Utility of a lung biopsy for the diagnosis of idiopathic pulmonary fibrosis

Gary W. Hunninghake, M. Bridget Zimmerman, David A. Schwartz, Talmadge E. King, Joseph Lynch, Richard Hegele, James Waldron, Thomas Colby, Nestor Müller, David Lynch, Jeff Galvin, Barry Gross, James Hogg, Galen Toews, Rick Helmers, J. Allen D. Cooper, Robert Baughman, Charlie Strange, Mark Millard

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Abstract

It is not known if a surgical lung biopsy is necessary in all patients for the diagnosis of idiopathic pulmonary fibrosis (IPF). We conducted a blinded, prospective study at eight referring centers. Initially, cases were evaluated by clinical history and examination, transbronchial biopsy, and high-resolution lung computed tomography scans. Pulmonologists at the referring centers then assessed their certainty of the diagnosis of IPF and provided an overall diagnosis, before surgical lung biopsy. The lung biopsies were reviewed by a pathology core and 54 of 91 patients received a pathologic diagnosis of IPF. The positive predictive value of a confident (certain) clinical diagnosis of IPF by the referring centers was 80%. The positive predictive value of a confident clinical diagnosis was higher, when the cases were reviewed by a core of pulmonologists (87%) or radiologists (96%). Lung biopsy was most important for diagnosis in those patients with an uncertain diagnosis and those thought unlikely to have IPF. These studies suggest that clinical and radiologic data that result in a confident diagnosis of IPF by an experienced pulmonologist or radiologist are sufficient to obviate the need for a lung biopsy. Lung biopsy is most helpful when clinical and radiologic data result in an uncertain diagnosis or when patients are thought not to have IPF.

Original languageEnglish (US)
Pages (from-to)193-196
Number of pages4
JournalAmerican journal of respiratory and critical care medicine
Volume164
Issue number2
DOIs
StatePublished - Jul 15 2001

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ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Hunninghake, G. W., Bridget Zimmerman, M., Schwartz, D. A., King, T. E., Lynch, J., Hegele, R., Waldron, J., Colby, T., Müller, N., Lynch, D., Galvin, J., Gross, B., Hogg, J., Toews, G., Helmers, R., Cooper, J. A. D., Baughman, R., Strange, C., & Millard, M. (2001). Utility of a lung biopsy for the diagnosis of idiopathic pulmonary fibrosis. American journal of respiratory and critical care medicine, 164(2), 193-196. https://doi.org/10.1164/ajrccm.164.2.2101090