Masanori Kitaichi

An Official American Thoracic Society/European Respiratory Society Statement: Update of the International Multidisciplinary Classification of the Idiopathic Interstitial Pneumonias

BACKGROUNDnIn 2002 the American Thoracic Society/European Respiratory Society (ATS/ERS) classification of idiopathic interstitial pneumonias (IIPs) defined seven specific entities, and provided standardized terminology and diagnostic criteria. In addition, the historical gold standard of histologic diagnosis was replaced by a multidisciplinary approach. Since 2002 many publications have provided new information about IIPs.nnnPURPOSEnThe objective of this statement is to update the 2002 ATS/ERS classification of IIPs.nnnMETHODSnAn international multidisciplinary panel was formed and developed key questions that were addressed through a review of the literature published between 2000 and 2011.nnnRESULTSnSubstantial progress has been made in IIPs since the previous classification. Nonspecific interstitial pneumonia is now better defined. Respiratory bronchiolitis-interstitial lung disease is now commonly diagnosed without surgical biopsy. The clinical course of idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia is recognized to be heterogeneous. Acute exacerbation of IIPs is now well defined. A substantial percentage of patients with IIP are difficult to classify, often due to mixed patterns of lung injury. A classification based on observed disease behavior is proposed for patients who are difficult to classify or for entities with heterogeneity in clinical course. A group of rare entities, including pleuroparenchymal fibroelastosis and rare histologic patterns, is introduced. The rapidly evolving field of molecular markers is reviewed with the intent of promoting additional investigations that may help in determining diagnosis, and potentially prognosis and treatment.nnnCONCLUSIONSnThis update is a supplement to the previous 2002 IIP classification document. It outlines advances in the past decade and potential areas for future investigation.

Usual Interstitial Pneumonia and Nonspecific Interstitial Pneumonia with and without Concurrent Emphysema: Thin-Section CT Findings

PURPOSEnTo determine whether concurrent emphysema influences the distinction between usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) at thin-section computed tomography (CT).nnnMATERIALS AND METHODSnInstitutional review board approval was obtained for this retrospective study; informed consent was not required. The study included 54 patients with NSIP and 42 patients with UIP (55 men, 41 women; mean age, 60.2 years +/- 9.2 [standard deviation]; age range, 33-77 years). Two independent readers assessed the CT images and made a first-choice diagnosis. The appearances of UIP and NSIP at CT were compared with univariate and multivariate analyses. Receiver operating characteristic curves were used to determine how concurrent emphysema influences the distinction of UIP from NSIP at thin-section CT.nnnRESULTSnThe diagnosis was correct in 136 (71%) of 192 readings. In patients with concurrent emphysema, the diagnosis was correct in 30 (44%) of 68 readings. Sensitivity, specificity, and accuracy for diagnosis were lower in patients with concurrent emphysema than in patients without concurrent emphysema. In patients with concurrent emphysema, there were no significant differences in extent of fibrosis, extent of honeycombing, extent of consolidation, coarseness of fibrosis score, extent of traction bronchiectasis, upper lung irregular lines, peribronchovascular distribution, and nodules between UIP and NSIP. According to multivariate analysis, the CT feature that helped best differentiate UIP from NSIP in patients with emphysema was traction bronchiolectasis.nnnCONCLUSIONnConcurrent emphysema influenced the distinction between UIP and NSIP.

NSIP in a curry sauce factory worker

Curry powder and ground pepper are commonly used spices in many countries of the world. Although a case of bronchiolitis obliterans organising pneumonia has been reported in a worker who inhaled spice dust in a potato chip factory,1 we report the first case of non-specific interstitial pneumonia (NSIP)2 with bronchiolar lesions associated with curry powder and ground pepper.nnA 50 year old male smoker (20 pack-years) developed a cough with sputum and shortness of breath on both working days and non-working days and was admitted to our hospital 1 month after developing the symptoms. He had worked in a factory that produced curry sauce for 13 years. His job was to carry sacks filled with curry powder (containing a mix of ground spices) and ground pepper on his shoulders and to empty …