CT Scan Findings of Probable Usual Interstitial Pneumonitis Have a High Predictive Value for Histologic Usual Interstitial Pneumonitis

Chung, Jonathan H.; Chawla, Ashish; Peljto, Anna L.; Cool, Carlyne D.; Groshong, Steve D.; Talbert, Janet; McKean, David F.; Brown, Kevin K.; Fingerlin, Tasha E.; Schwarz, Marvin I.; Schwartz, David A.; Lynch, David A.

doi:10.1378/chest.14-0976

Cited by 155 publications

(103 citation statements)

References 37 publications

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“…This case underscores findings in the literature indicating that characteristic HRCT features are not present in ∼30-40% of IPF patients and that lung biopsy may be needed to confirm diagnosis [27]. There is a growing body of evidence suggesting that subjects with probable IPF, accounting for ∼16% of cases, are likely to have UIP pattern on lung biopsy (82%) [28,29]. Interestingly, FELL et al [30] showed that in patients aged over 65 years with reticular abnormalities but no honeycombing, as described in the case above, the diagnostic likelihood of IPF exceeded 95%.…”

Section: Discussionsupporting

confidence: 54%

The multidisciplinary approach in the diagnosis of idiopathic pulmonary fibrosis: a patient case-based review

Tomassetti¹,

Piciucchi

Tantalocco³

et al. 2015

Eur Respir Rev

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Idiopathic pulmonary fibrosis (IPF) is a specific form of chronic, progressively fibrosing interstitial pneumonia that is associated with a significantly worse prognosis than other forms of chronic interstitial pneumonia. An early and accurate diagnosis of IPF is important to enable the initiation of disease-specific therapies, which have the potential to reduce disease progression, and the avoidance of inappropriate and potentially harmful drugs. Establishing an accurate diagnosis of IPF can be challenging. Recent studies and international guidelines advocate the importance of a multidisciplinary team (MDT) in the initial diagnostic assessment of patients with suspected IPF. Typical MDT members include a pulmonologist, a radiologist and a pathologist, with further input from a thoracic surgeon, a rheumatologist, a specialist nurse and an occupational physician where appropriate. Multidisciplinary diagnosis is considered the gold standard because it can improve the accuracy of diagnosis of IPF, avoid unnecessary testing (e.g. lung biopsy), and optimise patient management. Here we highlight the strengths and limitations of the multidisciplinary approach to IPF diagnosis through MDT discussion of two patient cases. @ERSpublicationsThe strengths and limitations of IPF management by a multidisciplinary team are highlighted in two patient cases http://ow.ly/H04Xe

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Section: Discussionsupporting

confidence: 54%

The multidisciplinary approach in the diagnosis of idiopathic pulmonary fibrosis: a patient case-based review

Tomassetti¹,

Piciucchi

Tantalocco³

et al. 2015

Eur Respir Rev

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“…Test characteristics included sensitivity, specificity, PPV, negative predictive value, area under the receiver-operator curve and positive likelihood ratios (LR+). To further demonstrate the effect of differing population prevalence rates (ie, differing pretest probabilities) of histopathological UIP on post-test probabilities, histopathological UIP prevalence rates were varied across a hypothetical range 10 12. Several sensitivity analyses were performed: including cases with possible UIP/unclassifiable PF on histopathology as ‘positive’ outcome (ie, as equivalent to definite/probable UIP cases); using the clinical diagnosis of IPF rather than histopathological UIP as the outcome; including patients with diagnoses of a defined connective tissue disease (CTD) prior to biopsy; and using individual radiologist interpretations of HRCT pattern rather than consensus pattern.…”

Section: Methodsmentioning

confidence: 99%

The use of pretest probability increases the value of high-resolution CT in diagnosing usual interstitial pneumonia

Brownell

Moua

Henry

et al. 2017

Thorax

115

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Background Recent studies have suggested that non-definitive patterns on high-resolution CT (HRCT) scan provide sufficient diagnostic specificity to forgo surgical lung biopsy in the diagnosis of idiopathic pulmonary fibrosis (IPF). The objective of this study was to determine test characteristics of non-definitive HRCT patterns for identifying histopathological usual interstitial pneumonia (UIP). Methods Patients with biopsy-proven interstitial lung disease (ILD) and non-definitive HRCT scans were identified from two academic ILD centres. Test characteristics for HRCT patterns as predictors of UIP on surgical lung biopsy were derived and validated in independent cohorts. Results In the derivation cohort, 64/385 (17%) had possible UIP pattern on HRCT; 321/385 (83%) had inconsistent with UIP pattern. 113/385 (29%) patients had histopathological UIP pattern in the derivation cohort. Possible UIP pattern had a specificity of 91.2% (95% CI 87.2% to 94.3%) and a positive predictive value (PPV) of 62.5% (95% CI 49.5% to 74.3%) for UIP pattern on surgical lung biopsy. The addition of age, sex and total traction bronchiectasis score improved the PPV. Inconsistent with UIP pattern demonstrated poor PPV (22.7%, 95% CI 18.3% to 27.7%). HRCT pattern specificity was nearly identical in the validation cohort (92.7%, 95% CI 82.4% to 98.0%). The substantially higher prevalence of UIP pattern in the validation cohort improved the PPV of HRCT patterns. Conclusions A possible UIP pattern on HRCT has high specificity for UIP on surgical lung biopsy, but PPV is highly dependent on underlying prevalence. Adding clinical and radiographic features to possible UIP pattern on HRCT may provide sufficient probability of histopathological UIP across prevalence ranges to change clinical decision-making.

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“…In a prior study, we reported on 201 of the 1,764 subjects included in the current study. 16 The prior report only included subjects with pathologic correlation; the current study expands on this by having a much larger subject number and includes new evaluation of the CT imaging pattern of pulmonary fibrosis relative to the MUC5B promoter site polymorphism. Of the 1,764 subjects, 1,491 had evidence of pulmonary fibrosis on chest CT scans and were included in our study.…”

Section: Study Populationmentioning

confidence: 99%

“…Confidence of diagnosis specific to UIP was scored as inconsistent with UIP, indeterminate UIP, probable UIP, or UIP depending on the radiologists' opinion of the likelihood of the diagnosis based on imaging findings (Figs 1-4). [16][17][18][19] A UIP pattern was defined as basilar and peripheral preponderant fibrosis with honeycombing and absence of features to suggest another alternative diagnosis. Probable UIP was defined as basilar and peripheral preponderant fibrosis with little or no honeycombing and absence of features to suggest another alternative diagnosis.…”

Section: Ct Imaging Evaluationmentioning

confidence: 99%

CT Imaging Phenotypes of Pulmonary Fibrosis in the MUC5B Promoter Site Polymorphism

Chung

Peljto

Chawla

et al. 2016

Chest

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CT Scan Findings of Probable Usual Interstitial Pneumonitis Have a High Predictive Value for Histologic Usual Interstitial Pneumonitis

Cited by 155 publications

References 37 publications

The multidisciplinary approach in the diagnosis of idiopathic pulmonary fibrosis: a patient case-based review

The multidisciplinary approach in the diagnosis of idiopathic pulmonary fibrosis: a patient case-based review

The use of pretest probability increases the value of high-resolution CT in diagnosing usual interstitial pneumonia

CT Imaging Phenotypes of Pulmonary Fibrosis in the MUC5B Promoter Site Polymorphism

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