13 ]. Applying different methodology, a comparable rate of interstitial fibrosis (60%) was pathologically identified in smokers [ 24 , 25 ].…”

“…Although comparison of quantitative methods of ILA evaluation to visual ILA showed potential modification from coexisting emphysema (5% or more) [ 8 ], a significant positive association was demonstrated between paraseptal emphysema and ILAs [ 9 ]. Recent studies have suggested that ILAs can show a higher prevalence (23.1 to 40.7%) and are associated with both a worse clinical course and higher mortality rates in COPD patients [ 10 – 13 ].…”

Idiopathic pulmonary fibrosis: Significance of the usual interstitial pneumonia (UIP) CT-scan patterns defined in new international guidelines

“…We also identified significantly more smokers with lung emphysema in the indeterminate UIP group. Some scans reclassified as indeterminate for UIP with emphysema lesions may have been retrospectively related to both smoking-related interstitial fibrosis (SRIF) and airspace enlargement with fibrosis (AEF) entities (Figure 4) (24,25), which are associated with a slower clinical course than UIP (26). We have not categorized these entities because their diagnostic criteria are not yet sufficiently validated on CT without pathological confirmation.…”

Interstitial Lung Abnormalities: What Radiologists Should Know

“…Previous studies have shown that nonemphysematous cysts usually present as thin-walled, inhomogeneous-sized cysts, and they are characterized by relatively asymmetric distributions and less involvement of the juxta-subpleural parenchyma (Fig. 9) (37)(38)(39). It is one of the imaging features that are predictive of ILA progression (odds ratio: 2.5; 95% CI: 1.3-5.1) and increased mortality (hazard ratio: 1.4; 95% CI: 1.1-1.8) (16), albeit not as strongly as the other features, including reticular markings and traction bronchiectasis.…”