Compatible with fibrotic hypersensitivity pneumonitis on high-resolution computed tomography: from the ATS/JRS/ALAT 2020 hypersensitivity pneumonitis guidelines

Shota Kaburaki; Ryo Okuda; Tamiko Takemura; Eri Hagiwara; Masahiro Seike; Akihiko Gemma; Takashi Ogura

doi:10.21037/jtd-23-1845

Compatible with fibrotic hypersensitivity pneumonitis on high-resolution computed tomography: from the ATS/JRS/ALAT 2020 hypersensitivity pneumonitis guidelines

J Thorac Dis. 2024 Apr 30;16(4):2353-2364. doi: 10.21037/jtd-23-1845. Epub 2024 Apr 12.

Authors

Shota Kaburaki^{1

2}, Ryo Okuda¹, Tamiko Takemura³, Eri Hagiwara¹, Masahiro Seike², Akihiko Gemma², Takashi Ogura¹

Affiliations

¹ Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
² Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
³ Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.

Abstract

Background: In compatible with fibrotic hypersensitivity pneumonitis (HP) of the computed tomography (CT) classification using the American Thoracic Society (ATS)/Japanese Respiratory Society (JRS)/Latin American Thoracic Association (ALAT) HP guidelines, the lung fibrosis pattern was classified as either a usual interstitial pneumonia (UIP) pattern or a diffuse ground-glass opacity (GGO) pattern with subtle fibrosis. We investigated whether patients with the same imaging classification had different disease progression. We also attempted to reclassify these patients using the CHEST HP guidelines.

Methods: Patients with fibrotic HP who had compatible CT pattern in the ATS/JRS/ALAT classification were investigated retrospectively.

Results: With 62 patients in the UIP pattern group and 25 patients in the diffuse GGO pattern group, 87 patients with fibrotic HP had compatible pattern on CT. Annual forced vital capacity changes in the UIP pattern group and diffuse GGO pattern group were -2.7% and +3.3% (P=0.004), respectively. The 5-year survival rates in the UIP pattern group and diffuse GGO pattern group were 86% and 100% (P=0.02). In UIP pattern group in the ATS/JRS/ALAT classification, 27% patients were classified as typical fibrotic HP pattern in the CHEST guidelines. In the diffuse GGO pattern group, 52% patients were classified as typical pattern of fibrotic HP. In the CHEST guidelines, more patients in the GGO pattern were classified as typical pattern compared with those in the UIP pattern (P=0.02).

Conclusions: The two patterns in compatible with fibrotic HP of CT classification using the ATS/JRS/ALAT HP guidelines had different disease progression. Typical patterns were more frequent in the CHEST guidelines than the ATS/JRS/ALAT guidelines.

Keywords: Chronic hypersensitivity pneumonitis (chronic HP); fibrotic hypersensitivity pneumonitis (fibrotic HP); high-resolution computed tomography classification (HRCT classification); hypersensitivity pneumonitis guidelines (HP guidelines).