One hundred consecutive granulomas in a pulmonary pathology consultation practice
Julianne Roberta Hutton Klein, Henry Dale Tazelaar, Kevin Orr Leslie, Thomas Vail Colby
Lung biopsies showing granulomatous disease are commonly sent for expert pathology consultation. On the basis of features we and others have identified, an algorithmic approach to diagnosis of these cases was developed. We hypothesized that applying this approach would increase the likelihood of rendering a more specific diagnosis, or by rendering either a narrower or broader differential diagnosis, offer a more clinically useful diagnosis. One hundred consecutive lung biopsies from patients with granulomatous and giant cell reactions were retrieved from our consultation files. Cases were categorized into those in which a confident diagnosis was made at sign out, ones in which a specific diagnosis was strongly favored, and those in which a differential diagnosis was suggested. One year later follow-up information was obtained and consultation diagnoses were compared with clinical diagnoses to determine the reliability of the approach. A confident diagnosis was rendered in 27 cases, a specific diagnosis was strongly favored in 34, and in 39 a differential diagnosis was provided. Consultant diagnoses were more specific in 47 of 75 (63 %) cases. In 15 cases, the differential diagnosis was expanded. The most common unrecognized diagnosis was aspiration pneumonia and the most common diagnosis omitted from the differential diagnosis by the primary pathologist was hypersensitivity pneumonia. Follow-up in 49% of cases in which it was sought, confirmed the consultant's diagnosis or was inconclusive in 97% of cases. The use of a standardized algorithmic approach to the interpretation of granulomatous disease in lung biopsies yields more specific and clinically useful diagnoses for consideration.
American Journal of Surgical Pathology
https://doi.org/10.1097/PAS.0b013e3181ef9fa0
Wegener granulomatosis
granulomatous inflammation
hypersensitivity pneumonia
lung granulomas
pathology consultation
10.1097/PAS.0b013e3181ef9fa0
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Granuloma Medicine & Life Sciences 100%
Referral and Consultation Medicine & Life Sciences 72%
Pathology Medicine & Life Sciences 61%
Lung Medicine & Life Sciences 52%
Differential Diagnosis Medicine & Life Sciences 27%
Aspiration Pneumonia Medicine & Life Sciences 9%
Giant Cells Medicine & Life Sciences 7%
Hutton Klein, J. R., Tazelaar, H. D., Leslie, K. O., & Colby, T. V. (2010). One hundred consecutive granulomas in a pulmonary pathology consultation practice. American Journal of Surgical Pathology, 34(10), 1456-1464. https://doi.org/10.1097/PAS.0b013e3181ef9fa0
One hundred consecutive granulomas in a pulmonary pathology consultation practice. / Hutton Klein, Julianne Roberta; Tazelaar, Henry Dale; Leslie, Kevin Orr et al.
In: American Journal of Surgical Pathology, Vol. 34, No. 10, 01.10.2010, p. 1456-1464.
Hutton Klein, JR, Tazelaar, HD, Leslie, KO & Colby, TV 2010, 'One hundred consecutive granulomas in a pulmonary pathology consultation practice', American Journal of Surgical Pathology, vol. 34, no. 10, pp. 1456-1464. https://doi.org/10.1097/PAS.0b013e3181ef9fa0
Hutton Klein JR, Tazelaar HD, Leslie KO, Colby TV. One hundred consecutive granulomas in a pulmonary pathology consultation practice. American Journal of Surgical Pathology. 2010 Oct 1;34(10):1456-1464. doi: 10.1097/PAS.0b013e3181ef9fa0
Hutton Klein, Julianne Roberta ; Tazelaar, Henry Dale ; Leslie, Kevin Orr et al. / One hundred consecutive granulomas in a pulmonary pathology consultation practice. In: American Journal of Surgical Pathology. 2010 ; Vol. 34, No. 10. pp. 1456-1464.
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title = "One hundred consecutive granulomas in a pulmonary pathology consultation practice",
abstract = "Lung biopsies showing granulomatous disease are commonly sent for expert pathology consultation. On the basis of features we and others have identified, an algorithmic approach to diagnosis of these cases was developed. We hypothesized that applying this approach would increase the likelihood of rendering a more specific diagnosis, or by rendering either a narrower or broader differential diagnosis, offer a more clinically useful diagnosis. One hundred consecutive lung biopsies from patients with granulomatous and giant cell reactions were retrieved from our consultation files. Cases were categorized into those in which a confident diagnosis was made at sign out, ones in which a specific diagnosis was strongly favored, and those in which a differential diagnosis was suggested. One year later follow-up information was obtained and consultation diagnoses were compared with clinical diagnoses to determine the reliability of the approach. A confident diagnosis was rendered in 27 cases, a specific diagnosis was strongly favored in 34, and in 39 a differential diagnosis was provided. Consultant diagnoses were more specific in 47 of 75 (63 %) cases. In 15 cases, the differential diagnosis was expanded. The most common unrecognized diagnosis was aspiration pneumonia and the most common diagnosis omitted from the differential diagnosis by the primary pathologist was hypersensitivity pneumonia. Follow-up in 49% of cases in which it was sought, confirmed the consultant's diagnosis or was inconclusive in 97% of cases. The use of a standardized algorithmic approach to the interpretation of granulomatous disease in lung biopsies yields more specific and clinically useful diagnoses for consideration.",
keywords = "Wegener granulomatosis, aspiration, granulomatous inflammation, hypersensitivity pneumonia, lung granulomas, pathology consultation",
author = "{Hutton Klein}, {Julianne Roberta} and Tazelaar, {Henry Dale} and Leslie, {Kevin Orr} and Colby, {Thomas Vail}",
doi = "10.1097/PAS.0b013e3181ef9fa0",
journal = "American Journal of Surgical Pathology",
T1 - One hundred consecutive granulomas in a pulmonary pathology consultation practice
AU - Hutton Klein, Julianne Roberta
AU - Tazelaar, Henry Dale
AU - Leslie, Kevin Orr
AU - Colby, Thomas Vail
N2 - Lung biopsies showing granulomatous disease are commonly sent for expert pathology consultation. On the basis of features we and others have identified, an algorithmic approach to diagnosis of these cases was developed. We hypothesized that applying this approach would increase the likelihood of rendering a more specific diagnosis, or by rendering either a narrower or broader differential diagnosis, offer a more clinically useful diagnosis. One hundred consecutive lung biopsies from patients with granulomatous and giant cell reactions were retrieved from our consultation files. Cases were categorized into those in which a confident diagnosis was made at sign out, ones in which a specific diagnosis was strongly favored, and those in which a differential diagnosis was suggested. One year later follow-up information was obtained and consultation diagnoses were compared with clinical diagnoses to determine the reliability of the approach. A confident diagnosis was rendered in 27 cases, a specific diagnosis was strongly favored in 34, and in 39 a differential diagnosis was provided. Consultant diagnoses were more specific in 47 of 75 (63 %) cases. In 15 cases, the differential diagnosis was expanded. The most common unrecognized diagnosis was aspiration pneumonia and the most common diagnosis omitted from the differential diagnosis by the primary pathologist was hypersensitivity pneumonia. Follow-up in 49% of cases in which it was sought, confirmed the consultant's diagnosis or was inconclusive in 97% of cases. The use of a standardized algorithmic approach to the interpretation of granulomatous disease in lung biopsies yields more specific and clinically useful diagnoses for consideration.
AB - Lung biopsies showing granulomatous disease are commonly sent for expert pathology consultation. On the basis of features we and others have identified, an algorithmic approach to diagnosis of these cases was developed. We hypothesized that applying this approach would increase the likelihood of rendering a more specific diagnosis, or by rendering either a narrower or broader differential diagnosis, offer a more clinically useful diagnosis. One hundred consecutive lung biopsies from patients with granulomatous and giant cell reactions were retrieved from our consultation files. Cases were categorized into those in which a confident diagnosis was made at sign out, ones in which a specific diagnosis was strongly favored, and those in which a differential diagnosis was suggested. One year later follow-up information was obtained and consultation diagnoses were compared with clinical diagnoses to determine the reliability of the approach. A confident diagnosis was rendered in 27 cases, a specific diagnosis was strongly favored in 34, and in 39 a differential diagnosis was provided. Consultant diagnoses were more specific in 47 of 75 (63 %) cases. In 15 cases, the differential diagnosis was expanded. The most common unrecognized diagnosis was aspiration pneumonia and the most common diagnosis omitted from the differential diagnosis by the primary pathologist was hypersensitivity pneumonia. Follow-up in 49% of cases in which it was sought, confirmed the consultant's diagnosis or was inconclusive in 97% of cases. The use of a standardized algorithmic approach to the interpretation of granulomatous disease in lung biopsies yields more specific and clinically useful diagnoses for consideration.
KW - Wegener granulomatosis
KW - aspiration
KW - granulomatous inflammation
KW - hypersensitivity pneumonia
KW - lung granulomas
KW - pathology consultation
U2 - 10.1097/PAS.0b013e3181ef9fa0
DO - 10.1097/PAS.0b013e3181ef9fa0
JO - American Journal of Surgical Pathology
JF - American Journal of Surgical Pathology