title: Diagnostic approach to interstitial pneumonias in a single centre: report on 88 cases.
abstract: BACKGROUND
  Interstitial pneumonias (IP) cover a broad spectrum of diseases. Open lung biopsies reveal histological patterns and suggest possible diagnoses. Complete clinical records are necessary for final diagnoses. Especially idiopathic interstitial pneumonias (IIP) according to the ATS/ERS classification can only be diagnosed under these predictions. The aim of this study was to compare the results of histological evaluations with the final diagnosis after interdisciplinary case evaluation.
  
  
  METHODS
  88 patients with interstitial pneumonia that underwent open lung biopsies were investigated. Histology and clinical records were available for review. Diagnosis was made in three steps: first on the sole basis of histology, second with clinical information given initially and third, on the basis of an interdisciplinary case evaluation.
  
  
  RESULTS
  63 patients (72%) were diagnosed as idiopathic interstitial pneumonias according to ATS/ERS criteria. Further 10 (11%) cases of hypersensitivity pneumonitis, 7 (8%) Langerhans cell histiocytosis and 8 (9%) interstitial pneumonias of other known causes or associations were detected. Histological patterns alone agreed with the final diagnosis in 67%. In 82% histology and clinical information given to the pathologist could provide correct diagnosis. In the rest of cases, especially in non idiopathic interstitial pneumonias, an interdisciplinary case evaluation was needed.
  
  
  CONCLUSIONS
  Diagnosis of interstitial pneumonias by open lung biopsies needs sufficient clinical information. Because of the overlap of histological patterns, an interdisciplinary case evaluation that includes at least one clinical expert and one pathologist with excellent expertise and the follow-up of the patients is necessary to find correct diagnosis in all cases.
  The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5031706258025129.
authors.affiliation: Institute of Pathology and Neuropathology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen 45147, Germany. dirk.theegarten@uk-essen.de
authors.forename: Dirk
authors.initials: D
authors.lastname: Theegarten
authors.forename: Heike Maria
authors.initials: HM
authors.lastname: Müller
authors.forename: Francesco
authors.initials: F
authors.lastname: Bonella
authors.forename: Jeremias
authors.initials: J
authors.lastname: Wohlschlaeger
authors.forename: Ulrich
authors.initials: U
authors.lastname: Costabel
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D005858:Germany; D006801:Humans; D054988:Idiopathic Interstitial Pneumonias / Q000473:pathology; D054990:Idiopathic Pulmonary Fibrosis / Q000473:pathology; D007150:Immunohistochemistry; D033183:Interdisciplinary Communication; D008168:Lung / Q000737:chemistry / Q000473:pathology*; D017563:Lung Diseases, Interstitial / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010348:Patient Care Team; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013194:Staining and Labeling
chemical_list: D015415:Biomarkers