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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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