title: Utility of a lung biopsy for the diagnosis of idiopathic pulmonary fibrosis.
abstract: 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.
authors.affiliation: Department of Medicine, University of Iowa and Veterans Affairs Medical Center, Iowa City, IA 52242, USA. gary-hunninghake@uiowa.edu
authors.forename: G W
authors.initials: GW
authors.lastname: Hunninghake
authors.forename: M B
authors.initials: MB
authors.lastname: Zimmerman
authors.forename: D A
authors.initials: DA
authors.lastname: Schwartz
authors.forename: T E
authors.initials: TE
authors.lastname: King
authors.forename: J
authors.initials: J
authors.lastname: Lynch
authors.forename: R
authors.initials: R
authors.lastname: Hegele
authors.forename: J
authors.initials: J
authors.lastname: Waldron
authors.forename: T
authors.initials: T
authors.lastname: Colby
authors.forename: N
authors.initials: N
authors.lastname: Müller
authors.forename: D
authors.initials: D
authors.lastname: Lynch
authors.forename: J
authors.initials: J
authors.lastname: Galvin
authors.forename: B
authors.initials: B
authors.lastname: Gross
authors.forename: J
authors.initials: J
authors.lastname: Hogg
authors.forename: G
authors.initials: G
authors.lastname: Toews
authors.forename: R
authors.initials: R
authors.lastname: Helmers
authors.forename: J A
authors.initials: JA
authors.lastname: Cooper
authors.forename: R
authors.initials: R
authors.lastname: Baughman
authors.forename: C
authors.initials: C
authors.lastname: Strange
authors.forename: M
authors.initials: M
authors.lastname: Millard
mesh_terms: D001706:Biopsy; D006801:Humans; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011658:Pulmonary Fibrosis / Q000473:pathology*; D012680:Sensitivity and Specificity