Publications by authors named "Thomas E Hartman"

54 Publications

Presenting Clinicoradiologic Features, Causes, and Clinical Course of Exogenous Lipoid Pneumonia in Adults.

Chest 2021 Feb 26. Epub 2021 Feb 26.

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address:

Background: Exogenous lipoid pneumonia (ELP) develops when lipid-containing substances enter the airways through aspiration or inhalation and incite an inflammatory response. The diagnosis of ELP often is difficult because findings may be nonspecific. The clinical course of ELP has not been well characterized.

Research Question: What are the presenting clinicoradiologic features of ELP, its causative agents, and clinical course?

Study Design And Methods: We searched the Mayo Clinic electronic medical records for patients diagnosed with ELP between 1998 and 2020. Inclusion diagnostic criteria were: (1) lipoid pneumonia (LP) on histopathologic examination, (2) lipid-laden macrophages in BAL fluid, or (3) fatty attenuation of parenchymal opacities on chest CT imaging. Additionally, all patients were required to have a clinician diagnosis of LP in the absence of conditions known to cause endogenous LP.

Results: Thirty-four patients were identified. Mean age was 71 years, with no sex predominance; one-half were asymptomatic. The diagnosis was confirmed by lung biopsy (including three lobectomies for suspected malignancy) in 71% of patients, CT scan in 24% of patients, and BAL in 5% of patients. Most patients manifested bilateral parenchymal opacities that commonly involved the lower lobes; fatty attenuation was identifiable in only 41% of patients. A causative substance was identified in 79% of patients, in most cases after the diagnosis was established. Over a median follow-up of 1.2 years, only 20% of patients with chronic respiratory symptoms improved, whereas 50% worsened. Over a median follow-up interval of 1 year, CT scan abnormalities improved or resolved in 33% of patients and progressed in 39% of patients. Patients who deteriorated were older, with a higher prevalence of GI disorders than those who remained stable or improved.

Interpretation: ELP often is asymptomatic and may not manifest fatty attenuation on chest CT imaging. Clinical and radiologic abnormalities persist or worsen in most affected patients, even when the causative agent is discontinued.
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http://dx.doi.org/10.1016/j.chest.2021.02.037DOI Listing
February 2021

Pulmonary nodules in patients with primary Sjögren's syndrome: Causes, clinico-radiologic features, and outcomes.

Respir Med 2020 Nov - Dec;174:106200. Epub 2020 Oct 22.

Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. Electronic address:

Background: Primary Sjögren's Syndrome (pSS) is characterized by an immune-mediated lymphoplasmacytic infiltration of the salivary and lacrimal glands. Pulmonary nodules are not uncommonly encountered in these patients.

Methods: We conducted a retrospective computer-assisted search for patients with pSS who were encountered at our institution between 1999 and 2018 and had histologically characterized pulmonary nodule(s)/mass (es) (PNs).

Results: Of 41 patients with pSS and PNs, median age was 67 years (IQR, 56-74), 94% were women, and 39% had a smoking history. The PNs proved to be non-Hodgkin lymphoma (NHL) in 16 patients (39%), lung carcinoma in 11 patients (27%), other malignancies in 2 patients (5%), and benign diseases in remaining 12 patients (29%), including 7 with amyloidomas. Patients with NHL were younger (p = 0.006) while smoking exposure was more prevalent in patients with lung carcinoma (p = 0.022). Patients with NHL had a higher number of PNs and more often manifested random distribution, cysts, ground-glass changes and consolidations. Upper and/or mid-lung location, spiculated borders, solitary nodule, increasing size, and higher SUV on FDG-PET scan were associated with lung carcinoma. At the end of follow-up (median 5.9 years), 8 patients (20%) had died and included 5 patients with lung carcinoma; no deaths were observed in the NHL group.

Conclusions: The majority of biopsied PNs in patients with pSS were malignant, most commonly lymphomas. Smoking exposure, solitary nodule, and high FDG avidity were more frequently associated with lung carcinoma. The clinical context, CT and FDG-PET are complementary in the evaluation and management of PNs in patients with pSS.
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http://dx.doi.org/10.1016/j.rmed.2020.106200DOI Listing
October 2020

Clinico-radiologic Features of Lung Disease Associated With Aspiration Identified on Lung Biopsy.

Chest 2019 12 6;156(6):1160-1166. Epub 2019 Aug 6.

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address:

Background: Aspiration-related lung diseases are commonly diagnosed presumptively based on the clinical context and radiologic findings. Limited data exist on the spectrum of clinico-radiologic presentations associated with aspiration.

Methods: This study reviewed all cases of aspiration identified on lung biopsy encountered at the Mayo Clinic between 2003 and 2017. Demographic and clinical features, including risk factors for aspiration, diagnoses suspected prior to biopsy, imaging findings, and microbiologic data, were analyzed.

Results: A total of 52 consecutive adult cases of aspiration identified on lung biopsy (histologic presence of food or other particulate matter) were included; patients' median age was 59 years (range, 22 to 79 years), 38% were women, and there were five lung transplant recipients. Of these, 63% were diagnosed according to results of surgical biopsy (including four cases of lobectomy) and 37% according to results of transbronchial biopsy. Aspiration was clinically suspected prior to biopsy in 35% of the subjects. Ninety percent of subjects had at least one identifiable risk factor for aspiration; gastroesophageal reflux disease was the most common (62%), followed by a structurally abnormal esophagogastric tract and the use of consciousness-impairing medications. Only 27% of patients reported dysphagia or choking. Chest CT imaging revealed a variety of parenchymal patterns, including bronchiolitis (42%), patchy consolidation (19%), and mass (15%). Of 25 patients undergoing a video-swallow evaluation, 14 (56%) had abnormal results with laryngeal penetration with or without aspiration. Microbial cultures obtained in 21 lung biopsy specimens yielded no pathogens.

Conclusions: Aspiration can occur in the absence of subjective or demonstrable swallowing difficulties and manifest a broad spectrum of clinico-radiologic presentations.
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http://dx.doi.org/10.1016/j.chest.2019.07.018DOI Listing
December 2019

Clinical and Histopathologic Features of Immune Checkpoint Inhibitor-related Pneumonitis.

Am J Surg Pathol 2019 10;43(10):1331-1340

Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.

Immune checkpoint inhibitors (ICIs) have revolutionized oncology, but are associated with immune-related adverse events. Clinically, pneumonitis is a well-recognized complication, but its histopathologic features are poorly understood. Institutional archives were searched for patients having ICI therapy and subsequent lung tissue sampling. After excluding infectious cases, 9 patients (5 women, median: 59 y) were identified with clinically suspected ICI-related pneumonitis. Clinical history, imaging, and pathology slides were reviewed. Patients received pembrolizumab (6 cases), nivolumab (1), ipilimumab followed by pembrolizumab (1), or pembrolizumab followed by nivolumab (1); the latter experienced pneumonitis with both agents. Treatment duration ranged from 1 to 33 cycles (median: 8). Three patients received concurrent chemotherapy and 1 received radiation; the remainder received ICI monotherapy. Symptoms were nonspecific; 2 patients were asymptomatic. Thoracic imaging showed bilateral ground glass or nodular opacities in all cases, often with pleural effusion. Histologically, organizing pneumonia was seen in 7 patients, all with subclinical or mild disease, admixed with vague non-necrotizing airspace granulomas in 3 cases; all 6 patients with follow-up did well. One patient had acute fibrinous pneumonitis and 1 had diffuse alveolar damage; both died. All 9 cases showed foamy macrophages and pneumocyte vacuolization; 6 had rare eosinophils. ICI-related pneumonitis presents as bilateral ground-glass opacities or nodules, and usually manifests as organizing pneumonia histopathologically, often with vague non-necrotizing airspace granulomas. Foamy macrophages and pneumocyte vacuolization are characteristic and rare eosinophils are often seen. Less commonly, acute fibrinous pneumonitis or diffuse alveolar damage can occur, which may be fatal.
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http://dx.doi.org/10.1097/PAS.0000000000001298DOI Listing
October 2019

Cowden Syndrome: A Cause of Pulmonary Cysts.

J Thorac Imaging 2018 Nov;33(6):W48-W50

Mayo Clinic, Rochester, MN.

Objective: To describe the pulmonary imaging findings in patients with Cowden syndrome (CS).

Materials And Methods: A retrospective review identified all patients with CS who underwent dedicated computed tomography examinations of the chest at our institution between January 2000 and October 2017. Patient demographics and imaging characteristics were identified through a review of the electronic medical record and relevant imaging.

Results: Fifteen patients (6 males/9 females; mean age 53 y) with a clinical diagnosis of CS were identified. Genetic confirmation of the PTEN mutation was available in 8/15 (50%) patients. Pulmonary cysts were present in 12/15 (80%) patients and in 8/8 (100%) patients with documented PTEN mutations. The cysts ranged in size from 4 to 63 mm and were <10 in 10/12 (83%). Cysts were distributed randomly in 10/12 (83%) cases. Solid pulmonary nodules were present in 13/15 (87%) patients and were distributed randomly in all cases.

Conclusions: Pulmonary cysts and solid nodules are common in patients with CS. Cysts tend to be distributed randomly, few in number, and may have traversing vessels. These findings should not be interpreted as evidence of another underlying disorder in the setting of CS.
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http://dx.doi.org/10.1097/RTI.0000000000000358DOI Listing
November 2018

Managing Incidental Findings on Thoracic CT: Mediastinal and Cardiovascular Findings. A White Paper of the ACR Incidental Findings Committee.

J Am Coll Radiol 2018 Aug 22;15(8):1087-1096. Epub 2018 Jun 22.

Massachusetts General Hospital, Boston, Massachusetts.

The ACR Incidental Findings Committee presents recommendations for managing incidentally detected mediastinal and cardiovascular findings found on CT. The Chest Subcommittee was composed of thoracic radiologists who developed the provided guidance. These recommendations represent a combination of current published evidence and expert opinion and were finalized by informal iterative consensus. The recommendations address the most commonly encountered mediastinal and cardiovascular incidental findings and are not intended to be a comprehensive review of all incidental findings associated with these compartments. Our goal is to improve the quality of care by providing guidance on how to manage incidentally detected thoracic findings.
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http://dx.doi.org/10.1016/j.jacr.2018.04.029DOI Listing
August 2018

Correlation of pulmonary function and usual interstitial pneumonia computed tomography patterns in idiopathic pulmonary fibrosis.

Respir Med 2017 08 21;129:152-157. Epub 2017 Jun 21.

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN, United States. Electronic address:

Background: Little is known about presenting 'inconsistent' or 'possible' usual interstitial pneumonia (UIP) computed tomography (CT) patterns advancing to 'consistent' UIP as disease progresses in idiopathic pulmonary fibrosis (IPF). We hypothesized that if 'consistent' UIP represented more advanced disease, such a pattern on presentation should also correlate with more severe pulmonary function test (PFT) abnormalities.

Material And Methods: Consecutive IPF patients (2005-2013) diagnosed by international criteria with baseline PFT and CT were included. Presenting CTs were assessed by three expert radiologists for consensus UIP pattern ('consistent', 'possible', and 'inconsistent'). Approximation of individual and combined interstitial abnormalities was also performed with correlation of interstitial abnormalities and UIP CT pattern made with PFT findings and survival.

Results: Three-hundred and fifty patients (70% male) were included with a mean age of 68.3 years. Mean percent predicted forced vital capacity (FVC%) and diffusion capacity (DLCO%) was 64% and 45.5% respectively. Older age and male gender correlated more with 'consistent' UIP CT pattern. FVC% was not associated with any UIP pattern but did correlate with total volume of radiologist assessed interstitial abnormalities. DLCO% was lower in those with 'consistent' UIP pattern. A 'consistent' UIP CT pattern was also not independently predictive of survival after correction for age, gender, FVC%, and DLCO%.

Conclusion: PFT findings appear to correlate with extent of radiologic disease but not specific morphologic patterns. Whether such UIP patterns represent different stages of disease severity or radiologic progression is not supported by coinciding pulmonary function decline.
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http://dx.doi.org/10.1016/j.rmed.2017.06.013DOI Listing
August 2017

Addition of the Fleischner Society Guidelines to Chest CT Examination Interpretive Reports Improves Adherence to Recommended Follow-up Care for Incidental Pulmonary Nodules.

Acad Radiol 2017 03 25;24(3):337-344. Epub 2016 Oct 25.

Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905.

Rationale And Objectives: The study aimed to determine whether the addition of the Fleischner Society guidelines to chest computed tomography (CT) reports identifying incidental pulmonary nodules affects follow-up care.

Patients And Methods: Beginning in 2008, a template containing the Fleischner Society guidelines was added at the interpreting radiologist's discretion to chest CT reports describing incidental solid pulmonary nodules at our institution. The records of all medical centers in Olmsted county were used to capture the complete medical history of local patients >35 years old diagnosed with a pulmonary nodule from April 1, 2008 to October 1, 2011. Patients with a history of cancer or previously diagnosed nodule, or who died before follow-up, were excluded. Patients were categorized according to whether they did ("template group") or did not ("control group") have the template added. Nodule size and smoking history were used to determine recommended follow-up care. Differences in follow-up were compared between groups using Pearson's chi-square test.

Results: A total of 510 patients (276 in the template group, 234 in the control group) were included in the study. Only 198 patients (39%) received their recommended follow-up care. Template group patients were significantly more likely to receive recommended follow-up care compared to control group patients (45% vs 31%, P = .0014). Most patients whose management did not adhere to Fleischner Society guidelines did not receive a recommended follow-up chest CT (210 out of 312, 67%).

Conclusions: The addition of the Fleischner Society guidelines to chest CT reports significantly increases the likelihood of receiving recommended follow-up care for patients with incidental pulmonary nodules. Additional education is needed to improve appropriate guideline utilization by radiologists and adherence by ordering providers.
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http://dx.doi.org/10.1016/j.acra.2016.08.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5309169PMC
March 2017

Pulmonary nodule characterization, including computer analysis and quantitative features.

J Thorac Imaging 2015 Mar;30(2):139-56

*Department of Radiology, Division of Thoracic Radiology Departments of †Immunology ‡Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN.

Pulmonary nodules are commonly detected in computed tomography (CT) chest screening of a high-risk population. The specific visual or quantitative features on CT or other modalities can be used to characterize the likelihood that a nodule is benign or malignant. Visual features on CT such as size, attenuation, location, morphology, edge characteristics, and other distinctive "signs" can be highly suggestive of a specific diagnosis and, in general, be used to determine the probability that a specific nodule is benign or malignant. Change in size, attenuation, and morphology on serial follow-up CT, or features on other modalities such as nuclear medicine studies or MRI, can also contribute to the characterization of lung nodules. Imaging analytics can objectively and reproducibly quantify nodule features on CT, nuclear medicine, and magnetic resonance imaging. Some quantitative techniques show great promise in helping to differentiate benign from malignant lesions or to stratify the risk of aggressive versus indolent neoplasm. In this article, we (1) summarize the visual characteristics, descriptors, and signs that may be helpful in management of nodules identified on screening CT, (2) discuss current quantitative and multimodality techniques that aid in the differentiation of nodules, and (3) highlight the power, pitfalls, and limitations of these various techniques.
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http://dx.doi.org/10.1097/RTI.0000000000000137DOI Listing
March 2015

Pulmonary fibrosis in dyskeratosis congenita: report of 2 cases.

Hum Pathol 2015 Jan 14;46(1):147-52. Epub 2014 Oct 14.

Division of Anatomic Pathology, Mayo Clinic, Rochester, MN. Electronic address:

Dyskeratosis congenita (DC) is a disorder of poor telomere maintenance and is related to 1 or more mutations that involve the vertebrate telomerase RNA component. Most affected patients develop mucocutaneous manifestations and cytopenias in the peripheral blood between 5 and 15 years of age. DC patients may also develop pulmonary complications including fibrotic interstitial lung disease and pulmonary vascular abnormalities. The radiologic and pathologic features of pulmonary fibrosis associated with DC are poorly defined. Herein, we report 2 new DC cases and suggest that the radiologic and histopathologic findings may resemble usual interstitial pneumonia but may not neatly fit into the current classification of interstitial lung disease.
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http://dx.doi.org/10.1016/j.humpath.2014.10.003DOI Listing
January 2015

Idiopathic pulmonary fibrosis: CT and risk of death.

Radiology 2014 Nov 12;273(2):570-9. Epub 2014 Jun 12.

From the Departments of Medicine (B.L., J.S.L., T.E.K., H.R.C.), Radiology (B.M.E.), Epidemiology and Biostatistics (E.V.), and Pathology (K.D.J.), University of California-San Francisco, 505 Parnassus Ave, Box 0111, San Francisco, CA 94143; Departments of Radiology (T.E.H.) and Medicine (J.H.R.), Mayo Clinic, Rochester, Minn; Department of Medicine, University of British Columbia, Vancouver, BC, Canada (C.J.R.); and Department of Respiratory Medicine, University of Southampton, Southampton, England (L.R.).

Purpose: To investigate the prognostic value of quantitative computed tomographic (CT) scoring for the extent of fibrosis or emphysema in the context of a clinical model that includes the gender, age, and physiology ( GAP gender, age, and physiology model) of the patient.

Materials And Methods: Study cohorts were approved by local institutional review boards, and all patients provided written consent. This was a retrospective cohort study that included 348 patients (246 men, 102 women; mean age, 69 years ± 9) with idiopathic pulmonary fibrosis from two institutions. Fibrosis and emphysema visual scores were independently determined by two radiologists. Models were based on competing risks regression for death and were evaluated by using the C index and reclassification improvement.

Results: The CT- GAP gender, age, and physiology model (a modification of the original GAP gender, age, and physiology model that replaces diffusion capacity of carbon monoxide with CT fibrosis score) had accuracy comparable to that of the original GAP gender, age, and physiology model, with a C index of 70.3 (95% confidence interval: 66.4, 74.0); difference in C index compared with the GAP gender, age, and physiology model of -0.4 (95% confidence interval: -2.2, 3.4). The performance of the original GAP gender, age, and physiology model did not change significantly with the simple addition of fibrosis score, with a change in C index of 0.0 (95% confidence interval: -1.8, 0.5) or of emphysema score, with a change in C index of 0.0 [95% confidence interval: -1.3, 0.4]).

Conclusion: CT fibrosis score can replace diffusion capacity of carbon monoxide test results in a modified GAP gender, age, and physiology model (the CT- GAP gender, age, and physiology model) with comparable performance. This may be a useful alternative model in situations where CT scoring is more reliable and available than diffusion capacity of carbon monoxide.
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http://dx.doi.org/10.1148/radiol.14130216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334234PMC
November 2014

Idiopathic pulmonary fibrosis: evolving concepts.

Mayo Clin Proc 2014 Aug 24;89(8):1130-42. Epub 2014 May 24.

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.

Idiopathic pulmonary fibrosis (IPF) occurs predominantly in middle-aged and older adults and accounts for 20% to 30% of interstitial lung diseases. It is usually progressive, resulting in respiratory failure and death. Diagnostic criteria for IPF have evolved over the years, and IPF is currently defined as a disease characterized by the histopathologic pattern of usual interstitial pneumonia occurring in the absence of an identifiable cause of lung injury. Understanding of the pathogenesis of IPF has shifted away from chronic inflammation and toward dysregulated fibroproliferative repair in response to alveolar epithelial injury. Idiopathic pulmonary fibrosis is likely a heterogeneous disorder caused by various interactions between genetic components and environmental exposures. High-resolution computed tomography can be diagnostic in the presence of typical findings such as bilateral reticular opacities associated with traction bronchiectasis/bronchiolectasis in a predominantly basal and subpleural distribution, along with subpleural honeycombing. In other circumstances, a surgical lung biopsy may be needed. The clinical course of IPF can be unpredictable and may be punctuated by acute deteriorations (acute exacerbation). Although progress continues in unraveling the mechanisms of IPF, effective therapy has remained elusive. Thus, clinicians and patients need to reach informed decisions regarding management options including lung transplant. The findings in this review were based on a literature search of PubMed using the search terms idiopathic pulmonary fibrosis and usual interstitial pneumonia, limited to human studies in the English language published from January 1, 2000, through December 31, 2013, and supplemented by key references published before the year 2000.
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http://dx.doi.org/10.1016/j.mayocp.2014.03.016DOI Listing
August 2014

Radiologic and clinical bronchiectasis associated with autosomal dominant polycystic kidney disease.

PLoS One 2014 18;9(4):e93674. Epub 2014 Apr 18.

Division of Nephrology, Mayo Clinic Rochester, Rochester, Minnesota, United States of America.

Background: Polycystin 1 and 2, the protein abnormalities associated with autosomal dominant polycystic kidney disease (ADPKD), are also found in airway cilia and smooth muscle cells. There is evidence of increased radiologic bronchiectasis associated with ADPKD, though the clinical and functional implications of this association are unknown. We hypothesized an increased prevalence of both radiologic and clinical bronchiectasis is associated with APDKD as compared to non-ADPKD chronic kidney disease (CKD) controls.

Materials And Methods: A retrospective case-control study was performed at our institution involving consecutive ADPKD and non-ADPKD chronic kidney disease (CKD) patients seen over a 13 year period with both chest CT and PFT. CTs were independently reviewed by two blinded thoracic radiologists. Manually collected clinical data included symptoms, smoker status, transplant history, and PFT findings.

Results: Ninety-two ADPKD and 95 non-ADPKD CKD control patients were compared. Increased prevalence of radiologic bronchiectasis, predominantly mild lower lobe disease, was found in ADPKD patients compared to CKD control (19 vs. 9%, P = 0.032, OR 2.49 (CI 1.1-5.8)). After adjustment for covariates, ADPKD was associated with increased risk of radiologic bronchiectasis (OR 2.78 (CI 1.16-7.12)). Symptomatic bronchiectasis occurred in approximately a third of ADPKD patients with radiologic disease. Smoking was associated with increased radiologic bronchiectasis in ADPKD patients (OR 3.59, CI 1.23-12.1).

Conclusions: Radiological bronchiectasis is increased in patients with ADPKD particularly those with smoking history as compared to non-ADPKD CKD controls. A third of such patients have symptomatic disease. Bronchiectasis should be considered in the differential in ADPKD patients with respiratory symptoms and smoking history.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0093674PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3991584PMC
January 2015

Automated quantification of radiological patterns predicts survival in idiopathic pulmonary fibrosis.

Eur Respir J 2014 Jan 5;43(1):204-12. Epub 2013 Apr 5.

Mayo Clinic Rochester, Rochester, MN.

Accurate assessment of prognosis in idiopathic pulmonary fibrosis remains elusive due to significant individual radiological and physiological variability. We hypothesised that short-term radiological changes may be predictive of survival. We explored the use of CALIPER (Computer-Aided Lung Informatics for Pathology Evaluation and Rating), a novel software tool developed by the Biomedical Imaging Resource Laboratory at the Mayo Clinic Rochester (Rochester, MN, USA) for the analysis and quantification of parenchymal lung abnormalities on high-resolution computed tomography. We assessed baseline and follow-up (time-points 1 and 2, respectively) high-resolution computed tomography scans in 55 selected idiopathic pulmonary fibrosis patients and correlated CALIPER-quantified measurements with expert radiologists' assessments and clinical outcomes. Findings of interval change (mean 289 days) in volume of reticular densities (hazard ratio 1.91, p=0.006), total volume of interstitial abnormalities (hazard ratio 1.70, p=0.003) and per cent total interstitial abnormalities (hazard ratio 1.52, p=0.017) as quantified by CALIPER were predictive of survival after a median follow-up of 2.4 years. Radiologist interpretation of short-term global interstitial lung disease progression, but not specific radiological features, was also predictive of mortality. These data demonstrate the feasibility of quantifying interval short-term changes on high-resolution computed tomography and their possible use as independent predictors of survival in idiopathic pulmonary fibrosis.
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http://dx.doi.org/10.1183/09031936.00071812DOI Listing
January 2014

Noninvasive characterization of the histopathologic features of pulmonary nodules of the lung adenocarcinoma spectrum using computer-aided nodule assessment and risk yield (CANARY)--a pilot study.

J Thorac Oncol 2013 Apr;8(4):452-60

Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.

Introduction: Pulmonary nodules of the adenocarcinoma spectrum are characterized by distinctive morphological and radiologic features and variable prognosis. Noninvasive high-resolution computed tomography-based risk stratification tools are needed to individualize their management.

Methods: Radiologic measurements of histopathologic tissue invasion were developed in a training set of 54 pulmonary nodules of the adenocarcinoma spectrum and validated in 86 consecutively resected nodules. Nodules were isolated and characterized by computer-aided analysis, and data were analyzed by Spearman correlation, sensitivity, and specificity and the positive and negative predictive values.

Results: Computer-aided nodule assessment and risk yield (CANARY) can noninvasively characterize pulmonary nodules of the adenocarcinoma spectrum. Unsupervised clustering analysis of high-resolution computed tomography data identified nine unique exemplars representing the basic radiologic building blocks of these lesions. The exemplar distribution within each nodule correlated well with the proportion of histologic tissue invasion, Spearman R = 0.87, p < 0.0001 and 0.89 and p < 0.0001 for the training and the validation set, respectively. Clustering of the exemplars in three-dimensional space corresponding to tissue invasion and lepidic growth was used to develop a CANARY decision algorithm that successfully categorized these pulmonary nodules as "aggressive" (invasive adenocarcinoma) or "indolent" (adenocarcinoma in situ and minimally invasive adenocarcinoma). Sensitivity, specificity, positive predictive value, and negative predictive value of this approach for the detection of aggressive lesions were 95.4, 96.8, 95.4, and 96.8%, respectively, in the training set and 98.7, 63.6, 94.9, and 87.5%, respectively, in the validation set.

Conclusion: CANARY represents a promising tool to noninvasively risk stratify pulmonary nodules of the adenocarcinoma spectrum.
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http://dx.doi.org/10.1097/JTO.0b013e3182843721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597987PMC
April 2013

Amyloid-associated cystic lung disease in primary Sjögren's syndrome.

Respir Med 2013 Apr 10;107(4):616-21. Epub 2013 Feb 10.

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA.

Background: Cystic lung disease can be seen in patients with Sjögren's syndrome (SS) and is generally thought to be due to lymphocytic interstitial pneumonia.

Methods: Using computer-assisted search we identified patients with primary SS seen at Mayo Clinic, Rochester, MN during a 14-year period from 1997 to 2010 who were diagnosed with pulmonary amyloidosis confirmed on lung biopsy. Clinical records, imaging studies, and pathologic specimens were reviewed to delineate presenting features, diagnostic evaluation, and clinical course.

Results: Eight patients (7 women, 1 man) with primary SS were diagnosed with pulmonary amyloidosis by lung biopsy (7 surgical, 1 bronchoscopic). Their median age was 55 years (range, 32-75 years) and all were nonsmokers. Presenting symptoms included dyspnea and cough but 4 patients presented with radiologic abnormalities in the absence of respiratory symptoms. CT findings included cystic lesions and nodular opacities in all eight patients. PET scan performed in six patients did not reveal (18)F-2-deoxyglucose (FDG) uptake except in one nodule with borderline uptake. Lung biopsy demonstrated the presence of amyloid in all patients and was associated with mucosa-associated lymphoid tissue (MALT) lymphoma in three patients. Pulmonary function results were normal in five patients and revealed mild impairment in a mixed pattern in one patient.

Conclusions: We conclude cystic and nodular lung lesions seen in patients with primary SS can represent amyloidosis which can be associated with MALT lymphoma in some of these patients.
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http://dx.doi.org/10.1016/j.rmed.2013.01.005DOI Listing
April 2013

Diffuse pulmonary lymphatic disease presenting as interstitial lung disease in adulthood: report of 3 cases.

Am J Surg Pathol 2012 Oct;36(10):1548-54

Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.

Diffuse pulmonary lymphatic diseases are typically diagnosed shortly after birth or in childhood, but rarely may become evident in adulthood. We report 3 adult patients who presented with diffuse interstitial lung disease clinically and radiologically but on biopsy were found to have diffuse pulmonary lymphatic disease (2 cases of pulmonary lymphangiectasis and 1 case of pulmonary lymphangiomatosis). These patients presented with the insidious onset of symptoms including shortness of breath and cough. Imaging studies of the chest showed diffuse pulmonary interstitial opacities, often with a perilymphatic distribution. The clinical differential diagnostic considerations before surgical lung biopsy included infection, neoplasm, and interstitial lung disease. The histopathologic features included abnormal vessels and associated fibrosis following lymphatic routes, namely visceral pleura, bronchovascular bundles, and interlobular septa. Lymphangiectasis was characterized by dilation of normally distributed lymphatic spaces, whereas lymphangiomatosis showed a complex anastamosing proliferation of lymphatic vascular spaces without significant dilatation. The dilated lymphatic spaces often had undergone muscularization, which could easily lead to misclassification as veins. Immunohistochemical staining for the lymphatic endothelial marker D2-40 was helpful in correctly classifying these lesions. Diffuse pulmonary lymphatic disease can rarely present in adulthood, wherein the histologic findings can be subtle and could be overlooked as nonspecific reactive changes or misdiagnosed as an idiopathic interstitial lung disease. Recognition of the characteristic lymphangitic distribution of abnormally dilated or reduplicated lymphatic spaces is key to the correct diagnosis.
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http://dx.doi.org/10.1097/PAS.0b013e31825eae67DOI Listing
October 2012

Frequency of undiagnosed cystic lung disease in patients with sporadic renal angiomyolipomas.

Chest 2012 Jan 7;141(1):163-168. Epub 2011 Jul 7.

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Department of Radiology, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Division of Biostatistics, Mayo Clinic, Rochester, MN.

Objective: The aim of this study was to assess the frequency of undiagnosed cystic lung lesions suggestive of pulmonary lymphangioleiomyomatosis (LAM) in patients who received a diagnosis of sporadic renal angiomyolipomas (AMLs).

Methods: We conducted a retrospective review of CT scans of the chest or abdomen for cystic lung lesions on 176 adult patients who received a diagnosis of sporadic renal AML during a 10-year period, 1997 to 2006, and comparison with chest CT scans of 176 control subjects without renal AML but matched for age, sex, and smoking history. Patients presenting with suspected or known pulmonary LAM and those with underlying tuberous sclerosis were excluded.

Results: Sporadic renal AML was diagnosed in 176 patients with a median age of 58 years (range, 20-91 years), the majority of whom were women (81.8%). Renal tumor was an incidental finding on imaging studies for most patients (90.3%). Nineteen patients (10.8%) had one or more cystic lung lesions and included nine patients (5.1%) with four or more cysts, all of whom were women. In comparison, eight control subjects (4.6%) had one to three cystic lung lesions and none of them exhibited four or more cysts. None of the patients with renal AML and cystic lung lesions, including six women with 10 or more cysts, had undergone an evaluation of their cystic lung disease.

Conclusions: We conclude that a significant portion of women with sporadic renal AMLs exhibit cystic lung lesions suggestive of pulmonary LAM but may remain undiagnosed. Coexistence of pulmonary LAM should be considered in women incidentally found to have sporadic renal AMLs.
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http://dx.doi.org/10.1378/chest.11-0669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4694079PMC
January 2012

Inappropriate application of nodule management guidelines in radiologist reports before and after revision of exclusion criteria.

AJR Am J Roentgenol 2011 May;196(5):1115-9

Mayo Clinic College of Medicine, Rochester, MN, USA.

Objective: The purpose of this study was to retrospectively evaluate appropriate and inappropriate application of nodule management guidelines in radiology reports of pulmonary nodules seen at CT.

Materials And Methods: The CT reports of 181 patients examined in July and August 2007 (94 males, 87 females; age range, 2-88 years; mean, 60.3 ± 13.0 years) and 177 patients examined in March 2009 (106 men, 71 women; age range, 24-91 years; mean, 60.7 ± 14.0 years) were retrospectively reviewed to assess whether nodule management guidelines were inappropriately applied. The exclusion criteria for the 2007 cases included multiple nodules, stable nodules, potential metastatic disease, probable infectious or inflammatory cause, and age younger than 35 years. The exclusion criteria for the 2009 cases were all of the 2007 criteria except multiple nodules.

Results: Guidelines were inappropriately applied 105 times in 2007 and 25 times in 2009. Reasons for inappropriate use in 2007 were multiple nodules in 70 of the 105 cases (67%), potential metastatic disease in 25 cases (24%), age younger than 35 years in four cases (4%), stable nodules in two cases (2%), probable infectious or inflammatory cause in two cases (2%), and protocol not included despite absence of exclusion criteria in two cases (2%). The reasons in 2009 were potential metastatic disease in 15 of the 25 cases (60%), age younger than 35 years in four cases (16%), stable nodules in three cases (12%), probable infectious or inflammatory cause in one case (4%), and protocol not included despite absence of exclusion criteria in two cases (8%). The percentage of cases with at least one error was 48.1% in 2007, significantly higher than the 13.6% in 2009 (p < 0.001).

Conclusion: Inappropriate application of guidelines for management of pulmonary nodules seen at CT was significantly reduced by removing multiple nodules from the exclusion criteria. Otherwise, causes for inappropriate application remained stable.
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http://dx.doi.org/10.2214/AJR.10.5141DOI Listing
May 2011

A rare case of horseshoe lung presenting in adulthood and associated with a pulmonary sling: case report and review of the literature.

J Thorac Imaging 2010 Aug;25(3):W97-9

Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55902, USA.

Horseshoe lung is a rare congenital malformation in which the pulmonary parenchyma connects in the midline posterior to the pericardium and anterior to the aorta and esophagus. There have been 51 case reports in the world literature. About 80% of these have been associated with Scimitar syndrome, and most cases are diagnosed in infancy due to pulmonary symptoms. To our knowledge, this is the first case report of horseshoe lung presenting in an adult and associated with a pulmonary sling, complete bowel malrotation, and renal ectopia.
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http://dx.doi.org/10.1097/rti.0b013e3181b6a8f9DOI Listing
August 2010

Iron deposition and increased alveolar septal capillary density in nonfibrotic lung tissue are associated with pulmonary hypertension in idiopathic pulmonary fibrosis.

Respir Res 2010 Apr 14;11:37. Epub 2010 Apr 14.

Department of Laboratory Medicine and Pathology, division of Anatomic Pathology Mayo Clinic, Rochester, Minnesota, USA.

Background: Early diagnosis of pulmonary hypertension (PH) in idiopathic pulmonary fibrosis (IPF) has potential prognostic and therapeutic implications but can be difficult due to the lack of specific clinical manifestations or accurate non-invasive tests. Histopathologic parameters correlating with PH in IPF are also not known. Remodeling of postcapillary pulmonary vessels has been reported in the nonfibrotic areas of explanted lungs from IPF patients. We hypothesized that iron deposition and increased alveolar capillaries, the findings often seen in postcapillary PH, might predict the presence of clinical PH, independent of the severity of fibrosis or ventilatory dysfunction in IPF patients. To test this hypothesis, we examined the association between these histologic parameters and the degree of PH, with consideration of the severity of disease in IPF.

Methods: Iron deposition and alveolar septal capillary density (ASCD) were evaluated on histologic sections with hematoxylin-eosin, iron, elastin and CD34 stainings. Percentage of predicted forced vital capacity (FVC%) was used for grading pulmonary function status. Fibrosis score assessed on high resolution computed tomography (HRCT) was used for evaluating overall degree of fibrosis in whole lungs. Right ventricular systolic pressure (RVSP) by transthoracic echocardiography was used for the estimation of PH. Univariate and multivariate regression analyses were performed.

Results: A cohort of 154 patients was studied who had the clinicopathological diagnosis of IPF with surgical lung biopsies or explants during the period of 1997 to 2006 at Mayo Clinic Rochester. In univariate analysis, RVSP in our IPF cases was associated with both iron deposition and ASCD (p < 0.001). In multivariate analysis with FVC% and HRCT fibrosis score included, iron deposition (p = 0.02), but not ASCD (p = 0.076), maintained statistically significant association with RVSP. FVC% was associated with RVSP on univariate analysis but not on multivariate analysis, while fibrosis score lacked any association with RVSP by either univariate or multivariate analyses.

Conclusions: Iron deposition and ASCD in non fibrotic lung tissue showed an association with RVSP, suggesting that these features are possible morphologic predictors of PH in IPF.
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http://dx.doi.org/10.1186/1465-9921-11-37DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2867975PMC
April 2010

Incidence, prevalence, and clinical course of idiopathic pulmonary fibrosis: a population-based study.

Chest 2010 Jan 11;137(1):129-37. Epub 2009 Sep 11.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Autoimmune Lung Center and Interstitial Lung Disease Program, National Jewish Health, 1400 Jackson Street G-10a, Denver, CO 80206, USA.

Background: Limited data exist regarding the population-based epidemiology of idiopathic pulmonary fibrosis (IPF). The objective of the study was to describe the trends in the incidence, prevalence, and clinical course of IPF in the community.

Methods: We conducted a population-based study of adult patients with IPF in Olmsted County, Minnesota, from 1997 to 2005. Two methods were used to identify IPF cases, as defined by the 2002 American Thoracic Society/European Respiratory Society consensus statement: (1) usual interstitial pneumonia (UIP) on a surgical lung biopsy specimen or a definite UIP pattern on a high-resolution CT image (narrow criteria) and (2) UIP on a surgical lung biopsy specimen or a definite or possible UIP pattern on CT image (broad criteria).

Results: Of 596 patients screened for the possibility of pulmonary disease or pulmonary fibrosis over 9 years of follow-up, 47 cases had IPF. Of these, 24 met the narrow criteria. The age- and sex-adjusted incidence was 8.8/100,000 and 17.4/100,000 person-years, for narrow and broad criteria, respectively. The age-adjusted incidence was higher in men than in women, and among patients aged 70-79 years. During the study period, the incidence of IPF decreased (P < .001). On December 31, 2005, the age- and sex-adjusted prevalence was 27.9/100,000 and 63/100,000 persons by narrow and broad criteria, respectively. Thirty-seven patients experienced a total of 53 respiratory exacerbations (26 IPF related, 27 non-IPF related), and 34 (72%) patients died. The primary cause of death was IPF related in 16 (47%) patients. Median survival for narrow-criteria and broad-criteria incidence cases was 3.5 and 4.4 years, respectively.

Conclusions: The incidence of IPF in Olmsted County decreased over the study period. Nonprimary IPF respiratory exacerbations are as frequent as primary IPF respiratory exacerbations and an important cause of death.
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http://dx.doi.org/10.1378/chest.09-1002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803118PMC
January 2010

5-year lung cancer screening experience: growth curves of 18 lung cancers compared to histologic type, CT attenuation, stage, survival, and size.

Chest 2009 Dec 6;136(6):1586-1595. Epub 2009 Jul 6.

Department of Biostatistics, Mayo Clinic, Rochester, MN.

Background: Although no study has prospectively documented the rate at which lung cancers grow, many have assumed exponential growth. The purpose of this study was to document the growth of lung cancers detected in high-risk participants receiving annual screening chest CT scans.

Methods: Eighteen lung cancers were evaluated by at least four serial CT scans (4 men, 14 women; age range, 53 to 79 years; mean age, 66 years). CT scans were retrospectively reviewed for appearance, size, and volume (volume [v] = pi/6[ab(2)]). Growth curves (x = time [in days]; y = volume [cubic millimeters]) were plotted and subcategorized by histology, CT scan attenuation, stage, survival, and initial size.

Results: Inclusion criteria favored smaller, less aggressive cancers. Growth curves varied, even when subcategorized by histology, CT scan attenuation, stage, survival, or initial size. Cancers associated with higher stages, mortality, or recurrence showed fairly steady growth or accelerated growth compared with earlier growth, although these growth patterns also were seen in lesser-stage lung cancers. Most lung cancers enlarged at fairly steady increments, but several demonstrated fairly flat growth curves, and others demonstrated periods of accelerated growth.

Conclusions: This study is the first to plot individual lung cancer growth curves. Although parameters favored smaller, less aggressive cancers in women, it showed that lung cancers are not limited to exponential growth. Tumor size at one point or growth between two points did not appear to predict future growth. Studies and equations assuming exponential growth may potentially misrepresent an indeterminate nodule or the aggressiveness of a lung cancer.
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http://dx.doi.org/10.1378/chest.09-0915DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789925PMC
December 2009

Abnormal fluorodeoxyglucose PET in pulmonary Langerhans cell histiocytosis.

Chest 2009 Jun 15;135(6):1542-1549. Epub 2009 May 15.

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address:

Background: Pulmonary Langerhans cell histiocytosis (PLCH) is an inflammatory lung disease strongly associated with cigarette smoking and an increased risk of malignant neoplasms. Although the chest CT scan characteristics of PLCH are well recognized, the PET scan characteristics of adults with PLCH are unknown.

Methods: We identified 11 patients with PLCH who underwent PET scanning over a 6-year period from July 2001 to June 2007. The presenting clinicoradiologic features including PET scan and chest CT scan findings were analyzed.

Results: Five of 11 patients had positive PET scan findings. Of the five PET scan-positive patients, 4 (80%) were women, 4 (80%) were current smokers, and the median age was 45 years (age range, 31 to 52 years). PET scan-positive findings were more likely to be present if the scan was performed early in the clinical course. Three PET scan-positive patients (60%) had multiorgan involvement. PET scan-positive patients had predominantly nodular inflammatory lung disease (> 100 nodules) with most nodules measuring < 8 mm, whereas all PET scan-negative patients had predominantly cystic lung disease with fewer nodules (< 25 nodules). Notable abnormal PET scan findings included foci of increased uptake in nodular lung lesions, thick-walled cysts, bone, and liver lesions. The mean maximum standardized uptake value of the PET scan-positive lesions ranged from 2.0 to 18.2.

Conclusions: PLCH may be associated with abnormal thoracic and extrathoracic PET scan results. Patients with nodular disease seen on chest CT scans appear more likely to have abnormal PET scan findings. Our results suggest that PET scan imaging cannot reliably distinguish between the benign inflammatory nodular lesions of PLCH and malignant lesions.
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http://dx.doi.org/10.1378/chest.08-1899DOI Listing
June 2009

High-resolution CT findings of parenchymal fibrosis correlate with prognosis in hypersensitivity pneumonitis.

Chest 2008 Jul 10;134(1):133-8. Epub 2008 Apr 10.

Division of Pulmonary, Critical Care, and Sleep, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Background: Histopathologic evidence of fibrosis on surgical lung biopsy has been associated with reduced survival in patients with hypersensitivity pneumonitis (HP). Changes of pulmonary fibrosis detected on CT may also correlate with prognosis in patients with HP.

Methods: We identified 69 consecutive patients with HP diagnosed between January 1997 and December 2002 at Mayo Clinic, Rochester, MN. Patients were stratified into fibrotic and nonfibrotic groups based on the CT findings. Fibrosis was defined by the presence of irregular linear opacities, traction bronchiectasis, or honeycombing.

Measurements And Main Results: Of 69 patients, 26 were classified as fibrotic and 43 as nonfibrotic. Patients in the fibrotic group were older, had longer symptom duration, were more likely to have crackles on auscultation, more likely to be exposed to avian antigen, and had greater restrictive lung impairment (p<0.05 for all comparisons). There were 11 deaths in the fibrotic group and 1 death in the nonfibrotic group (p<0.0001). In the regression analysis, CT evidence of fibrosis, more severe pulmonary function abnormalities, and the presence of crackles on auscultation were predictive of reduced survival (p<0.05 for all). The presence as well as the extent of fibrosis on CT was associated with increased mortality. The age-adjusted hazard ratio for mortality in patients with fibrosis was 4.6 (95% confidence interval, 2.0 to 20.1; p<0.0001).

Conclusion: CT findings of parenchymal fibrosis are associated with reduced survival in patients with HP and may serve as a useful prognostic indicator.
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http://dx.doi.org/10.1378/chest.07-3005DOI Listing
July 2008

Idiopathic nonspecific interstitial pneumonia: report of an American Thoracic Society project.

Am J Respir Crit Care Med 2008 Jun 3;177(12):1338-47. Epub 2008 Apr 3.

Attending Thoracic Pathologist, Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.

Rationale: The 2002 American Thoracic Society/European Respiratory Society classification of idiopathic interstitial pneumonias identified nonspecific interstitial pneumonia (NSIP) as a provisional diagnosis. Concern was expressed that NSIP was a "wastebasket" category, difficult to distinguish from other idiopathic interstitial pneumonias.

Objectives: The following questions were addressed: (1) Is idiopathic NSIP a distinct entity? 2) If so, what are its clinical, radiologic and pathologic characteristics? (3) What is the role of radiology and pathology in establishing the diagnosis? (4) To make a diagnosis of idiopathic NSIP, what other disorders need to be excluded and how should this be done?

Methods: Investigators who had previously reported cases of idiopathic NSIP were invited to submit cases for review (n = 305). After initial review, cases with complete clinical, radiologic, and pathologic information (n = 193) were reviewed in a series of workshops.

Measurements And Main Results: Sixty-seven cases were identified as NSIP. Mean age was 52 years, 67% were women, 69% were never-smokers, and 46% were from Asian countries. The most common symptoms were dyspnea (96%) and cough (87%); 69% had restriction. By high-resolution computed tomography, the lower lung zones were predominantly involved in 92% of cases; 46% had a peripheral distribution; 47% were diffuse. Most showed a reticular pattern (87%) with traction bronchiectasis (82%) and volume loss (77%). Lung biopsies showed uniform thickening of alveolar walls with a spectrum of cellular to fibrosing patterns. Five-year survival was 82.3%.

Conclusions: Idiopathic NSIP is a distinct clinical entity that occurs mostly in middle-aged women who are never-smokers. The prognosis of NSIP is very good.
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http://dx.doi.org/10.1164/rccm.200611-1685OCDOI Listing
June 2008

Profusion of fibroblast foci in patients with idiopathic pulmonary fibrosis does not predict outcome.

Respir Med 2008 Jun 7;102(6):852-6. Epub 2008 Mar 7.

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.

Rationale: The prognostic significance of fibroblast foci in surgical lung biopsies from patients with idiopathic pulmonary fibrosis (IPF) is unclear.

Objectives: We assessed the relationship between profusion of fibroblast foci and survival in 43 patients with IPF seen at a tertiary referral medical center from 1996 to 2002.

Methods: Fibroblast foci in surgical lung biopsies were counted using a systematic morphometric point-counting technique. Patients with either clinical or pathologic evidence of accelerated disease were excluded from analysis. The association of fibroblast counts with survival was assessed using proportional hazards regression.

Results: The mean age (+/-SD) of the study population was 64+/-9 years; 26 (60%) patients were male. The mean (%+/-SD) profusion of fibroblastic foci was 0.6+/-0.7, expressed as a percentage of total points counted. Fibroblast foci counts did not differ markedly between upper, middle, and lower lobes. Median survival from the time of biopsy was 2.4 years; there were 25 (58%) deaths in the follow up period. There was no significant relationship between profusion of fibroblast foci and survival in the overall group (p=0.250).

Conclusions: Higher prevalence of fibroblast foci assessed using a simple point-counting technique applied to surgical lung biopsies is not associated with survival in patients with clinically stable IPF.
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http://dx.doi.org/10.1016/j.rmed.2008.01.012DOI Listing
June 2008

Colorectal cancer screening perceptions and practices: results from a national survey of gastroenterology, surgery and radiology trainees.

J Cancer Educ 2007 ;22(4):219-26

Mayo Clinic College of Medicine, Rochester, MN, USA.

Background: Colorectal cancer (CRC) screening in the United States is suboptimal. We conducted a national survey to learn about CRC screening perceptions and practices among trainees who perform CRC screening tests including those enrolled in Gastroenterology and Hepatology (GIH), General and Colorectal Surgery, and Diagnostic and Abdominal Radiology training programs.

Methods: Program directors/administrators (PDs/PAs) from 642 programs were contacted by e-mail with an invitation to forward our survey to trainees in their programs. Participating trainees then completed an anonymous, Web-based questionnaire.

Results: A total of 130/642 (20%) PDs/PAs forwarded our survey to their trainees, with responses received from 476 trainees (80 GIH, 261 surgery, 135 radiology). Colonoscopy was felt to be the best CRC screening test at reducing CRC mortality, with patient-related factors perceived as greater barriers than system-related factors. No single guideline was deemed very influential on CRC screening practices by most trainees. A total of 2 of 5 above-average risk patient profiles were not recognized by most trainees. Colonoscopy was selected as the preferred follow-up test for a positive CRC screening test by most trainees. However, 34% of respondents chose an option other than colonoscopy alone for follow-up of a positive fecal occult blood test.

Conclusions: Based on data from this national survey of gastroenterology, surgery, and radiology trainees, opportunities exist for curricular changes that may help enhance current perceptions and practices of trainees who perform CRC screening tests.
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http://dx.doi.org/10.1007/BF03174120DOI Listing
March 2008

Diagnosis of interstitial lung diseases.

Mayo Clin Proc 2007 Aug;82(8):976-86

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

Interstitial lung diseases (ILDs), a broad heterogeneous group of parenchymal lung disorders, can be classified into those with known and unknown causes. The definitions and diagnostic criteria for several major forms of ILDs have been revised in recent years. Although well over 100 distinct entities of ILDs are recognized, a limited number of disorders, including idiopathic pulmonary fibrosis, sarcoidosis, and connective tissue disease-related ILDs, account for most ILDs encountered clinically. In evaluating patients with suspected ILD, the clinician should confirm the presence of the disease and then try to determine its underlying cause or recognized clinicopathologic syndrome. Clues from the medical history along with the clinical context and radiologic findings provide the initial basis for prioritizing diagnostic possibilities for a patient with ILD. High-resolution computed tomography of the chest has become an invaluable tool in the diagnostic process. A confident diagnosis can sometimes be made on the basis of high-resolution computed tomography and clinical context. Serologic testing can be helpful in selected cases. Histopathologic findings procured through bronchoscopic or surgical lung biopsy are often needed in deriving a specific diagnosis. An accurate prognosis and optimal treatment strategy for patients with ILDs depend on an accurate diagnosis, one guided by recent advances in our understanding of the causes and pathogenetic mechanisms of ILDs.
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http://dx.doi.org/10.4065/82.8.976DOI Listing
August 2007