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Impact of computed tomographic patterns and extent on clinical management and outcomes of patients with organising pneumonia

Tang-Hsiu Huang, Sheng-Huan Wei, Li-Ting Huang, Hong-Ping Er, Yu-Ting Yu, Chung-Ta Lee, Yau-Lin Tseng, Chao-Liang Wu
ERJ Open Research 2023 9: 00505-2022; DOI: 10.1183/23120541.00505-2022
Tang-Hsiu Huang
1Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
2Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
8These authors contributed equally
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Sheng-Huan Wei
1Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
8These authors contributed equally
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  • ORCID record for Sheng-Huan Wei
Li-Ting Huang
3Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Hong-Ping Er
1Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
4Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
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Yu-Ting Yu
5Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Chung-Ta Lee
5Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Yau-Lin Tseng
6Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Chao-Liang Wu
2Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
7Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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  • ORCID record for Chao-Liang Wu
  • For correspondence: wumolbio@mail.ncku.edu.tw
  • Article
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Figures

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  • Supplementary Materials
  • FIGURE 1
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    FIGURE 1

    Flow chart of inclusion and exclusion for this study.

  • FIGURE 2
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    FIGURE 2

    Representative images of the various computed tomographic patterns observed in patients of our study cohort: a) alveolar consolidation; b) nodular; c) multilobar ground-glass opacity (GGO); d) mass-like; e) bronchocentric; f) a combination of GGO and reticulo-infiltrative opacity; g) reverse halo sign in a background of mixed GGO and alveolar consolidation; and h) crazy paving pattern mixed with GGO.

  • FIGURE 3
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    FIGURE 3

    Distribution of frequencies of a) aetiologies, b) methods of tissue sampling, c) treatments, d) need of supplemental oxygen, e) use of mechanical ventilation and f) different outcomes among patients of the three subgroups based on the combined assessment of the extent and patterns of involvement on computed tomography images (Group 1: single-lobe and single-pattern; Group 2: single-lobe and mixed-pattern or multilobe and single-pattern; Group 3: multilobe and mixed-pattern). CT: computed tomography; CTD: connective tissue disease.

  • FIGURE 4
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    FIGURE 4

    Forest plots showing a) crude and adjusted odds ratios of secondary organising pneumonia b) crude and adjusted odds ratios of immunosuppressive treatments, and c) crude and adjusted odds ratios of severe disease, for patients with different radiographic features. Note: Groups are based on the combined assessment of the extent and patterns of involvement on computed tomographic images: Group 1: single-lobe and single-pattern; Group 2: single-lobe and mixed-pattern or multilobe and single-pattern; Group 3: multilobe and mixed-pattern. OR: odds ratio.

  • FIGURE 5
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    FIGURE 5

    Kaplan–Meier survival analyses a) between “single-lobe” and “multilobe” groups, b) between “single-pattern” and “mixed-pattern” groups and c) among Groups 1, 2 and 3. Note: Groups are based on the combined assessment of the extent and patterns of involvement on computed tomographic images: Group 1: single-lobe and single-pattern; Group 2: single-lobe and mixed-pattern or multilobe and single-pattern; Group 3: multilobe and mixed-pattern.

Tables

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  • Supplementary Materials
  • TABLE 1

    Baseline characteristics, management and outcomes of the study cohort

    Age years61.5 (54.4–71.1)
    Sex
     Female66 (42)
     Male90 (58)
    Body height cm160.9±9.3
    Body weight kg60.3 (53.7–66.6)
    Charlson comorbidity index3 (2–5)
    Cigarette smoking status
     Never-smoker105 (67)
     Current smoker29 (19)
     Former smoker22 (14)
    Time between CT and histologic diagnosis of OP, days13 (7–30)
    Method of biopsy
     Surgical91 (58)
     CT-guided percutaneous49 (31)
     Transbronchial forceps15 (10)
     Sonography-guided percutaneous1 (1)
    Season of diagnosis
     Spring (March–May)40 (26)
     Summer (June–August)50 (32)
     Autumn (September–November)37 (24)
     Winter (December–February)29 (18)
    Aetiology
     Cryptogenic130 (83)
     Secondary26 (17)
      CTD-related14 (9)
       Rheumatoid arthritis6 (4)
       Dermatomyositis/polymyositis3 (2)
       Primary Sjögren's syndrome3 (2)
       Anti-synthetase syndrome1 (1)
       Systemic lupus erythematosus1 (1)
      Drug-related10 (6)
       Amiodarone5 (3)
       Pembrolizumab2 (2)
       Agent(s) in cancer chemotherapeutic regimens2 (2)
       Crizotinib1 (1)
      Post-transplantation2 (2)
    Duration of follow-up, weeks120.6 (31.1–269.4)
    Treatments
     Observation only45 (29)
     Surgical resection48 (31)
     Corticosteroid alone55 (35)
     Combined corticosteroid and another immunosuppressant7 (4)
     Non-steroid immunosuppressant1 (1)
    Needed supplementary oxygen during the course41 (26)
    Needed mechanical ventilatory support during the course17 (11)
    Outcomes
     Improved without recurrence129 (82)
     Persistent disease11 (7)
     Improved but then recurred5 (3)
     Death11 (8)

    Discrete variables are presented as counts (% of the total 156 patients). Continuous variables are presented as mean±sd if normally distributed, and medians (interquartile ranges) if not normally distributed. CT: computed tomography; OP: organising pneumonia; CTD: connective tissue disease.

    • TABLE 2

      Computed tomographic (CT) features of organising pneumonia

      Cases, n (%)Age yearsMale/female, n (%)
      Extent of parenchymal involvement on CT images
       Single lobe74 (47)61 (53–70)47 (30)/27 (17)
       Multiple lobes82 (53)63 (57–74)43 (28)/39 (25)
        Ipsilateral9 (6)75 (53–81)6 (4)/3 (2)
        Bilateral73 (47)62 (57–70)37 (24)/36 (23)
      CT imaging patterns
       Single-pattern100 (64)61 (53–69)58 (37)/42 (27)
        Nodular42 (27)63 (54–70)21 (13)/21 (13)
        Alveolar consolidation32 (21)61 (53–69)20 (13)/12 (8)
        Mass-like18 (11)56 (51–67)13 (8)/5 (3)
        GGO8 (5)61 (47–67)4 (3)/4 (3)
       Mixed-pattern56 (36)65 (57–76)32 (20)/24 (16)
        Alveolar consolidation+GGO13 (7)69 (58–79)10 (6)/3 (2)
        Alveolar consolidation+bronchocentric6 (4)64 (41–73)3 (2)/3 (2)
        Alveolar consolidation+nodular4 (3)65 (51–75)2 (1)/2 (1)
        GGO+bronchocentric7 (4)58 (56–75)3 (2)/4 (3)
        GGO+reticulo-infiltrative3 (2)66 (41–70)1 (1)/2 (1)
        GGO+nodular2 (1)61 (58–63)0 (0)/2 (1)
        GGO+crazy paving2 (1)79 (74–84)2 (1)/0 (0)
        Mass+nodular3 (2)65 (62–71)2 (1)/1 (1)
        Mass+reverse halo1 (1)45 (NA)1 (1)/0 (0)
        Alveolar consolidation+GGO+bronchocentric6 (4)68 (53–81)3 (2)/3 (2)
        Alveolar consolidation+GGO+reverse halo3 (2)57 (54–60)2 (1)/1 (1)
        Alveolar consolidation+GGO+reticulo-infiltrative1 (1)69 (NA)0 (0)/1 (1)
        Alveolar consolidation+GGO+crazy paving1 (1)58 (NA)0 (0)/1 (1)
        Alveolar consolidation+GGO+nodular1 (1)87 (NA)1 (1)/0 (0)
        GGO+reverse halo+reticulo-infiltrative1 (1)61 (NA)0 (0)/1 (1)
        Alveolar consolidation+GGO+bronchocentric+crazy paving2 (1)62 (58–66)2 (1)/0 (0)
      Combined extent and patterns on CT images
       Single-lobe and single-pattern71 (46)61 (53–70)46 (29)/25 (16)
       Multilobe and single-pattern29 (18)61 (52–66)12 (8)/17 (11)
       Single-lobe and mixed-pattern3 (2)57 (50–64)1 (1)/2 (1)
       Multilobe and mixed-pattern53 (34)65 (57–76)31 (20)/22 (14)

      Values are presented as counts (% of total 156 patients) or medians (interquartile range or range, as appropriate). Examples of the various radiographic features are presented in figure 2 and supplementary figure S1a–q. GGO: ground-glass opacity; NA: not available.

      Supplementary Materials

      • Figures
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      • Supplementary Material

        Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

        Supplementary material 00505-2022.SUPPLEMENT

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      Impact of computed tomographic patterns and extent on clinical management and outcomes of patients with organising pneumonia
      Tang-Hsiu Huang, Sheng-Huan Wei, Li-Ting Huang, Hong-Ping Er, Yu-Ting Yu, Chung-Ta Lee, Yau-Lin Tseng, Chao-Liang Wu
      ERJ Open Research Jan 2023, 9 (1) 00505-2022; DOI: 10.1183/23120541.00505-2022

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      Impact of computed tomographic patterns and extent on clinical management and outcomes of patients with organising pneumonia
      Tang-Hsiu Huang, Sheng-Huan Wei, Li-Ting Huang, Hong-Ping Er, Yu-Ting Yu, Chung-Ta Lee, Yau-Lin Tseng, Chao-Liang Wu
      ERJ Open Research Jan 2023, 9 (1) 00505-2022; DOI: 10.1183/23120541.00505-2022
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