title: Diagnostic accuracy of computed tomography and histopathology in the diagnosis of usual interstitial pneumonia.
abstract: BACKGROUND
  The relative clinical benefit of histopathology and computed tomography (CT) in patients with idiopathic interstitial pneumonia (IIP) is under debate.
  
  
  OBJECTIVE
  To analyze thin-section CT features and histopathologic findings in patients with usual interstitial pneumonia (UIP) in the clinical context of idiopathic pulmonary fibrosis (IPF), and to evaluate and compare diagnostic accuracy of the two methods among patients with an appropriate spectrum of IIP.
  
  
  METHODS
  The study included 91 patients (49 men; mean age 53.2 years; median follow-up 7.2 years) with clinically suspected interstitial lung disease. All underwent surgical lung biopsy and thin-section CT. Two independent readers retrospectively assessed the CT images for the extent and pattern of abnormality and made a first-choice diagnosis. Two pathologists retrospectively assessed the histopathologic slides. In 64 patients with IIP, a retrospective composite reference standard identified 41 patients with UIP. CT characteristics of UIP and IIPs other than UIP were compared with univariate and multivariate analyses.
  
  
  RESULTS
  There was good agreement between the readers for the correct first-choice CT diagnosis of UIP (κ = 0.79). The sensitivity, specificity, and positive predictive value of the CT diagnosis of UIP were 63%, 96%, and 96%, respectively. The sensitivity, specificity, and positive predictive value of the histological diagnosis of UIP were 73%, 74%, and 83%, respectively. The CT feature that best differentiated UIP from IIPs other than UIP was the extent of reticular pattern (odds ratio, 5.1).
  
  
  CONCLUSIONS
  Surgical lung biopsy may not be warranted in patients with thin-section CT diagnosis of UIP.
authors.affiliation: Department of Radiology, Oslo University Hospital Rikshospitalet, Norway. trond.mogens.aalokken@rikshospitalet.no
authors.forename: Trond Mogens
authors.initials: TM
authors.lastname: Aaløkken
authors.forename: Anne
authors.initials: A
authors.lastname: Naalsund
authors.forename: Georg
authors.initials: G
authors.lastname: Mynarek
authors.forename: Audun Elnaes
authors.initials: AE
authors.lastname: Berstad
authors.forename: Steinar
authors.initials: S
authors.lastname: Solberg
authors.forename: Erik H
authors.initials: EH
authors.lastname: Strøm
authors.forename: Helge
authors.initials: H
authors.lastname: Scott
authors.forename: Alf
authors.initials: A
authors.lastname: Kolbenstvedt
authors.forename: Vidar
authors.initials: V
authors.lastname: Søyseth
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000473:pathology*; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult