Abstract
Background Idiopathic pulmonary fibrosis (IPF) can be diagnosed confidently and non-invasively when clinical and computed tomography (CT) criteria are met. Many do not meet these criteria due to absence of CT honeycombing. We investigated predictors of IPF and combinations allowing accurate diagnosis in individuals without honeycombing. Methods We utilized prospectively collected clinical and CT data from patients enrolled in the Lung Tissue Research Consortium. Included patients had no honeycombing, no connective tissue disease, underwent diagnostic lung biopsy, and had CT pattern consistent with fibrosing ILD (n = 200). Logistic regression identified clinical and CT variables predictive of IPF. The probability of IPF was assessed at various cut-points of important clinical and CT variables. Results A multivariable model adjusted for age and gender found increasingly extensive reticular densities (OR 2.93, CI 95% 1.55–5.56, p = 0.001) predicted IPF, while increasing ground glass densities predicted a diagnosis other than IPF (OR 0.55, CI 95% 0.34–0.89, p = 0.02). The model-based probability of IPF was 80% or greater in patients with age at least 60 years and extent of reticular density one-third or more of total lung volume; for patients meeting or exceeding these clinical thresholds the specificity for IPF is 96% (CI 95% 91–100%) with 21 of 134 (16%) biopsies avoided. Conclusions In patients with suspected fibrotic ILD and absence of CT honeycombing, extent of reticular and ground glass densities predict a diagnosis of IPF. The probability of IPF exceeds 80% in subjects over age 60 years with one-third of total lung having reticular densities.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 88-95 |
| Number of pages | 8 |
| Journal | Respiratory Medicine |
| Volume | 118 |
| DOIs | |
| State | Published - Sep 1 2016 |
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Keywords
- Diagnosis
- High resolution computed tomography
- Idiopathic pulmonary fibrosis
- Interstitial lung disease
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
Cite this
Predictors of idiopathic pulmonary fibrosis in absence of radiologic honeycombing : A cross sectional analysis in ILD patients undergoing lung tissue sampling. / Salisbury, Margaret L.; Xia, Meng; Murray, Susan; Bartholmai, Brian Jack; Kazerooni, Ella A.; Meldrum, Catherine A.; Martinez, Fernando J.; Flaherty, Kevin R.
In: Respiratory Medicine, Vol. 118, 01.09.2016, p. 88-95.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Predictors of idiopathic pulmonary fibrosis in absence of radiologic honeycombing
T2 - A cross sectional analysis in ILD patients undergoing lung tissue sampling
AU - Salisbury, Margaret L.
AU - Xia, Meng
AU - Murray, Susan
AU - Bartholmai, Brian Jack
AU - Kazerooni, Ella A.
AU - Meldrum, Catherine A.
AU - Martinez, Fernando J.
AU - Flaherty, Kevin R.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Background Idiopathic pulmonary fibrosis (IPF) can be diagnosed confidently and non-invasively when clinical and computed tomography (CT) criteria are met. Many do not meet these criteria due to absence of CT honeycombing. We investigated predictors of IPF and combinations allowing accurate diagnosis in individuals without honeycombing. Methods We utilized prospectively collected clinical and CT data from patients enrolled in the Lung Tissue Research Consortium. Included patients had no honeycombing, no connective tissue disease, underwent diagnostic lung biopsy, and had CT pattern consistent with fibrosing ILD (n = 200). Logistic regression identified clinical and CT variables predictive of IPF. The probability of IPF was assessed at various cut-points of important clinical and CT variables. Results A multivariable model adjusted for age and gender found increasingly extensive reticular densities (OR 2.93, CI 95% 1.55–5.56, p = 0.001) predicted IPF, while increasing ground glass densities predicted a diagnosis other than IPF (OR 0.55, CI 95% 0.34–0.89, p = 0.02). The model-based probability of IPF was 80% or greater in patients with age at least 60 years and extent of reticular density one-third or more of total lung volume; for patients meeting or exceeding these clinical thresholds the specificity for IPF is 96% (CI 95% 91–100%) with 21 of 134 (16%) biopsies avoided. Conclusions In patients with suspected fibrotic ILD and absence of CT honeycombing, extent of reticular and ground glass densities predict a diagnosis of IPF. The probability of IPF exceeds 80% in subjects over age 60 years with one-third of total lung having reticular densities.
AB - Background Idiopathic pulmonary fibrosis (IPF) can be diagnosed confidently and non-invasively when clinical and computed tomography (CT) criteria are met. Many do not meet these criteria due to absence of CT honeycombing. We investigated predictors of IPF and combinations allowing accurate diagnosis in individuals without honeycombing. Methods We utilized prospectively collected clinical and CT data from patients enrolled in the Lung Tissue Research Consortium. Included patients had no honeycombing, no connective tissue disease, underwent diagnostic lung biopsy, and had CT pattern consistent with fibrosing ILD (n = 200). Logistic regression identified clinical and CT variables predictive of IPF. The probability of IPF was assessed at various cut-points of important clinical and CT variables. Results A multivariable model adjusted for age and gender found increasingly extensive reticular densities (OR 2.93, CI 95% 1.55–5.56, p = 0.001) predicted IPF, while increasing ground glass densities predicted a diagnosis other than IPF (OR 0.55, CI 95% 0.34–0.89, p = 0.02). The model-based probability of IPF was 80% or greater in patients with age at least 60 years and extent of reticular density one-third or more of total lung volume; for patients meeting or exceeding these clinical thresholds the specificity for IPF is 96% (CI 95% 91–100%) with 21 of 134 (16%) biopsies avoided. Conclusions In patients with suspected fibrotic ILD and absence of CT honeycombing, extent of reticular and ground glass densities predict a diagnosis of IPF. The probability of IPF exceeds 80% in subjects over age 60 years with one-third of total lung having reticular densities.
KW - Diagnosis
KW - High resolution computed tomography
KW - Idiopathic pulmonary fibrosis
KW - Interstitial lung disease
UR - http://www.scopus.com/inward/record.url?scp=84984807297&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84984807297&partnerID=8YFLogxK
U2 - 10.1016/j.rmed.2016.07.016
DO - 10.1016/j.rmed.2016.07.016
M3 - Article
C2 - 27578476
AN - SCOPUS:84984807297
VL - 118
SP - 88
EP - 95
JO - Respiratory Medicine
JF - Respiratory Medicine
SN - 0954-6111
ER -