Мультидисциплинарный подход в диагностике идиопатической неспецифической интерстициальной пневмонии
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Ovcharenko S.I., Son E.A., Kapustina V.A. Multidisciplinary approach in the diagnosis of idiopathic nonspecific interstitial pneumonia. Therapeutic Archive. 2019; 91 (3): #–106. DOI: 10.26442/00403660.2019.03.000077
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Ключевые слова: интерстициальные заболевания легких, идиопатическая интерстициальная пневмония, идиопатическая неспецифическая интерстициальная пневмония, идиопатический легочный фиброз, мультидисциплинарный подход, компьютерная томография высокого разрешения.
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The article provides a modern classification of interstitial lung diseases. The focus is on the poorly studied and difficult to diagnose idiopathic nonspecific interstitial pneumonia, isolated in a separate nosological form and included in the classification only in 2002. The paper presents the features of the clinical, radiological, histological picture of idiopathic nonspecific interstitial pneumonia in comparison with idiopathic pulmonary fibrosis. The presented materials are based on the results of the largest study conducted by the working group of the American Thoracic Society, which shows the importance of the interaction of specialists in the diagnosis of idiopathic nonspecific interstitial pneumonia. A comprehensive assessment of the examination of patients conducted in collaboration with the clinician and radiologist, after their cooperative discussion, in many cases can help to avoid lung biopsy, and the study of morphological material is more often necessary only in difficult diagnostic situations.
Keywords: interstitial lung diseases, idiopathic interstitial pneumonia, idiopathic nonspecific interstitial pneumonia, idiopathic pulmonary fibrosis, multidisciplinary approach, high resolution computed tomography.
2. Travis WD, et al. Idiopathic nonspecific interstitial pneumonia: report of an American Thoracic Society project. Amer J Respiratory and Critical Care Medicine. 2008;177:1338-47. https://doi.org/10.1164/rccm.2006 11-1685OC
3. Nicholson AG, Colby TV, Wells AU. Histopathological approach to patterns of interstitial pneumonia in patient with connective tissue disorders. Sarcoidosis Vasculitis and Diffuse Lung Diseases. 2002;19:10-7.
4. Fujita J, Yoshinouchi T, Ohtsuki Y, Tokuda M, Yang Y, Yamadori I, Bandoh S, Ishida T, Takaharaa J, Ueda R. Non-specific interstitial pneumonia as pulmonary involvement of systemic sclerosis. Annals of the Rheumatic Diseases. 2001;60:281-3. https://doi.org/10.1136/ard.60.3.281
5. Desai SR, Veeraraghavan S, Hansell DM, Nikolakopolou A, Goh NSL, Nicholson AG, Colby TV, Denton CP, Black CM, du Bois RM, Wells AU. CT features of lung disease in patients with systemic sclerosis: comparison with idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia. Radiology. 2004;232:560-7. https://doi.org/10.1148/radiol.2322031223
6. Bouros D, Wells AU, Nicholson AG, Colby TV, Polychronopoulos V, Pantelidis P, Haslam PL, Vassilakis DA, Black CM, du Bois RM. Histopathologic subsets of fibrosing alveolitis in patients with systemic sclerosis and their relationship to outcome. Amer J Respiratory and Critical Care Medicine. 2002;165:1581-6. https://doi.org/10.1164/rccm.2106012
7. Tansey D, Wells AU, Colby TV, Ip S, Nikolakoupolou A, du Bois RM, Hansell DM, Nicholson AG. Variations in histological patterns of interstitial pneumonia between connective tissue disorders and their relationship to prognosis. Histopathology. 2004;44:585-96. https://doi.org/10.1111/j.1365-255 9.2004.01896.x
8. Kim DS, Yoo B, Lee JS, Kim EK, Lim CM, Lee SD, Koh Y, Kim WS, Kim WD, Colby TV, Kitiaichi M. The major histopathologic pattern of pulmonary fibrosis in scleroderma in nonspecific interstitial pneumonia. Sarcoidosis, Vasculitis, and Diffuse Lung Diseases. 2002;19:121-7.
9. Flieder DB, Travis WD. Pathologic characteristics of drug-induced lung disease. Clinics in Chest Medicine. 2004;25:37-45. https://doi.org/10.1016/ s0272-5231(03)00138-2
10. Rossi SE, Erasmus JJ, McAdams HP, Sporn TA, Goodman PC. Pulmonary drug toxicity: radiologic and pathologic manifestations. Radiographics. 2000;20:1245-59. https://doi.org/10.1148/radiographics.20.5.g0 0se081245
11. Pesenti S, Lauque D, Daste G, Boulay V, Pujazon M-C, Carles P. Diffuse infiltrative lung disease associated with flecainide: report of two cases. Respiration. 2002;69:182-5. https://doi.org/10.1159/000056325
12. Nishiyama O, Kondoh Y, Taniguchi H, Yamaki K, Suzuki R, Yokoi T, Takagi K. Serial high resolution CT findings in nonspecific interstitial pneumonia/fibrosis. J Computer Assisted Tomography. 2000;24:41-6. https:// doi.org/10.1097/00004728-200001000-00008
13. Schwaiblmair M, Behr W, Haeckel T, Märk B, Foerg W, Berghaus T. Drug induced interstitial lung disease. The Open Respiratory Medicine J. 2012;6:63-74. https://doi.org/10.2174/1874306401206010063
14. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Amer J Respiratory and Critical Care Medicine. 2013;188(6):733-48. https://doi.org/10.1164/rccm.201308-148 3ST
15. An Official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Amer J Respiratory and Critical Care Medicine. 2011;183:788-824. https://doi.org/10.1164/rccm.201308-1483ST
16. ATS/ERS/JRS/ALAT Clinical Practice Guideline: treatment of idiopathic pulmonary fibrosis. Amer J Respiratory and Critical Care Medicine. 2015;192(2):e3-e19. https://doi.org/10.1164/rccm.201506-1063ST
17. Matsushima H, Takayanagi N, Sakamoto T, et al. Pathologic findings both before and after steroid therapy in a case of desquamative interstitial pneumonia [article in Japanese]. Nihon Kokyuki Gakkai Zasshi. 2001;39:609-14.
18. Ryerson CJ, Urbania TH, Richeldi L, Mooney JJ, Lee JS, Jones KD, Elicker BM, Koth LL, King TEJr, Wolters PJ, Collard HR. Prevalence and prognosis of unclassifiable interstitial lung disease. European Respiratory J. 2013;42(3):750-7. https://doi.org/10.1183/09031936.00131912
19. Johkoh T, Müller NL, Colby TV, Ichikado K, Taniguchi H, Kondoh Y, Fujimoto K, Kinoshita M, Arakawa H, Yamada H, Suga M, Ando M, Koyama M, Nakamura H. Nonspecific interstitial pneumonia: correlation between thin-section CT findings and pathologic subgroups in 55 patients. Radiology. 2002;225:199-204. https://doi.org/10.1148/radiol.2251011555
20. Park JS, Lee KS, Kim JS, Park CS, Suh YL, Choi DL, Kim KJ. Nonspecific interstitial pneumonia with fibrosis: radiographic and CT findings in seven patients. Radiology. 1995;195:645-8. https://doi.org/10.1148/ radiology.195.3.7753988
21. Katzenstein AL, Fiorelli RF. Nonspecific interstitial pneumonia/fibrosis: histologic features and significance. Am J Surg Pathol. 1994;18:136-47. https://doi.org/10.1097/00000478-199402000-00003
22. Do KH, Lee JS, Colby TV, Kitaichi M, Kim DS. Nonspecific interstitial pneumonia versus usual interstitial pneumonia: differences in the density histogram of high-resolution CT. J Computer Assisted Tomography. 2005;29:544-8. https://doi.org/10.1097/01.rct.0000164255.43859.96
23. Jegal Y, Kim DS, Shim TS, Lim C-M, Lee SD, Koh Y, Kim WS, Kim WD, Lee JS, Travis WD, Kitaichi M, Colby TV. Physiology is a stronger predictor of survival than pathology in fibrotic interstitial pneumonia. Amer J Respiratory and Critical Care Medicine. 2005;171:639-44. http://doi.org/10.1164/rccm.200403-331oc
24. Nagai S, Kitaichi M, Itoh H, Nishimura K, Izumi T, Colby TV. Idiopathic nonspecific interstitial pneumonia/fibrosis: comparison with idiopathic pulmonary fibrosis and BOOP. European Respiratory J. 1998;12:1010-9. https://doi.org/10.1183/09031936.98.12051010
25. Daniil ZD, Gilchrist FC, Nicholson AG, Hansell DM, Harris J, Colby TV, du Bois RM. histologic pattern of nonspecific interstitial pneumonia is associated with a better prognosis than usual interstitial pneumonia in patients with cryptogenic fibrosing alveolitis. Amer J Respiratory and Critical Care Medicine. 1999;160:899-905. https://doi.org/10.1164/ajrccm.16 0.3.9903021
26. Cottin V, Donsbeck A-V, Revel D, Loire R, Cordier J-F. Nonspecific interstitial pneumonia. Individualization of a clinicopathologic entity in a series of 12 patients. Amer J Respiratory and Critical Care Medicine. 1998;158:1286-93. https://doi.org/10.1164/ajrccm.158.4.9802119
27. Travis WD, Matsui K, Moss J, Ferrans VJ. Idiopathic nonspecific interstitial pneumonia: prognostic significance of cellular and fibrosing patterns: survival comparison with usual interstitial pneumonia and desquamative interstitial pneumonia. Amer J Surgical Pathology. 2000;24:19-33.
28. Bjoraker JA, Ryu JH, Edwin MK, Myers JL, Tazelaar HD, Schroeder DR, Offord KP. Prognostic significance of histopathologic subsets in idiopathic pulmonary fibrosis. Amer J Respiratory and Critical Care Medicine. 1998;157:199-203. https://doi.org/10.1164/ajrccm.157.1.9704130
29. Padley SP, Adler B, Müller NL. High-resolution computed tomography of the chest: current indications. J Thoracic Imaging. 1993;8:189-99. https://doi.org/10.1007/978-3-642-79887-0_11
30. Lynch DA, Rose CS, Way D, King TE. Hypersensitivity pneumonitis: sensitivity of high-resolution CT in a population-based study. Amer J Roentgenology. 1992;159:469-72. https://doi.org/10.2214/ajr.159.3.1503007
31. Orens JB, Kazerooni EA, Martinez FJ, Curtis JL, Gross BH, Flint A, Lynch JP. The sensitivity of high-resolution CT in detecting idiopathic pulmonary fibrosis proved by open lung biopsy. A prospective study. Chest. 1995;108:109-15. https://doi.org/10.1378/chest.108.1.109
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33. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;246;697-722. https://doi.org/10.1148/radiol.2462070712
34. Grenier P, Chevret S, Beigelman C, Brauner MW, Chastang C, Valeyre D. Chronic diffuse infiltrative lung disease: determination of the diagnostic value of clinical data, chest radiography, and CT and Bayesian analysis. Radiology. 1994;191:383-90. https://doi.org/10.1148/radiology.191.2.8153310
35. Hartman TE, Swensen SJ, Hansell DM, Colby TV, Myers JL, Tazelaar HD, Nicholson AG, Wells AU, Ryu JH, Midthun DE, du Bois RM, Müller NL. Nonspecific interstitial pneumonia: variable appearance at high-resolution chest CT. Radiology. 2000;217:701-5. https://doi.org/10.1148/radiology.217.3.r00 nv31701
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1. American Thoracic Society; European Respiratory Society. American Thoracic Society/European Respiratory Society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. Amer J Respiratory and Critical Care Medicine. 2002;165:277-304. https://doi.org/10.1164/ajrccm.165.2.ats01
2. Travis WD, et al. Idiopathic nonspecific interstitial pneumonia: report of an American Thoracic Society project. Amer J Respiratory and Critical Care Medicine. 2008;177:1338-47. https://doi.org/10.1164/rccm.2006 11-1685OC
3. Nicholson AG, Colby TV, Wells AU. Histopathological approach to patterns of interstitial pneumonia in patient with connective tissue disorders. Sarcoidosis Vasculitis and Diffuse Lung Diseases. 2002;19:10-7.
4. Fujita J, Yoshinouchi T, Ohtsuki Y, Tokuda M, Yang Y, Yamadori I, Bandoh S, Ishida T, Takaharaa J, Ueda R. Non-specific interstitial pneumonia as pulmonary involvement of systemic sclerosis. Annals of the Rheumatic Diseases. 2001;60:281-3. https://doi.org/10.1136/ard.60.3.281
5. Desai SR, Veeraraghavan S, Hansell DM, Nikolakopolou A, Goh NSL, Nicholson AG, Colby TV, Denton CP, Black CM, du Bois RM, Wells AU. CT features of lung disease in patients with systemic sclerosis: comparison with idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia. Radiology. 2004;232:560-7. https://doi.org/10.1148/radiol.2322031223
6. Bouros D, Wells AU, Nicholson AG, Colby TV, Polychronopoulos V, Pantelidis P, Haslam PL, Vassilakis DA, Black CM, du Bois RM. Histopathologic subsets of fibrosing alveolitis in patients with systemic sclerosis and their relationship to outcome. Amer J Respiratory and Critical Care Medicine. 2002;165:1581-6. https://doi.org/10.1164/rccm.2106012
7. Tansey D, Wells AU, Colby TV, Ip S, Nikolakoupolou A, du Bois RM, Hansell DM, Nicholson AG. Variations in histological patterns of interstitial pneumonia between connective tissue disorders and their relationship to prognosis. Histopathology. 2004;44:585-96. https://doi.org/10.1111/j.1365-255 9.2004.01896.x
8. Kim DS, Yoo B, Lee JS, Kim EK, Lim CM, Lee SD, Koh Y, Kim WS, Kim WD, Colby TV, Kitiaichi M. The major histopathologic pattern of pulmonary fibrosis in scleroderma in nonspecific interstitial pneumonia. Sarcoidosis, Vasculitis, and Diffuse Lung Diseases. 2002;19:121-7.
9. Flieder DB, Travis WD. Pathologic characteristics of drug-induced lung disease. Clinics in Chest Medicine. 2004;25:37-45. https://doi.org/10.1016/ s0272-5231(03)00138-2
10. Rossi SE, Erasmus JJ, McAdams HP, Sporn TA, Goodman PC. Pulmonary drug toxicity: radiologic and pathologic manifestations. Radiographics. 2000;20:1245-59. https://doi.org/10.1148/radiographics.20.5.g0 0se081245
11. Pesenti S, Lauque D, Daste G, Boulay V, Pujazon M-C, Carles P. Diffuse infiltrative lung disease associated with flecainide: report of two cases. Respiration. 2002;69:182-5. https://doi.org/10.1159/000056325
12. Nishiyama O, Kondoh Y, Taniguchi H, Yamaki K, Suzuki R, Yokoi T, Takagi K. Serial high resolution CT findings in nonspecific interstitial pneumonia/fibrosis. J Computer Assisted Tomography. 2000;24:41-6. https:// doi.org/10.1097/00004728-200001000-00008
13. Schwaiblmair M, Behr W, Haeckel T, Märk B, Foerg W, Berghaus T. Drug induced interstitial lung disease. The Open Respiratory Medicine J. 2012;6:63-74. https://doi.org/10.2174/1874306401206010063
14. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Amer J Respiratory and Critical Care Medicine. 2013;188(6):733-48. https://doi.org/10.1164/rccm.201308-148 3ST
15. An Official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Amer J Respiratory and Critical Care Medicine. 2011;183:788-824. https://doi.org/10.1164/rccm.201308-1483ST
16. ATS/ERS/JRS/ALAT Clinical Practice Guideline: treatment of idiopathic pulmonary fibrosis. Amer J Respiratory and Critical Care Medicine. 2015;192(2):e3-e19. https://doi.org/10.1164/rccm.201506-1063ST
17. Matsushima H, Takayanagi N, Sakamoto T, et al. Pathologic findings both before and after steroid therapy in a case of desquamative interstitial pneumonia [article in Japanese]. Nihon Kokyuki Gakkai Zasshi. 2001;39:609-14.
18. Ryerson CJ, Urbania TH, Richeldi L, Mooney JJ, Lee JS, Jones KD, Elicker BM, Koth LL, King TEJr, Wolters PJ, Collard HR. Prevalence and prognosis of unclassifiable interstitial lung disease. European Respiratory J. 2013;42(3):750-7. https://doi.org/10.1183/09031936.00131912
19. Johkoh T, Müller NL, Colby TV, Ichikado K, Taniguchi H, Kondoh Y, Fujimoto K, Kinoshita M, Arakawa H, Yamada H, Suga M, Ando M, Koyama M, Nakamura H. Nonspecific interstitial pneumonia: correlation between thin-section CT findings and pathologic subgroups in 55 patients. Radiology. 2002;225:199-204. https://doi.org/10.1148/radiol.2251011555
20. Park JS, Lee KS, Kim JS, Park CS, Suh YL, Choi DL, Kim KJ. Nonspecific interstitial pneumonia with fibrosis: radiographic and CT findings in seven patients. Radiology. 1995;195:645-8. https://doi.org/10.1148/ radiology.195.3.7753988
21. Katzenstein AL, Fiorelli RF. Nonspecific interstitial pneumonia/fibrosis: histologic features and significance. Am J Surg Pathol. 1994;18:136-47. https://doi.org/10.1097/00000478-199402000-00003
22. Do KH, Lee JS, Colby TV, Kitaichi M, Kim DS. Nonspecific interstitial pneumonia versus usual interstitial pneumonia: differences in the density histogram of high-resolution CT. J Computer Assisted Tomography. 2005;29:544-8. https://doi.org/10.1097/01.rct.0000164255.43859.96
23. Jegal Y, Kim DS, Shim TS, Lim C-M, Lee SD, Koh Y, Kim WS, Kim WD, Lee JS, Travis WD, Kitaichi M, Colby TV. Physiology is a stronger predictor of survival than pathology in fibrotic interstitial pneumonia. Amer J Respiratory and Critical Care Medicine. 2005;171:639-44. http://doi.org/10.1164/rccm.200403-331oc
24. Nagai S, Kitaichi M, Itoh H, Nishimura K, Izumi T, Colby TV. Idiopathic nonspecific interstitial pneumonia/fibrosis: comparison with idiopathic pulmonary fibrosis and BOOP. European Respiratory J. 1998;12:1010-9. https://doi.org/10.1183/09031936.98.12051010
25. Daniil ZD, Gilchrist FC, Nicholson AG, Hansell DM, Harris J, Colby TV, du Bois RM. histologic pattern of nonspecific interstitial pneumonia is associated with a better prognosis than usual interstitial pneumonia in patients with cryptogenic fibrosing alveolitis. Amer J Respiratory and Critical Care Medicine. 1999;160:899-905. https://doi.org/10.1164/ajrccm.16 0.3.9903021
26. Cottin V, Donsbeck A-V, Revel D, Loire R, Cordier J-F. Nonspecific interstitial pneumonia. Individualization of a clinicopathologic entity in a series of 12 patients. Amer J Respiratory and Critical Care Medicine. 1998;158:1286-93. https://doi.org/10.1164/ajrccm.158.4.9802119
27. Travis WD, Matsui K, Moss J, Ferrans VJ. Idiopathic nonspecific interstitial pneumonia: prognostic significance of cellular and fibrosing patterns: survival comparison with usual interstitial pneumonia and desquamative interstitial pneumonia. Amer J Surgical Pathology. 2000;24:19-33.
28. Bjoraker JA, Ryu JH, Edwin MK, Myers JL, Tazelaar HD, Schroeder DR, Offord KP. Prognostic significance of histopathologic subsets in idiopathic pulmonary fibrosis. Amer J Respiratory and Critical Care Medicine. 1998;157:199-203. https://doi.org/10.1164/ajrccm.157.1.9704130
29. Padley SP, Adler B, Müller NL. High-resolution computed tomography of the chest: current indications. J Thoracic Imaging. 1993;8:189-99. https://doi.org/10.1007/978-3-642-79887-0_11
30. Lynch DA, Rose CS, Way D, King TE. Hypersensitivity pneumonitis: sensitivity of high-resolution CT in a population-based study. Amer J Roentgenology. 1992;159:469-72. https://doi.org/10.2214/ajr.159.3.1503007
31. Orens JB, Kazerooni EA, Martinez FJ, Curtis JL, Gross BH, Flint A, Lynch JP. The sensitivity of high-resolution CT in detecting idiopathic pulmonary fibrosis proved by open lung biopsy. A prospective study. Chest. 1995;108:109-15. https://doi.org/10.1378/chest.108.1.109
32. Chuchalin AG, Avdeev SN, Aisanov ZR, Belevskiy AS, Demura SA, Il'kovich MM, Kogan EA, Samsonova MV, Speranskaya AA, Tyurin IE, Chernyaev AL, Chernyak BA, Chernyak AV, Shmelev EI. Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis. Federal Guidelines. Russian Pulmonology. 2016;26(4):399-419 (In Russ.). http://dx.doi.org/10.18093/0869-0189-2016-26-4-399-419.
33. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;246;697-722. https://doi.org/10.1148/radiol.2462070712
34. Grenier P, Chevret S, Beigelman C, Brauner MW, Chastang C, Valeyre D. Chronic diffuse infiltrative lung disease: determination of the diagnostic value of clinical data, chest radiography, and CT and Bayesian analysis. Radiology. 1994;191:383-90. https://doi.org/10.1148/radiology.191.2.8153310
35. Hartman TE, Swensen SJ, Hansell DM, Colby TV, Myers JL, Tazelaar HD, Nicholson AG, Wells AU, Ryu JH, Midthun DE, du Bois RM, Müller NL. Nonspecific interstitial pneumonia: variable appearance at high-resolution chest CT. Radiology. 2000;217:701-5. https://doi.org/10.1148/radiology.217.3.r00 nv31701
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)», Москва, Россия
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S.I. Ovcharenko, E.A. Son, V.A. Kapustina
I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia