The use of pretest probability increases the value of high-resolution CT in diagnosing usual interstitial pneumonia

Robert Brownell, Teng Moua, Travis S. Henry, Brett M. Elicker, Darin White, Eric Vittinghoff, Kirk D. Jones, Anatoly Urisman, Carlos Aravena, Kerri A. Johannson, Jeffrey A. Golden, Talmadge E. King, Paul J. Wolters, Harold R. Collard, Brett Ley

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Abstract

Background Recent studies have suggested that nondefinitive patterns on high-resolution CT (HRCT) scan provide sufficient diagnostic specificity to forgo surgical lung biopsy in the diagnosis of idiopathic pulmonary fibrosis (IPF). The objective of this study was to determine test characteristics of non-definitive HRCT patterns for identifying histopathological usual interstitial pneumonia (UIP). Methods Patients with biopsy-proven interstitial lung disease (ILD) and non-definitive HRCT scans were identified from two academic ILD centres. Test characteristics for HRCT patterns as predictors of UIP on surgical lung biopsy were derived and validated in independent cohorts. Results In the derivation cohort, 64/385 (17%) had possible UIP pattern on HRCT; 321/385 (83%) had inconsistent with UIP pattern. 113/385 (29%) patients had histopathological UIP pattern in the derivation cohort. Possible UIP pattern had a specificity of 91.2% (95% CI 87.2% to 94.3%) and a positive predictive value (PPV) of 62.5% (95% CI 49.5% to 74.3%) for UIP pattern on surgical lung biopsy. The addition of age, sex and total traction bronchiectasis score improved the PPV. Inconsistent with UIP pattern demonstrated poor PPV (22.7%, 95% CI 18.3% to 27.7%). HRCT pattern specificity was nearly identical in the validation cohort (92.7%, 95% CI 82.4% to 98.0%). The substantially higher prevalence of UIP pattern in the validation cohort improved the PPV of HRCT patterns. Conclusions A possible UIP pattern on HRCT has high specificity for UIP on surgical lung biopsy, but PPV is highly dependent on underlying prevalence. Adding clinical and radiographic features to possible UIP pattern on HRCT may provide sufficient probability of histopathological UIP across prevalence ranges to change clinical decision-making.

Original languageEnglish (US)
Pages (from-to)424-429
Number of pages6
JournalThorax
Volume72
Issue number5
DOIs
StatePublished - 2017

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ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Brownell, R., Moua, T., Henry, T. S., Elicker, B. M., White, D., Vittinghoff, E., Jones, K. D., Urisman, A., Aravena, C., Johannson, K. A., Golden, J. A., King, T. E., Wolters, P. J., Collard, H. R., & Ley, B. (2017). The use of pretest probability increases the value of high-resolution CT in diagnosing usual interstitial pneumonia. Thorax, 72(5), 424-429. https://doi.org/10.1136/thoraxjnl-2016-209671