title: Diagnostic certainty of idiopathic pulmonary fibrosis/usual interstitial pneumonia: The effect of the integrated clinico-radiological assessment.
abstract: OBJECTIVE
  To reevaluate idiopathic pulmonary fibrosis (IPF) cases which had surgical lung biopsy (SLB) for diagnosis of usual interstitial pneumonia (UIP), and examine the influence of computed tomography (CT) findings and clinical information based on diagnostic certainty.
  
  
  METHODS
  Ninety-five cases with multidisciplinary diagnoses of IPF were identified from eight institutions. All cases had SLB. Two expert chest radiologists and five expert pulmonologists used a 5-point scale to grade their level of certainty in the diagnosis of a radiological pattern of UIP or a clinical diagnosis of IPF (level 1 "definitely no" to level 5 "definitely yes"). Radiologists independently evaluated thin-section CT images and pulmonologists independently assessed clinical information. The two groups then discussed their diagnosis to obtain a final consensus, and listed alternative diagnoses. Changes in the level of certainty during the diagnostic process were investigated.
  
  
  RESULTS
  The level of certainty for IPF was judged as low (level 1 or 2) in 32 cases (34%) by radiologists and in three cases (3%) by pulmonologists; in the final consensus 39 cases (41%) were judged as low. Chronic hypersensitivity pneumonitis (CHP), interstitial pneumonia associated with collagen tissue diseases (CTD-IP), and idiopathic nonspecific interstitial pneumonia (idiopathic NSIP) were listed as alternative diagnoses.
  
  
  CONCLUSIONS
  In this retrospective series, some cases that had UIP confirmed on SLB for IPF diagnosis were classified into a low-level certainty group by expert chest radiologists and pulmonologists. When a diagnosis of IPF is made, the possibility of CHP, CTD-IP, and idiopathic NSIP must be also considered.
authors.affiliation: Department of Diagnostic Radiology, Tohoku University School of Medicine, Sendai 9808574, Japan; Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Hidaka 3501298, Japan. Electronic address: jrtomi@jf6.so-net.ne.jp.
authors.forename: Junya
authors.initials: J
authors.lastname: Tominaga
authors.affiliation: Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Hidaka 3501298, Japan.
authors.forename: Fumikazu
authors.initials: F
authors.lastname: Sakai
authors.affiliation: Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami 6648533, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Johkoh
authors.affiliation: Department of Radiology, Tenri Hospital, Tenri 6328552, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Noma
authors.affiliation: Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai 5918555, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Akira
authors.affiliation: Department of Radiology and Center for Diagnostic Imaging, Kurume University School of Medicine, Kurume 8300011, Japan.
authors.forename: Kiminori
authors.initials: K
authors.lastname: Fujimoto
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ 85054, USA.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Colby
authors.affiliation: Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama 2360051, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ogura
authors.affiliation: Clinical Research Center, National Hospital Organization Kinki Chuo-Chest Medical Center, Sakai 5918555, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 4898642, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Taniguchi
authors.affiliation: Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo 1438541, Japan.
authors.forename: Sakae
authors.initials: S
authors.lastname: Homma
authors.affiliation: Department of Respiratory Medicine, Tenri Hospital, Tenri 6328552, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Taguchi
authors.affiliation: Department of Medicine, Division of Pulmonary Medicine, Jichi Medical University, Simotsuke 3290498, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Sugiyama
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Clinic-radiological diagnosis; Computed tomography; Idiopathic pulmonary fibrosis; Usual interstitial pneumonia