Could central bronchial deformity in pulmonary sarcoidosis be a sign of upper lobe fibrosis?

Abstract

Background Central bronchial deformity (CBD) has been proposed as a radiological marker of a fibrotic upper-lobe phenotype in pulmonary sarcoidosis. Purpose To evaluate whether CBD and predefined high-resolution computed tomography (HRCT) findings at diagnosis predict the upper-lobe shrinkage (SUL) within 1 year in patients with pulmonary sarcoidosis with upper-lobe involvement. Material and Methods This retrospective cohort included adults with histopathologically confirmed pulmonary sarcoidosis who underwent HRCT and chest radiography at diagnosis and approximately 1 year later. Patients with baseline SUL were excluded. Two radiologists independently assessed CBD and predefined HRCT findings. SUL was evaluated on chest radiographs using prespecified signs of upper-lobe volume loss. Results Among 79 patients, baseline CBD was present in 33 (42%). Compared with patients without CBD, those with CBD were older (54 ± 12 vs. 46 ± 14 years; P = 0.009), had greater smoking exposure (25 (12–35) vs. 15 (6–20) pack-years; P = 0.046), more frequently received treatment (67% vs. 39%; P = 0.029), and had lower spirometric values. Neither baseline CBD ( P = 0.966) nor other baseline HRCT findings were associated with incident SUL. At 1 year, SUL was more frequent among patients with CBD (28% vs. 3%; P = 0.007) and ground-glass attenuation (29% vs. 10%; P = 0.031). Conclusion CBD was associated with lung remodeling and lower spirometric values but did not predict SUL within 1 year. Its associaton with SUL at 1 year suggests that CBD may be a contemporaneous marker of advanced parenchymal involvement and airway distortion rather than a short-term predictor.