title: The revised ATS/ERS/JRS/ALAT diagnostic criteria for idiopathic pulmonary fibrosis (IPF)--practical implications.
abstract: Idiopathic pulmonary fibrosis (IPF), the most prevalent idiopathic interstitial pneumonia, is associated with a poor prognosis. An accurate diagnosis of IPF is essential for optimal management. The recent ATS/ERS/JRS/ALAT recommendations on the diagnosis and management of IPF were developed from a systematic review of the published literature. High-resolution computed tomography (HRCT) scanning has a central role in the IPF diagnostic pathway with formal designation of criteria for an HRCT pattern of UIP. In the correct clinical context, a UIP pattern on HRCT is indicative of a definite diagnosis of IPF without the need for a surgical lung biopsy. However, although the 2011 ATS/ERS/JRS/ALAT statement is a major advance, the application of guideline recommendations by clinicians has identified limitations that need to be addressed in future statements. Key problems include: 1) the lack of management recommendations for the highly prevalent clinical scenarios of probable and possible IPF; 2) the ongoing confusion about the diagnostic role of bronchoalveolar lavage (reflecting ambiguity in the current recommendation); 3) HRCT misdiagnosis by less experienced radiologists, increasingly recognised as a major problem; and 4) the lack of integration of clinical data, including the treated course of disease, in the designation of the diagnostic likelihood of IPF.
authors.affiliation: Royal Brompton and Harefield NHS Foundation Trust, London, UK. Athol.Wells@rbht.nhs.uk
authors.forename: Athol U
authors.initials: AU
authors.lastname: Wells
mesh_terms: D018893:Bronchoalveolar Lavage / Q000592:standards*; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D003951:Diagnostic Errors / Q000517:prevention & control; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000175:diagnosis* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D015272:Pulmonary Medicine / Q000592:standards*; D014057:Tomography, X-Ray Computed / Q000592:standards*