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Haga A, Iwasawa T, Misumi T, Okudela K, Oda T, Kitamura H, Saka T, Matsushita S, Baba T, Natsume-Kitatani Y, Utsunomiya D, Ogura T. Correlation of CT-based radiomics analysis with pathological cellular infiltration in fibrosing interstitial lung diseases. Jpn J Radiol 2024:10.1007/s11604-024-01607-2. [PMID: 38888852 DOI: 10.1007/s11604-024-01607-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE We aimed to identify computed tomography (CT) radiomics features that are associated with cellular infiltration and construct CT radiomics models predictive of cellular infiltration in patients with fibrotic ILD. MATERIALS AND METHODS CT images of patients with ILD who underwent surgical lung biopsy (SLB) were analyzed. Radiomics features were extracted using artificial intelligence-based software and PyRadiomics. We constructed a model predicting cell counts in histological specimens, and another model predicting two classifications of higher or lower cellularity. We tested these models using external validation. RESULTS Overall, 100 patients (mean age: 62 ± 8.9 [standard deviation] years; 61 men) were included. The CT radiomics model used to predict cell count in 140 histological specimens predicted the actual cell count in 59 external validation specimens (root-mean-square error: 0.797). The two-classification model's accuracy was 70% and the F1 score was 0.73 in the external validation dataset including 30 patients. CONCLUSION The CT radiomics-based model developed in this study provided useful information regarding the cellular infiltration in the ILD with good correlation with SLB specimens.
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Affiliation(s)
- Akira Haga
- Dept. of Radiology, Kanagawa Cardiovascular & Respiratory Center, Yokohama, Japan
- Dept. of Radiology, Yokohama City Univ. School of Medicine, Yokohama, Japan
| | - Tae Iwasawa
- Dept. of Radiology, Kanagawa Cardiovascular & Respiratory Center, Yokohama, Japan.
| | - Toshihiro Misumi
- Department of Data Science, National Cancer Center Hospital East, Kashiwa, Japan
| | - Koji Okudela
- Department of Pathology, Saitama Medical University, Moroyama, Japan
- Dept. of Pathology, Kanagawa Cardiovascular & Respiratory Center, Yokohama, Japan
| | - Tsuneyuki Oda
- Dept. of Respiratory Medicine, Kanagawa Cardiovascular & Respiratory Center, Yokohama, Japan
| | - Hideya Kitamura
- Dept. of Respiratory Medicine, Kanagawa Cardiovascular & Respiratory Center, Yokohama, Japan
| | | | | | - Tomohisa Baba
- Dept. of Respiratory Medicine, Kanagawa Cardiovascular & Respiratory Center, Yokohama, Japan
| | - Yayoi Natsume-Kitatani
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
- Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Daisuke Utsunomiya
- Dept. of Radiology, Yokohama City Univ. School of Medicine, Yokohama, Japan
| | - Takashi Ogura
- Dept. of Respiratory Medicine, Kanagawa Cardiovascular & Respiratory Center, Yokohama, Japan
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Bermudez J, Habert P, Coiffard B. [The concept of interstitial pneumonia with autoimmune features (IPAF)]. Rev Med Interne 2024; 45:343-349. [PMID: 38433068 DOI: 10.1016/j.revmed.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/02/2024] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
Interstitial lung diseases (ILD) are a heterogeneous group of respiratory diseases often related to connective tissue diseases. Some patients will develop an ILD with autoimmune features without reaching the recommended criteria for autoimmune diseases. Their management is difficult because they have both features for idiopathic and connective tissue disease. To better identify these patients, the concept of interstitial pneumonia with autoimmune features (IPAF) has been created. The diagnosis relies on ILD without identified cause and the presence of at least one defined criterion among 2 of the 3 following domains: clinic, serologic, and morphologic. The mean age at diagnosis is 60, a sex ratio of 1/1, and depending on the authors close to 20% of patients with IPAF will develop a connective tissue disease according to the international criterion. Their prognosis is better than for patients with idiopathic ILD and with an average 5-year survival of 70%. Older age at diagnosis, a pattern of usual interstitial pneumonia, and an impaired diffusing capacity for carbon monoxide have been identified as poor prognosis factors. The treatment relies on usual care for chronic respiratory diseases and is often associated with immunosuppressive and/or antifibrotic therapies. The objective of this classification is to better characterize these patients and improve their management.
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Affiliation(s)
- J Bermudez
- Service de pneumologie, équipe de transplantation pulmonaire adulte, centre de compétences nationales des maladies pulmonaires rares, centre de compétences nationales de l'hypertension pulmonaire, CRCM adulte, hôpital Nord, CHU Nord, Assistance publique-Hôpitaux de Marseille, 15, chemin des Bourrely, 13015 Marseille, France; Inserm, centre de recherche en cardiovasculaire et nutrition (C2VN), Aix-Marseille université, Marseille, France.
| | - P Habert
- Service de radiologie cardiothoracique diagnostique et interventionnelle, hôpital Nord, Aix-Marseille université, AP-HM, Marseille, France; LIIE, Aix-Marseille université, Marseille, France
| | - B Coiffard
- Service de pneumologie, équipe de transplantation pulmonaire adulte, centre de compétences nationales des maladies pulmonaires rares, centre de compétences nationales de l'hypertension pulmonaire, CRCM adulte, hôpital Nord, CHU Nord, Assistance publique-Hôpitaux de Marseille, 15, chemin des Bourrely, 13015 Marseille, France; Inserm, centre de recherche en cardiovasculaire et nutrition (C2VN), Aix-Marseille université, Marseille, France
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Ngo LT, Rekowski MJ, Koestler DC, Yorozuya T, Saito A, Azeem I, Harrison A, Demoruelle MK, Boomer J, England BR, Wolters P, Molyneaux PL, Castro M, Lee JS, Solomon JJ, Koronuma K, Washburn MP, Matson SM. Proteomic profiling of bronchoalveolar lavage fluid uncovers protein clusters linked to survival in idiopathic forms of interstitial lung disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.30.24308215. [PMID: 38853991 PMCID: PMC11160891 DOI: 10.1101/2024.05.30.24308215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background Idiopathic interstitial pneumonias (IIPs) such as idiopathic pulmonary fibrosis (IPF) and interstitial pneumonia with autoimmune features (IPAF), present diagnostic and therapeutic challenges due to their heterogeneous nature. This study aimed to identify intrinsic molecular signatures within the lung microenvironment of these IIPs through proteomic analysis of bronchoalveolar lavage fluid (BALF). Methods Patients with IIP (n=23) underwent comprehensive clinical evaluation including pre-treatment bronchoscopy and were compared to controls without lung disease (n=5). Proteomic profiling of BALF was conducted using label-free quantitative methods. Unsupervised cluster analyses identified protein expression profiles which were then analyzed to predict survival outcomes and investigate associated pathways. Results Proteomic profiling successfully differentiated IIP from controls. k-means clustering, based on protein expression revealed three distinct IIP clusters, which were not associated with age, smoking history, or baseline pulmonary function. These clusters had unique survival trajectories and provided more accurate survival predictions than the Gender Age Physiology (GAP) index (C-index 0.794 vs. 0.709). The cluster with the worst prognosis featured decreased inflammatory signaling and complement activation, with pathway analysis highlighting altered immune response pathways related to immunoglobulin production and B cell-mediated immunity. Conclusions The unsupervised clustering of BALF proteomics provided a novel stratification of IIP patients, with potential implications for prognostic and therapeutic targeting. The identified molecular phenotypes underscore the diversity within the IIP classification and the potential importance of personalized treatments for these conditions. Future validation in larger, multi-ethnic cohorts is essential to confirm these findings and to explore their utility in clinical decision-making for patients with IIP.
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Affiliation(s)
- Linh T. Ngo
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Michaella J. Rekowski
- Department of Cancer Biology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Devin C. Koestler
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Takafumi Yorozuya
- Department of Respiratory Medicine and Allergology, Sapporo Medical University, Sapporo, Japan
| | - Atsushi Saito
- Department of Respiratory Medicine and Allergology, Sapporo Medical University, Sapporo, Japan
| | - Imaan Azeem
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Alexis Harrison
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - M. Kristen Demoruelle
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jonathan Boomer
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Bryant R. England
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE USA and Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Paul Wolters
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Joyce S. Lee
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO, USA
| | - Joshua J. Solomon
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health Hospital, Denver, CO
| | - Koji Koronuma
- Department of Respiratory Medicine and Allergology, Sapporo Medical University, Sapporo, Japan
| | - Michael P. Washburn
- Department of Cancer Biology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Scott M. Matson
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
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Libra A, Colaci M, Spicuzza L, Luca G, Fischetti S, Pashalidis G, Ferrara CA, Ielo G, Sambataro D, La Rosa G, Libra F, Palmucci S, Vancheri C, Sambataro G. The Pattern and Progression of "Usual" Interstitial Pneumonia with Autoimmune Features: Comparison with Patients with Classic Interstitial Pneumonia with Autoimmune Features and Idiopathic Pulmonary Fibrosis. J Clin Med 2024; 13:369. [PMID: 38256503 PMCID: PMC10816405 DOI: 10.3390/jcm13020369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND We proposed the term "UIPAF" to define patients with Usual Interstitial Pneumonia (UIP) associated with only one domain of the classification called "Interstitial Pneumonia with Autoimmune Features" (IPAF). The objective of this study was to evaluate the clinical presentation and prognosis of UIPAF patients, compared with two cohorts, composed of IPAF and idiopathic pulmonary fibrosis (IPF) patients, respectively. METHODS The patients were enrolled as IPAF, UIPAF, or IPF based on clinical, serological, and radiological data and evaluated by a multidisciplinary team. RESULTS We enrolled 110 patients with IPF, 69 UIPAF, and 123 IPAF subjects. UIPAF patients were similar to IPAF regarding autoimmune features, except for the prevalence of Rheumatoid Factor in UIPAF and anti-SSA in IPAF. A similar proportion of the two cohorts progressed toward a specific autoimmune disease (SAD), with differences in the kind of SAD developed. The real-life management and prognosis of UIPAF patients proved to be almost identical to IPF. CONCLUSIONS UIPAF shared with IPAF similar autoimmune features, suggesting the opportunity to be considered IPAF, excluding the morphological domain by the classification. However, the real-life management and prognosis of UIPAF are similar to IPF. These data suggest a possible modification in the therapeutic management of UIPAF.
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Affiliation(s)
- Alessandro Libra
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Michele Colaci
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Division of Rheumatology, Cannizzaro Hospital, University of Catania, 95123 Catania, Italy;
| | - Lucia Spicuzza
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Giuliana Luca
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Sefora Fischetti
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Giorgio Pashalidis
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Chiara Alfia Ferrara
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Giuseppe Ielo
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Domenico Sambataro
- Artroreuma s.r.l., Rheumatology Outpatient Clinic, 95030 Mascalucia (CT), Italy;
| | - Giuliana La Rosa
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (G.L.R.); (F.L.)
| | - Federica Libra
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (G.L.R.); (F.L.)
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, Unità Operativa Semplice Dipartimentale di Imaging Polmonare e Tecniche Radiologiche Avanzate (UOSD IPTRA), 95123 Catania, Italy;
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
| | - Gianluca Sambataro
- Department of Clinical and Experimental Medicine, Regional Referral Center for Rare Lung Disease, Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (A.L.); (L.S.); (G.L.); (S.F.); (G.P.); (C.A.F.); (G.I.); (C.V.)
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, Division of Rheumatology, Cannizzaro Hospital, University of Catania, 95123 Catania, Italy;
- Artroreuma s.r.l., Rheumatology Outpatient Clinic, 95030 Mascalucia (CT), Italy;
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