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Am. J. Respir. Crit. Care Med., Volume 164, Number 2, July 2001, 193-196

Utility of a Lung Biopsy for the Diagnosis of Idiopathic Pulmonary Fibrosis

GARY W. HUNNINGHAKE, M. BRIDGET ZIMMERMAN, DAVID A. SCHWARTZ, TALMADGE E. KING JR.,1 JOSEPH LYNCH, RICHARD HEGELE, JAMES WALDRON, THOMAS COLBY, NESTOR MÜLLER, DAVID LYNCH, JEFF GALVIN,2 BARRY GROSS, JAMES HOGG, GALEN TOEWS, RICK HELMERS, J. ALLEN D. COOPER JR., ROBERT BAUGHMAN, CHARLIE STRANGE, and MARK MILLARD

Departments of Medicine, Biostatistics, and Radiology, University of Iowa and Veterans Affairs Medical Center, Iowa City, Iowa; Departments of Medicine and Radiology, University of Colorado, Denver, Colorado; Department of Radiology, University of Michigan, Ann Arbor, Michigan; Departments of Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona; Department of Medicine, Birmingham VAMC and University of Alabama Medical School, Birmingham, Alabama; Department of Medicine, University of Cincinnati, Cincinnati, Ohio; Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; Department of Medicine, Baylor University Medical Center, Houston, Texas; Departments of Medicine and Pathology, University of British Columbia, Vancouver, BC, Canada; and Department of Pathology, University of Arkansas, Little Rock, Arkansas

It is not known if a surgical lung biopsy is necessary in all patients for the diagnosis of idiopathic pulmonary fibrosis (IPF). We conducted a blinded, prospective study at eight referring centers. Initially, cases were evaluated by clinical history and examination, transbronchial biopsy, and high-resolution lung computed tomography scans. Pulmonologists at the referring centers then assessed their certainty of the diagnosis of IPF and provided an overall diagnosis, before surgical lung biopsy. The lung biopsies were reviewed by a pathology core and 54 of 91 patients received a pathologic diagnosis of IPF. The positive predictive value of a confident (certain) clinical diagnosis of IPF by the referring centers was 80%. The positive predictive value of a confident clinical diagnosis was higher, when the cases were reviewed by a core of pulmonologists (87%) or radiologists (96%). Lung biopsy was most important for diagnosis in those patients with an uncertain diagnosis and those thought unlikely to have IPF. These studies suggest that clinical and radiologic data that result in a confident diagnosis of IPF by an experienced pulmonologist or radiologist are sufficient to obviate the need for a lung biopsy. Lung biopsy is most helpful when clinical and radiologic data result in an uncertain diagnosis or when patients are thought not to have IPF.




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G. W. Hunninghake, D. A. Lynch, J. R. Galvin, B. H. Gross, N. Muller, D. A. Schwartz, T. E. King Jr, J. P. Lynch III, R. Hegele, J. Waldron, et al.
Radiologic Findings Are Strongly Associated With a Pathologic Diagnosis of Usual Interstitial Pneumonia
Chest, October 1, 2003; 124(4): 1215 - 1223.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Cell Mol. Bio.Home page
N. Kaminski, J. A. Belperio, P. B. Bitterman, L. Chen, S. W. Chensue, A. M.K. Choi, S. Dacic, J. H. Dauber, R. M. du Bois, J. J. Enghild, et al.
Idiopathic Pulmonary Fibrosis
Am. J. Respir. Cell Mol. Biol., September 1, 2003; 29(3): S1 - 105.
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 Am. J. Respir. Crit. Care Med.Home page
H. R. Collard, T. E. King Jr., B. B. Bartelson, J. S. Vourlekis, M. I. Schwarz, and K. K. Brown
Changes in Clinical and Physiologic Variables Predict Survival in Idiopathic Pulmonary Fibrosis
Am. J. Respir. Crit. Care Med., September 1, 2003; 168(5): 538 - 542.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
P. I. Latsi, R. M. du Bois, A. G. Nicholson, T. V. Colby, D. Bisirtzoglou, A. Nikolakopoulou, S. Veeraraghavan, D. M. Hansell, and A. U. Wells
Fibrotic Idiopathic Interstitial Pneumonia: The Prognostic Value of Longitudinal Functional Trends
Am. J. Respir. Crit. Care Med., September 1, 2003; 168(5): 531 - 537.
[Abstract] [Full Text] [PDF]

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 ThoraxHome page
K R Flaherty, E L Thwaite, E A Kazerooni, B H Gross, G B Toews, T V Colby, W D Travis, J A Mumford, S Murray, A Flint, et al.
Radiological versus histological diagnosis in UIP and NSIP: survival implications
Thorax, February 1, 2003; 58(2): 143 - 148.
[Abstract] [Full Text] [PDF]

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 Arch Intern MedHome page
H. R. Collard and T. E. King Jr
Demystifying Idiopathic Interstitial Pneumonia
Arch Intern Med, January 13, 2003; 163(1): 17 - 29.
[Abstract] [Full Text] [PDF]

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 ThoraxHome page
H Ishii, H Mukae, J Kadota, H Kaida, T Nagata, K Abe, S Matsukura, and S Kohno
High serum concentrations of surfactant protein A in usual interstitial pneumonia compared with non-specific interstitial pneumonia
Thorax, January 1, 2003; 58(1): 52 - 57.
[Abstract] [Full Text] [PDF]

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 ChestHome page
F. H.Y. Green
Overview of Pulmonary Fibrosis
Chest, December 1, 2002; 122 (2009): 334S - 339S.
[Abstract] [Full Text] [PDF]

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 Eur Respir JHome page
J. Behr
Is "nonusual interstitial pneumonia" an acceptable diagnosis?
Eur. Respir. J., November 1, 2002; 20(5): 1069 - 1070.
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 Eur Respir JHome page
M. Demedts and U. Costabel
ATS/ERS international multidisciplinary consensus classification of the idiopathic interstitial pneumonias
Eur. Respir. J., May 1, 2002; 19(5): 794 - 796.
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 Evid. Based Med.Home page
ADDITIONAL ARTICLES ABSTRACTED IN ACP JOURNAL CLUB
Evid. Based Med., March 1, 2002; 7(2): 35 - 35.
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 Am. J. Respir. Crit. Care Med.Home page
M. J. TOBIN
Tuberculosis, Lung Infections, Interstitial Lung Disease, and Socioeconomic Issues in AJRCCM 2001
Am. J. Respir. Crit. Care Med., March 1, 2002; 165(5): 631 - 641.
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 Am. J. Respir. Crit. Care Med.Home page
American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias . This Joint Statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS Board of Directors, June 2001 and by The ERS Executive Committee, June 2001
Am. J. Respir. Crit. Care Med., January 15, 2002; 165(2): 277 - 304.
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 Am. J. Respir. Crit. Care Med.Home page
A.-L. A. Katzenstein and J. L. Myers
Idiopathic Pulmonary Fibrosis . To Biopsy or Not to Biopsy
Am. J. Respir. Crit. Care Med., July 15, 2001; 164(2): 185 - 186.
[Full Text] [PDF]

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 RadiologyHome page
S. L. S. MacDonald, M. B. Rubens, D. M. Hansell, S. J. Copley, S. R. Desai, R. M. du Bois, A. G. Nicholson, T. V. Colby, and A. U. Wells
Nonspecific Interstitial Pneumonia and Usual Interstitial Pneumonia: Comparative Appearances at and Diagnostic Accuracy of Thin-Section CT
Radiology, December 1, 2001; 221(3): 600 - 605.
[Abstract] [Full Text] [PDF]

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 RadiologyHome page
D. A. Lynch
Nonspecific Interstitial Pneumonia: Evolving Concepts
Radiology, December 1, 2001; 221(3): 583 - 584.
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