Abstract
Purpose
To investigate radiographic and computed tomography features of radiation-induced organizing pneumonia syndrome after breast-conserving surgery.
Materials and methods
The appearances and distribution of lung parenchymal abnormalities were retrospectively analyzed on chest radiographs (n = 12) and computed tomography scan images (n = 10) of 12 women (range 37–78 years, mean 55.8 years) with radiation-induced organizing pneumonia syndrome after breast-conserving surgery.
Results
The principal radiographic feature was an airspace filling pattern in all patients that involved the middle and lower lung zones in 10 of the 12 patients. Multi-focal lesions manifesting airspace consolidation surrounded by ground-glass opacities were the predominant CT finding in all 10 of these patients. The main lesion was predominantly located in the lung periphery in nine patients and contiguously extended to the central portion of the lung in seven patients. Frequent ancillary findings were airway dilation within the consolidation and lobar volume loss in nine and eight patients, respectively. All had solitary (6/10) or multifocal (4/10) distant lung opacities, mostly consistent with the finding of ground-glass opacities (9/10). Migration of the lung disease was observed in ten patients on subsequent radiographs.
Conclusion
The cardinal radiologic feature of this syndrome is airspace consolidation surrounded by ground-glass opacification with airway dilation and volume loss, involving primarily the irradiated, subpleural area, along with distant opacities.
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References
Davis SD, Yankelevitz DF, Henschke CI. Radiation effects on the lung: clinical features, pathology, and imaging findings. AJR Am J Roentgenol. 1992;159:1157–64.
Crestani B, Kambouchner M, Soler P, Crequit J, Brauner M, Battesti JP, et al. Migratory bronchiolitis obliterans organizing pneumonia after unilateral radiation therapy for breast carcinoma. Eur Respir J. 1995;8:318–21.
Bayle JY, Nesme P, Bejui-Thivolet F, Loire R, Guerin JC, Cordier JF. Migratory organizing pneumonitis “primed” by radiation therapy. Eur Respir J. 1995;8:322–6.
Crestani B, Valeyre D, Roden S, Wallaert B, Dalphin JC, Cordier JF, et al. Bronchiolitis obliterans organizing pneumonia syndrome primed by radiation therapy to the breast. Am J Respir Crit Care Med. 1998;158:1929–35.
Ogo E, Komaki R, Fujimoto K, Uchida M, Abe T, Nakamura K, et al. A survey of radiation-induced bronchiolitis obliterans organizing pneumonia syndrome after breast-conserving therapy in Japan. Int J Radiat Oncol Biol Phys. 2008;71:123–31.
Katayama N, Sato S, Katsui K, Takemoto M, Tsuda T, Yoshida A, et al. Analysis of factors associated with radiation-induced bronchiolitis obliterans organizing pneumonia syndrome after breast-conserving therapy. Int J Radiat Oncol Biol Phys. 2009;73:1049–54.
Takigawa N, Segawa Y, Saeki T, Kataoka M, Ida M, Kishino D, et al. Bronchiolitis obliterans organizing pneumonia syndrome in breast-conserving therapy for early breast cancer: radiation-induced lung toxicity. Int J Radiat Oncol Biol Phys. 2000;48:751–5.
Majori M, Poletti V, Curti A, Corradi M, Falcone F, Pesci A. Bronchoalveolar lavage in bronchiolitis obliterans organizing pneumonia primed by radiation therapy to the breast. J Allergy Clin Immunol. 2000;105:239–44.
Nambu A, Araki T, Ozawa K, Kanazawa M, Ohki Z, Miyata K. Bronchiolitis obliterans organizing pneumonia after tangential beam irradiation to the breast: discrimination from radiation pneumonitis. Radiat Med. 2002;20:151–4.
Oikonomou A, Hansell DM. Organizing pneumonia: the many morphological faces. Eur Radiol. 2002;12:1486–96.
Ujita M, Renzoni EA, Veeraraghavan S, Wells AU, Hansell DM. Organizing pneumonia: perilobular pattern at thin-section CT. Radiology. 2004;232:757–61.
Preidler KW, Szolar DM, Moelleken S, Tripp R, Schreyer H. Distribution pattern of computed tomography findings in patients with bronchiolitis obliterans organizing pneumonia. Invest Radiol. 1996;31:251–5.
Kim SJ, Lee KS, Ryu YH, Yoon YC, Choe KO, Kim TS, et al. Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. AJR Am J Roentgenol. 2003;180:1251–4.
Lee KS, Kullinig P, Hartman TE, Muller NL. Cryptogenic organizing pneumonia: CT findings in 43 patients. AJR Am J Roentgenol 1994;162:543–6.
Akira M, Yamamoto S, Sakatani M. Bronchiolitis obliterans organizing pneumonia manifesting as multiple large nodules or masses. AJR Am J Roentgenol. 1998;170:291–5.
Haddock JA, Hansell DM. The radiology and terminology of cryptogenic organizing pneumonia. Br J Radiol. 1992;65:674–80.
Flowers JR, Clunie G, Burke M, Constant O. Bronchiolitis obliterans organizing pneumonia: the clinical and radiological features of seven cases and a review of the literature. Clin Radiol. 1992;45:371–7.
Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;246:697–722.
Wells AU. Cryptogenic organizing pneumonia. Semin Respir Crit Care Med. 2001;22:449–59.
Johkoh T, Itoh H, Muller NL, Ichikado K, Nakamura H, Ikezoe J, et al. Crazy-paving appearance at thin-section CT: spectrum of diseases and pathologic findings. Radiology. 1999;211:155–60.
Rossi SE, Erasmus JJ, Volpacchio M, Franquet T, Castiglioni T, McAdams P. “Crazy-paving” pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics. 2003;23:1509–19.
Mihara N, Johkoh T, Ichikado K, Honda O, Higashi M, Tomiyama N, et al. Can acute interstitial pneumonia be differentiated from bronchiolitis obliterans organizing pneumonia by high-resolution CT? Radiat Med. 2000;18:299–304.
Lynch DA. Fibrotic idiopathic interstitial pneumonia: high-resolution computed tomography considerations. Semin Respir Crit Care Med. 2003;24:365–75.
Ichikado K, Jokoh T, Ikezoe J, Yoshida S, Honda O, Mihara N, et al. A case of acute interstitial pneumonia indistinguishable from bronchiolitis obliterans organizing pneumonia/cryptogenic organizing pneumonia: high-resolution CT findings and pathologic correlation. Radiat Med. 1998;16:367–70.
Robert CM, Foulcher E, Zaunders JJ, Bryant DH, Freund J, Cairns D, et al. Radiation pneumonitis: a possible lymphocyte-mediated hypersensitivity reaction. Ann Intern Med. 1993;118:696–700.
Cottin V, Frognier R, Monnot H, Levy A, DeVuyst P, Cordier JF, et al. Chronic eosinophilic pneumonia after radiation therapy for breast cancer. Eur Respir J. 2004;23:9–13.
Kaufman J, Komorowski R. Bronchiolitis obliterans organizing pneumonia in common variable immunodeficiency syndrome. Chest. 1991;100:552–3.
Iijima M, Sakahara H. Radiation pneumonitis resembling bronchiolitis obliterans organizing pneumonia after postoperative irradiation for lung cancer: a case report. Nippon Acta Radiol. 2003;63:332–3.
Hamanishi T, Morimatsu Y, Oida K, Kori Y, Taguchi Y, Tanaka E, et al. Occurrence of BOOP outside radiation field after radiation therapy for small cell lung cnacer. Nihon Kokyuuki Gakkai Zasshi. 2001;39:683–8.
Bentzen SM, Skyoczylas JZ, Overgard M, Overgard J. Radiotherapy-related lung fibrosis enhanced by tamoxifen. J Natl Cancer Inst. 1996;88:918–22.
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Kano, A., Ujita, M., Kobayashi, M. et al. Radiographic and CT features of radiation-induced organizing pneumonia syndrome after breast-conserving therapy. Jpn J Radiol 30, 128–136 (2012). https://doi.org/10.1007/s11604-011-0024-9
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DOI: https://doi.org/10.1007/s11604-011-0024-9