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Fukihara J, Kondoh Y, Brown KK, Kimura T, Kataoka K, Matsuda T, Yamano Y, Suzuki A, Furukawa T, Sumikawa H, Takahashi O, Johkoh T, Tanaka T, Fukuoka J, Hashimoto N, Hasegawa Y. Probable usual interstitial pneumonia pattern on chest CT: is it sufficient for a diagnosis of idiopathic pulmonary fibrosis? Eur Respir J 2020; 55:13993003.02465-2018. [PMID: 32029448 DOI: 10.1183/13993003.02465-2018] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 12/31/2019] [Indexed: 12/26/2022]
Abstract
Recent studies have suggested that in patients with an idiopathic interstitial pneumonia (IIP), a probable usual interstitial pneumonia (UIP) pattern on chest computed tomography (CT) is sufficient to diagnose idiopathic pulmonary fibrosis (IPF) without histopathology.We retrospectively compared the prognosis and time to first acute exacerbation (AE) in IIP patients with a UIP and a probable UIP pattern on initial chest CT.One hundred and sixty IIP patients with a UIP pattern and 242 with a probable UIP pattern were identified. Probable UIP pattern was independently associated with longer survival time (adjusted hazard ratio 0.713, 95% CI 0.536-0.950; p=0.021) and time to first AE (adjusted hazard ratio 0.580, 95% CI 0.389-0.866; p=0.008). In subjects with a probable UIP pattern who underwent surgical lung biopsy, the probability of a histopathological UIP pattern was 83%. After multidisciplinary discussion and the inclusion of longitudinal behaviour, a diagnosis of IPF was made in 66% of cases. In IPF patients, survival time and time to first AE were not associated with CT pattern. Among subjects with a probable UIP pattern, compared to non-IPF patients, survival time and time to first AE were shorter in IPF patients.In conclusion, IIP patients with a probable UIP pattern on initial chest CT had a better prognosis and longer time to first AE than those with a UIP pattern. However, when baseline data and longitudinal behaviour provided a final diagnosis of IPF, CT pattern was not associated with these outcomes. This suggests diagnostic heterogeneity among patients with a probable UIP pattern.
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Affiliation(s)
- Jun Fukihara
- Dept of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Dept of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Yasuhiro Kondoh
- Dept of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Kevin K Brown
- Dept of Medicine, National Jewish Health, Denver, CO, USA
| | - Tomoki Kimura
- Dept of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Kensuke Kataoka
- Dept of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Toshiaki Matsuda
- Dept of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Yasuhiko Yamano
- Dept of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Atsushi Suzuki
- Dept of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Dept of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Taiki Furukawa
- Dept of Medical IT Center, Nagoya University Hospital, Nagoya, Japan
| | | | - Osamu Takahashi
- Support Unit for Conducting Clinically Essential Study, St Luke's International University Graduate School of Public Health, Tokyo, Japan
| | - Takeshi Johkoh
- Dept of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Japan
| | - Tomonori Tanaka
- Dept of Pathology, Kinki University Faculty of Medicine, Osakasayama, Japan
| | - Junya Fukuoka
- Dept of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naozumi Hashimoto
- Dept of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Hasegawa
- Dept of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Jo HE, Glaspole I, Goh N, Hopkins PMA, Moodley Y, Reynolds PN, Chapman S, Walters EH, Zappala C, Allan H, Macansh S, Grainge C, Keir GJ, Hayen A, Henderson D, Klebe S, Heinze SB, Miller A, Rouse HC, Duhig E, Cooper WA, Mahar AM, Ellis S, McCormack SR, Ng B, Godbolt DB, Corte TJ. Implications of the diagnostic criteria of idiopathic pulmonary fibrosis in clinical practice: Analysis from the Australian Idiopathic Pulmonary Fibrosis Registry. Respirology 2018; 24:361-368. [PMID: 30328644 DOI: 10.1111/resp.13427] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/13/2018] [Accepted: 09/23/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Current guidelines for the diagnosis of idiopathic pulmonary fibrosis (IPF) provide specific criteria for diagnosis in the setting of multidisciplinary discussion (MDD). We evaluate the utility and reproducibility of these diagnostic guidelines, using clinical data from the Australian IPF Registry. METHODS All patients enrolled in the registry undergo a diagnostic review whereby international IPF guidelines are applied via a registry MDD. We investigated the clinical applicability of these guidelines with regard to: (i) adherence to guidelines, (ii) Natural history of IPF diagnostic categories and (iii) Concordance for diagnostic features. RESULTS A total of 417 participants (69% male, 70.6 ± 8.0 years) with a clinical diagnosis of IPF underwent MDD. The 23% of participants who did not meet IPF diagnostic criteria displayed identical disease behaviour to those with confirmed IPF. Honeycombing on radiology was associated with a worse prognosis and this translated into poorer prognosis in the 'definite' IPF group. While there was moderate agreement for IPF diagnostic categories, agreement for specific radiological features, other than honeycombing, was poor. CONCLUSION In clinical practice, physicians do not always follow IPF diagnostic guidelines. We demonstrate a cohort of IPF patients who do not meet IPF diagnostic guideline criteria, based largely on their radiology and lack of lung biopsy, but who have outcomes identical to those with IPF.
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Affiliation(s)
- Helen E Jo
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia
| | - Ian Glaspole
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia.,Department of Allergy and Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia.,Faculty of Medicine, Monash University, Melbourne, VIC, Australia
| | - Nicole Goh
- Department of Allergy and Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia.,Department of Respiratory Medicine, Austin Hospital, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Peter M A Hopkins
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Yuben Moodley
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia
| | - Paul N Reynolds
- Department of Respiratory Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia.,Department of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Sally Chapman
- Department of Respiratory Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Eugene Haydn Walters
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia.,Department of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Christopher Zappala
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | | | | | - Christopher Grainge
- National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Gregory J Keir
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Andrew Hayen
- Department of Public Health, University of Technology, Sydney, NSW, Australia
| | - Douglas Henderson
- Department of Anatomical pathology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Sonja Klebe
- Department of Radiology, Royal Melbourne Hospital, Adelaide, SA, Australia
| | - Stefan B Heinze
- Department of Radiology, Royal Melbourne Hospital, Adelaide, SA, Australia
| | - Anne Miller
- Department of Radiology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Hannah C Rouse
- Department of Radiology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Edwina Duhig
- Department of Anatomical Pathology, Sullivan Nicolaides Pathology, Brisbane, QLD, Australia
| | - Wendy A Cooper
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Annabelle M Mahar
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Samantha Ellis
- Department of Radiology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Samuel R McCormack
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Bernard Ng
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - David B Godbolt
- Pathology Queensland, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Tamera J Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,National Health and Medical Research Council Centre of Research Excellence in Pulmonary Fibrosis, University of Sydney, Sydney, NSW, Australia
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Martinez FJ, Chisholm A, Collard HR, Flaherty KR, Myers J, Raghu G, Walsh SLF, White ES, Richeldi L. The diagnosis of idiopathic pulmonary fibrosis: current and future approaches. THE LANCET RESPIRATORY MEDICINE 2016; 5:61-71. [PMID: 27932290 DOI: 10.1016/s2213-2600(16)30325-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 12/13/2022]
Abstract
With the recent development of two effective treatments for patients with idiopathic pulmonary fibrosis, an accurate diagnosis is crucial. The traditional approach to diagnosis emphasises the importance of thorough clinical and laboratory evaluations to exclude secondary causes of disease. High-resolution CT is a critical initial diagnostic test and acts as a tool to identify patients who should undergo surgical lung biopsy to secure a definitive histological diagnosis of usual interstitial pneumonia pattern. This diagnostic approach faces several challenges. Many patients with suspected idiopathic pulmonary fibrosis present with atypical high-resolution CT characteristics but are unfit for surgical lung biopsy, therefore preventing a confident diagnosis. The state of the art suggests an iterative, multidisciplinary process that incorporates available clinical, laboratory, imaging, and histological features. Recent research has explored genomic techniques to molecularly phenotype patients with interstitial lung disease. In the future, clinicians will probably use blood-specific or lung-specific molecular markers in combination with other clinical, physiological, and imaging features to enhance diagnostic efforts, refine prognostic recommendations, and influence the initial or subsequent treatment options. There is an urgent and increasing need for well designed, large, prospective studies measuring the effect of different diagnostic approaches. Ultimately, this will help to inform the development of guidelines and tailor clinical practice for the benefit of patients.
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Affiliation(s)
- Fernando J Martinez
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA.
| | | | - Harold R Collard
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kevin R Flaherty
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey Myers
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Ganesh Raghu
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Simon L F Walsh
- Department of Radiology, Royal Brompton Hospital, London, UK
| | - Eric S White
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Luca Richeldi
- Catholic University of the Sacred Heart, A. Gemelli University Hospital, Rome, Italy; Academic Unit of Clinical and Experimental Sciences, NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
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