Diagnostic procedures and clinico-radiological findings of acute fibrinous and organizing pneumonia: a systematic review and pooled analysis

• Published in: European radiology 2021-10, Vol.31 (10), p.7283-7294
• Main Authors: Lee, Jong Hyuk, Yum, Ho-Kee, Jamous, Fady, Santos, Cláudia, Campisi, Alessio, Surani, Salim, Lococo, Filippo, Goo, Jin Mo, Yoon, Soon Ho
• Format: Article
• Language: English
• Subjects: Biopsy; Chest; Computed tomography; Consolidation; Diagnostic Radiology; Dyspnea; Fever; Imaging; Internal Medicine; Interventional Radiology; Mechanical ventilation; Medical diagnosis; Medical imaging; Medical prognosis; Medicine; Medicine & Public Health; Neuroradiology; Patients; Pneumonia; Prognosis; Radiology; Regression analysis; Respiration; Survival; Survival analysis; Testing; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-021-07868-z

Objectives To evaluate the clinico-radiological findings of acute fibrinous and organizing pneumonia (AFOP) in the literature according to whether a surgical or non-surgical biopsy was performed, as well as to identify prognostic predictors. Methods We searched the Embase and OVID-MEDLINE databases to identify studies that presented CT findings of AFOP and had extractable individual patient data. We compared the clinical and CT findings of the patients depending on whether a surgical or non-surgical biopsy was performed and identified survival predictors using a multivariate logistic regression analysis. Results Eighty-one patients (surgical biopsy, n = 52; non-surgical biopsy, n = 29) from 63 studies were included. The surgical biopsy group frequently experienced an acute fulminant presentation ( p = .011) and dyspnea ( p = .001) and less frequently had a fever ( p = .006) than the non-surgical biopsy group. The surgical biopsy group had a worse prognosis than the non-surgical biopsy group in terms of mechanical ventilation and mortality (both, p = .023). For survival analysis, the patients with the predominant CT finding of patchy or mass-like air-space consolidation survived more frequently ( p < .001) than those with other CT findings. For prognostic predictors, subacute indolent presentation ( p = .001) and patchy or mass-like air-space consolidation on CT images ( p = .002) were independently associated with good survival. Conclusions Approximately one-third of alleged AFOP cases in the literature were diagnosed via non-surgical biopsy, but those cases had different symptomatic presentations and prognosis from surgically proven AFOP. Subacute indolent presentation and patchy or mass-like air-space consolidation at the presentation on CT images indicated a good prognosis in patients with AFOP. Key Points • Acute fibrinous and organizing pneumonia (AFOP) cases diagnosed via non-surgical biopsy had different symptomatic presentations and prognosis from surgically proven AFOP. • Subacute indolent presentation and patchy or mass-like air-space consolidation on CT images indicated a good prognosis in patients with acute fibrinous and organizing pneumonia.