title: Transbronchial biopsy is useful in predicting UIP pattern.
abstract: BACKGROUND
  Usual interstitial pneumonia (UIP), is a necessary feature pathologically or radiologically for the diagnosis of idiopathic pulmonary fibrosis (IPF). The predictive value of transbronchial biopsy (TBB) in identifying UIP is currently unknown. The objective of this study is to assess the accuracy with which histopathologic criteria of usual interstitial pneumonia (UIP) can be identified in transbronchial biopsy (TBB) and to assess the usefulness of TBBx in predicting a the diagnosis of UIP pattern. We conducted a retrospective blinded and controlled analysis of TBB specimens from 40 established cases of UIP and 24 non-UIP interstitial lung diseases.
  
  
  RESULTS
  Adequate TBB specimens were available in 34 UIP cases (85% of all UIP cases). TBB contained histopathologic criteria to suggest a UIP pattern (ie. at least one of three pathologic features of UIP present; patchy interstitial fibrosis, fibroblast foci, honeycomb changes) in 12 cases (30% of all UIP cases). Sensitivity, specificity, positive and negative predictive values for the two pathologists were 30% (12/40), 100% (24/24), 100% (12/12), 46% (24/52) and 30% (12/40), 92% (22/24), 86% (12/14), 55% (22/40) respectively. Kappa coefficient of agreement between pathologists was good (0.61, 95% CI 0.31-0.91). The likelihood of identifying UIP on TBB increased with the number and size of the TBB specimens.
  
  
  CONCLUSIONS
  Although sensitivity is low our data suggest that even modest amount of patchy interstitial fibrosis, fibroblast foci, honeycomb changes detected on TBB can be highly predictive of a UIP pattern. Conversely, the absence of UIP histopathologic criteria on TBB does not rule out UIP.
authors.affiliation: Department of Diseases of the Thorax, Via C, Forlanini, Forlì, FC, 34-47121, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Tomassetti
authors.forename: Alberto
authors.initials: A
authors.lastname: Cavazza
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Colby
authors.forename: Jay H
authors.initials: JH
authors.lastname: Ryu
authors.forename: Oriana
authors.initials: O
authors.lastname: Nanni
authors.forename: E
authors.initials: E
authors.lastname: Scarpi
authors.forename: Paola
authors.initials: P
authors.lastname: Tantalocco
authors.forename: Matteo
authors.initials: M
authors.lastname: Buccioli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Dubini
authors.forename: Sara
authors.initials: S
authors.lastname: Piciucchi
authors.forename: Claudia
authors.initials: C
authors.lastname: Ravaglia
authors.forename: Christian
authors.initials: C
authors.lastname: Gurioli
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Casoni
authors.forename: Carlo
authors.initials: C
authors.lastname: Gurioli
authors.forename: Micaela
authors.initials: M
authors.lastname: Romagnoli
authors.forename: Venerino
authors.initials: V
authors.lastname: Poletti
mesh_terms: D000293:Adolescent; D000328:Adult; D001980:Bronchi / Q000473:pathology*; D001995:Bronchography; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult