@article {KambouchnerP2363, author = {Marianne Kambouchner and Pierre L{\'e}vy and Kirsten Schubel and Eline Magois and S{\'e}verine Feuillet and Andrew G. Nicholson and Dominique Valeyre and Jean-Fran{\c c}ois Bernaudin and Hilario Nunes}, title = {Prognostic relevance of histologic features in nonspecific interstitial pneumonia (NSIP)}, volume = {42}, number = {Suppl 57}, elocation-id = {P2363}, year = {2013}, publisher = {European Respiratory Society}, abstract = {Rationale: Although positively defined at pathology, NSIP can overlap with other patterns. NSIP is mainly idiopathic or associated with connective tissue diseases (CTDs) or chronic hypersensitivity pneumonitis (cHP).Objectives: To separate NSIP into various pathologic sub-types and correlate them with clinical causes and survival.Methods: 136 patients with surgical lung biopsy-proven NSIP were included (CTDs: 23\%, cHP: 12\%, idiopathic: 65\%). In addition to the indisputable NSIP criteria, 7 sub-types were a priori set up based on pathologic superimposed minor features: UIP-like, cHP-like, OP-like, organizing DAD-like, DIP-like, LIP-like, and essential NSIP in the absence of discriminating feature. Biopsies were reviewed independently by 2 pathologists and a consensus was obtained.Results: Inter-observer concordance was excellent (kappa=0.87), resulting in following consensus: UIP-like (26\%), cHP-like (10\%), OP-like (6\%), organizing DAD-like (10\%), DIP-like (7\%), LIP-like (2\%), essential NSIP (36\%). Five cases were unclassifiable. OP-like pattern was linked with CTDs (p=0.04) and cHP-like pattern with a clinical diagnosis of cHP (p=0.02). Survival was significantly different between sub-groups (p=0.0002). Organizing DAD-like pattern showed the poorer survival (32\% at 5 years), followed by UIP-like pattern (57\% at 5 years). Independent predictors of mortality included organizing DAD-like pattern (HR: 4.99, 95\%CI: 2.15-11.58, p=0.0002), UIP-like pattern (HR: 2.11, 95\%CI: 1.12-3.99, p=0.02) and a clinical diagnosis of cHP (HR: 2.17, 95\%IC: 1.05-4.47, p=0.035).Conclusion: NSIP subdivision into discrete pathologic sub-types has a clinical relevance from a prognosis and causal perspective.}, issn = {0903-1936}, URL = {https://erj.ersjournals.com/content/42/Suppl_57/P2363}, eprint = {https://erj.ersjournals.com/content/42/Suppl_57/P2363.full.pdf}, journal = {European Respiratory Journal} }