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Usefulness of new diagnostic criteria for chronic hypersensitivity pneumonitis established on the basis of a Delphi survey: A Japanese cohort study
Institution:1. Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan;2. Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public Health Teachers, Itami, Japan;3. Department of Laboratory of Pathology, Nagasaki University Hospital, Nagasaki, Japan;1. Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan;2. Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public Health Teachers, Itami, Japan;3. Division of Clinical Epidemiology, Graduate School of Public Health, St. Luke''s International University, Tokyo, Japan;1. Department of Internal Medicine V, University Hospital, Ludwig Maximilian University (LMU) Munich, Member of the German Center for Lung Research (DZL), Munich, Germany;2. Asklepios Lung Center Gauting, DZL, Munich, Germany;3. Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover Medical School, Hannover, Germany;4. Center for Interstitial And Rare Lung Diseases, Department of Pneumology, Thoraxklinik Heidelberg University Hospital, Heidelberg, Germany;5. Coordinating Center for Clinical Trials, Philipps University Marburg, Marburg, Member of the German Center for Lung Research, Germany;6. Lung Clinic Grosshansdorf, Grosshansdorf, Germany;7. Department of Pulmonary Medicine, Ruhrlandklinik, University Essen, Essen, Germany;8. Zentralklinik Bad Berka, Department of Pulmonary Medicine, Bad Berka, Germany;9. Protestantic Lung Clinic Berlin, Berlin, Germany;10. Department of Pulmonary Medicine, KWM Missio Clinic, Würzburg, Würzburg, Germany;11. Department of Pulmonary Medicine, Saarland University Medical Center, Homburg, Germany;12. Lung Clinic Immenhausen, Immenhausen, Germany;13. Lung Clinic Coswig, University Carl Gustav Carus Dresden, Dresden, Germany;14. Donaustauf Hospital, Center for Pneumology, Donaustauf, Germany;15. Department of Pulmonary Medicine, University Hospital Leipzig, Leipzig, Germany;p. Paracelsus Medical University Nuernberg, Nuernberg General Hospital, Nuernberg, Germany;q. Department of Pulmonary Medicine, Catholic Clinic Koblenz Montabaur, Koblenz, Germany;r. Helios Klinikum Emil von Behring, Lungenklinik Heckeshorn, Berlin, Germany;s. Comprehensive Pneumology Center, Helmholtz Center Munich, Ludwig Maximilian University Munich, Munich, Germany;t. Asklepios Clinic Gauting, Munich, Germany;u. Center for Interstitial and Rare Lung Diseases, Justus-Liebig University Giessen, Giessen, Germany;v. Member of the German Center for Lung Research and Cardiopulmonary Institute, and Agaplesion Lung Clinic Waldhof-Elgershausen, Greifenstein, Germany;1. Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI;2. Department of Biostatistics, University of Michigan, Ann Arbor, MI;3. Department of Radiology, University of Michigan, Ann Arbor, MI;4. Department of Pathology, University of Michigan, Ann Arbor, MI;5. Division of Pulmonary and Critical Medicine, Cornell Medical College, New York, NY;1. Department of Medicine, University of California, San Francisco, CA;2. Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia;3. Central Clinical School, Monash University, Melbourne, Australia;4. Département de Médecine, Centre Hospitalier de l’Université de Montréal, Québec, Canada;5. National Heart and Lung Institute, Imperial College London, England;6. Royal Brompton Hospital, London, England;1. Department of Pulmonary Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China;2. Department of Medicine, University of California, San Francisco, San Francisco, CA;3. Department of Pathology, University of California, San Francisco, San Francisco, CA;4. Department of Radiology, University of California, San Francisco, San Francisco, CA
Abstract:BackgroundChronic hypersensitivity pneumonitis (CHP) is a fibrotic interstitial lung disease (ILD) caused by repeated exposure to a variety of organic particles. In November 2017, new criteria for CHP diagnosis were proposed by Morisset et al. based on a modified Delphi survey of ILD experts. However, it remains unclear whether these criteria are useful to accurately diagnose CHP. We aimed to evaluate the newly proposed CHP diagnostic criteria.MethodsWe retrospectively applied Morisset's CHP diagnostic criteria to consecutive Japanese patients who underwent surgical lung biopsy for diagnosis of ILD from 2008 to 2015. All patients underwent bronchoalveolar lavage and pulmonary function testing. Patients who had connective tissue disease complications or showed an acute or subacute disease onset were excluded.ResultsA total of 251 patients were included. The diagnoses based on multidisciplinary discussion (MDD) were CHP (n = 27), idiopathic pulmonary fibrosis (n = 117), unclassifiable interstitial pneumonia (IP) (n = 65), and other diagnoses (n = 42). Of the 27 MDD-CHP patients, 14 were classified as a CHP group with diagnostic confidence >50% and 13 were not categorized (sensitivity, 51.9%; specificity, 77.7%). Morisset's CHP diagnostic criteria could help avoid SLB for the diagnosis of CHP in seven patients. Of the 13 MDD-CHP patients who were not categorized in the CHP group with diagnostic confidence >50%, the reason for the exclusion was an inconsistent with UIP pattern without CHP features.ConclusionsHalf of the MDD-CHP patients were diagnosed with CHP using Morisset's CHP diagnostic criteria. Further investigation will be important for developing improved diagnostic criteria for CHP.
Keywords:Chronic hypersensitivity pneumonitis  Diagnostic accuracy  Delphi survey  Japanese cohort study  ATS"}  {"#name":"keyword"  "$":{"id":"kwrd0035"}  "$$":[{"#name":"text"  "_":"American Thoracic Society  BAL"}  {"#name":"keyword"  "$":{"id":"kwrd0045"}  "$$":[{"#name":"text"  "_":"bronchoalveolar lavage  CHP"}  {"#name":"keyword"  "$":{"id":"kwrd0055"}  "$$":[{"#name":"text"  "_":"chronic hypersensitivity pneumonitis  ERS"}  {"#name":"keyword"  "$":{"id":"kwrd0065"}  "$$":[{"#name":"text"  "_":"European Respiratory Society  HRCT"}  {"#name":"keyword"  "$":{"id":"kwrd0075"}  "$$":[{"#name":"text"  "_":"high-resolution computed tomography  ILD"}  {"#name":"keyword"  "$":{"id":"kwrd0085"}  "$$":[{"#name":"text"  "_":"interstitial lung disease  IP"}  {"#name":"keyword"  "$":{"id":"kwrd0095"}  "$$":[{"#name":"text"  "_":"interstitial pneumonia  IPF"}  {"#name":"keyword"  "$":{"id":"kwrd0105"}  "$$":[{"#name":"text"  "_":"idiopathic pulmonary fibrosis  MDD"}  {"#name":"keyword"  "$":{"id":"kwrd0115"}  "$$":[{"#name":"text"  "_":"multidisciplinary discussion  SLB"}  {"#name":"keyword"  "$":{"id":"kwrd0125"}  "$$":[{"#name":"text"  "_":"surgical lung biopsy  UIP"}  {"#name":"keyword"  "$":{"id":"kwrd0135"}  "$$":[{"#name":"text"  "_":"usual interstitial pneumonia
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