Lung biopsy may not be needed for idiopathic pulmonary fibrosis diagnosis


WESTPORT, CT (Reuters Health) – When a "confident diagnosis" of idiopathic pulmonary fibrosis (IPF) is made by a pulmonologist or radiologist who has extensive experience caring for patients with interstitial lung diseases, a lung biopsy may not be necessary, according to results of prospective study.

Eight referring centers in the US and Canada entered 91 patients suspected of having IPF in the trial. Each patient underwent high resolution computed tomography and transbronchial biopsy, and if necessary, surgical biopsy. A pulmonologist at each center provided a diagnosis for each patient.

Dr. Gary W. Hunninghake, of the University of Iowa College of Medicine and Veterans Administration Medical Center, in Iowa City, and colleagues enlisted three pulmonologists to make a diagnosis based on radiography and clinical information. Also, four chest radiologists made diagnoses based on CT scans alone, and three lung pathologists made diagnoses based on pathology slides.

Fifty-four patients were diagnosed with IPF based on pathological findings, the investigators report in the American Journal of Respiratory and Critical Care Medicine for July 15. Of these patients, 11 were not thought to have IPF before biopsy results were obtained. Nine patients with a preliminary diagnosis of IPF were ultimately diagnosed with lung cancer, sarcoidosis, hypersensitivity pneumonitis, silicosis, or emphysema.

"The probability that a patient has IPF given a confident (certain) diagnosis by the referring center was 0.81," the researchers write. Corresponding probability figures were 0.96 for the radiologists and 0.87 for the pulmonologists.

According to the authors, the results suggest that "lung biopsy may be required for diagnosis when patients are cared for by less experienced clinicians, when the diagnosis is uncertain, and when the clinical diagnosis is not IPF."

"A confident clinical diagnosis identified only about half of patients subsequently shown to have IPF," Dr. Anna-Luise A. Katzenstein, of Crouse Hospital and Upstate Medical University, in Syracuse, New York, and Dr. Jeffrey L. Myers, of the Mayo Clinic, in Rochester, Minnesota, point out in a related editorial.

They note that new data suggesting that usual interstitial pneumonia responds to treatment with interferon-gamma make it important for physicians to accurately diagnose the condition.

While a confident clinical diagnosis by an experienced clinician may be sufficient to diagnose IPF, lung biopsy may still be required for patients wishing to participate in investigative studies, they add.

Am J Respir Crit Care Med 2001;164:185-186,193-196.

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