Performance of Forced Vital Capacity and Lung Diffusion Cutpoints for Associated Radiographic Interstitial Lung Disease in Systemic Sclerosis. Academic Article uri icon

Overview

abstract

  • OBJECTIVE: Forced vital capacity (FVC) and DLCO are used for screening of systemic sclerosis-associated interstitial lung disease (SSc-ILD). The study purpose was to determine the sensitivity, specificity, and negative predictive value (NPV) (proportion of true negative screening tests) of FVC and DLCO thresholds for SSc-ILD on chest high-resolution computed tomography (HRCT) scans. METHODS: Patients fulfilling American College of Rheumatology 2013 SSc criteria with a chest HRCT scan and pulmonary function tests (PFT) were studied. A thoracic radiologist quantified radiographic ILD. Optimal FVC and DLCO % predicted thresholds for ILD were identified using receiver-operating characteristic curves. The FVC and DLCO combinations with greatest sensitivity and specificity were also determined. Subanalysis was performed in patients with positive Scl-70 autoantibodies. RESULTS: The study included 265 patients. Of 188 (71%) with radiographic ILD, 59 (31%) had "normal" FVC (≥ 80% predicted), and 65 out of 151 (43%) had "normal" DLCO (≥ 60% predicted). FVC < 80% (sensitivity 0.69, specificity 0.73), and DLCO < 62% (sensitivity 0.60, specificity 0.70) were optimal thresholds for radiographic SSc-ILD. All FVC and DLCO threshold combinations evaluated had NPV < 0.70. The NPV for radiographic ILD for FVC < 80% was lower in patients with positive Scl-70 autoantibody (NPV = 0.05) compared to negative Scl-70 autoantibody (NPV = 0.57). CONCLUSION: Radiographic ILD is prevalent in SSc despite "normal" PFT. No % predicted FVC or DLCO threshold combinations yielded high NPV for SSc-ILD screening. "Normal" FVC and DLCO in patients with SSc, especially those with positive Scl-70 autoantibodies, should not obviate consideration of HRCT for ILD evaluation.

authors

  • Showalter, Kimberly
  • Hoffmann, Aileen
  • Rouleau, Gerald
  • Aaby, David
  • Lee, Jungwha
  • Richardson, Carrie
  • Dematte, Jane
  • Agrawal, Rishi
  • Chang, Rowland W
  • Hinchcliff, Monique

publication date

  • October 1, 2018

Research

keywords

  • Lung
  • Lung Diseases, Interstitial
  • Scleroderma, Systemic
  • Vital Capacity

Identity

PubMed Central ID

  • PMC6214765

Scopus Document Identifier

  • 85055860083

Digital Object Identifier (DOI)

  • 10.3899/jrheum.171362

PubMed ID

  • 30275265

Additional Document Info

volume

  • 45

issue

  • 11