The article by Dr. Travis and colleagues based on an American Thoracic Society project (1) highlights the difficulties encountered by a physician treating a patient with the histological lesion of nonspecific interstitial pneumonia (NSIP). Of 305 cases reviewed by the multidisciplinary workshop, each presumably considered an exemplar case of idiopathic NSIP by the submitting clinician, less than 6% fulfilled a consensus classification of definite idiopathic NSIP. Furthermore, of the 67 patients with definite or probable NSIP, a significant number had symptoms or serum markers suggestive of undifferentiated connective tissue disease (CTD) (2). Two of the patients later developed overt CTD. A large proportion of patients initially considered to have idiopathic NSIP were subsequently reclassified as having hypersensitivity pneumonitis (HP), idiopathic pulmonary fibrosis (IPF), or organizing pneumonia (OP).
Publication information
Maher TM'Understanding non-specific interstitial pneumonia: the need for a diagnostic gold standard', Am J Resp Crit Care Med 2009; 179: 255 – 256.