Abstract
Background: The additional diagnostic value of performing surgical lung biopsy (SLB) in patients with 'possible usual interstitial pneumonia (UIP)' based on ATS/ERS HRCT diagnostic criteria is not known. It has been suggested that most such patients over the age of 65 years will have UIP at biopsy, but this has not been confirmed in separate cohorts.
Aims: We aimed to explore the clinical utility of SLB in suspected IPF and hypothesized that advanced age and a 'fibrotic' appearing HRCT, despite the absence of honeycomb change, would be strong predictors of IPF.
Methods: Between 01/01/07 and 31/12/13, 555 consecutive incident patients with suspected idiopathic interstitial pneumonia (IIP) presented to the Edinburgh lung fibrosis clinic. Patient HRCT scans were categorised based on 2011 ATS/ERS criteria. Of these patients 166 underwent video-assisted thoracoscopic lung biopsy. Post-operative mortality and complication rates were examined.
Results: Based on the 2011 ATS/ERS HRCT criteria, 91 patients were categorised as 'definite UIP', of whom 7 underwent SLB for clinical indications. IPF was confirmed in 5 patients based on 2013 ATS/ERS/JRS/ALAT diagnostic criteria. 207 patients were diagnosed with 'possible UIP'; 40 underwent SLB, IPF was subsequently diagnosed in 28. In this group, 25 patients were aged over 65 years and 21/25 (84%) had UIP on biopsy. 257 patients had HRCTs deemed 'inconsistent with UIP, SLB was performed in 119 patients. Post-operative mortality was 3.6%.
Conclusions: Further research is required to identify clinical data that can accurately predict a diagnosis of IPF over the other IIPs, therefore obliterating the risk associated with invasive procedures in this population.
- Copyright ©ERS 2015