Meta-analysis of the radiological and clinical features of Usual Interstitial Pneumonia (UIP) and Nonspecific Interstitial Pneumonia (NSIP)

Abstract

PurposeTo conduct a meta-analysis to determine specific computed tomography (CT) patterns and clinical features that discriminate between nonspecific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP). Materials and methodsThe PubMed/Medline and Embase databases were searched for studies describing the radiological patterns of UIP and NSIP in chest CT images. Only studies involving histologically confirmed diagnoses and a consensus diagnosis by an interstitial lung disease (ILD) board were included in this analysis. The radiological patterns and patient demographics were extracted from suitable articles. We used random-effects meta-analysis by DerSimonian & Laird and calculated pooled odds ratios for binary data and pooled mean differences for continuous data. ResultsOf the 794 search results, 33 articles describing 2,318 patients met the inclusion criteria. Twelve of these studies included both NSIP (338 patients) and UIP (447 patients). NSIPpatients were significantly younger (NSIP: median age 54.8 years, UIP: 59.7 years; mean difference (MD) -4.4; p = 0.001; 95% CI: -6.97 to -1.77), less often male (NSIP: median 52.8%, UIP: 73.6%; pooled odds ratio (OR) 0.32; p<0.001; 95% CI: 0.17 to 0.60), and less often smokers (NSIP: median 55.1%, UIP: 73.9%; OR 0.42; p = 0.005; 95% CI: 0.23 to 0.77) than patients with UIP. The CT findings from patients with NSIP revealed significantly lower levels of the honeycombing pattern (NSIP: median 28.9%, UIP: 73.4%; OR 0.07; p<0.001; 95% CI: 0.02 to 0.30) with less peripheral predominance (NSIP: median 41.8%, UIP: 83.3%; PLOS ONE | https://doi.OR 0.21; p<0.001; 95% CI: 0.11 to 0.38) and more subpleural sparing (NSIP: median 40.7%, UIP: 4.3%; OR 16.3; p = 0.005; 95% CI: 2.28 to 117). ConclusionHoneycombing with a peripheral predominance was significantly associated with a diagnosis of UIP. The NSIP pattern showed more subpleural sparing. The UIP pattern was predominantly observed in elderly males with a history of smoking, whereas NSIP occurred in a younger patient population.Meta-analysis of the radiological UIP and NSIP pattern PLOS ONE | https://doi.org/10.

Overlap Syndromes in Sarcoidosis: Clinical Features and Outcomes

“…35 NSIP is usually described as ground glass with subpleural sparing, reticulations, and/or traction bronchiectasis in the middle and lower lung zones. 36,37 The radiographic appearance of RA ILD is typically more consistent with the lower lobe honeycombing seen in idiopathic pulmonary fibrosis. 38 In comparison, pulmonary fibrosis in sarcoidosis tends to cause bilateral fibrocystic architectural distortion predominately the upper and mid lung zones 39 (►Fig.…”

Simple method for detecting idiopathic interstitial pneumonias by measuring vertical lung length on chest X-ray

“…One hypothesis suggests that mechanical stress caused by repeated ventilation is stronger in the lower lobe because of the large motion of the chest wall and diaphragm 20 – 22 . In addition to IPF, most IIPs demonstrate predominantly lower lobe lesions 16 , 19 , 20 , 23 . Patients in the current study with non-IPF IIPs showed decreased l VLL and l / u VLL ratio, similar to patients with IPF.…”

Fibrotic Idiopathic Interstitial Lung Disease: The Molecular and Cellular Key Players

“…Among such cases, nonspecific interstitial pneumonia (NSIP) represents the second most common type of IIP after IPF, accounting for 25% of IIP cases [43]. Furthermore, non-specific interstitial pneumonia (NSIP) can be either idiopathic or associated with connective tissue diseases (e.g., scleroderma), hypersensitivity pneumonia, drug reactions, or diffuse alveolar damage (DAD) and affects more often women ranging from 40 to 50 years of age [23]. The histological pattern of NSIP is characterized by the homogeneous inflammation and expansion of alveolar walls; there are three different subtypes depending on the pattern distribution-cellular, fibrotic and mixed-that are related to different prognoses, where the fibrotic is the representative for the worst prognosis.…”

“…In particular, the IIPs are divided into four main groups (chronic fibrosing, smoking-related, acute/subacute, and rare) with the addition of a new disease: idiopathic pleuro parenchymal fibroelastosis [1]. Most of the ILDs have unknown etiology while there are a group of ILDs related/due to occupational and environmental exposure [21][22][23]. Although the majority of the ILDs can have unknown etiology, different works suggest that environmental factors could represent a risk factor in ILDs such as IPF since they may increase the probability of developing the disease in genetically susceptible individuals.…”