Junya Tominaga1, Fumikazu Sakai2, Takeshi Johkoh3, Satoshi Noma4, Masanori Akira5, Kiminori Fujimoto6, Thomas V Colby7, Takashi Ogura8, Yoshikazu Inoue9, Hiroyuki Taniguchi10, Sakae Homma11, Yoshio Taguchi12, Yukihiko Sugiyama13. 1. Department of Diagnostic Radiology, Tohoku University School of Medicine, Sendai 9808574, Japan; Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Hidaka 3501298, Japan. Electronic address: jrtomi@jf6.so-net.ne.jp. 2. Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Hidaka 3501298, Japan. 3. Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami 6648533, Japan. 4. Department of Radiology, Tenri Hospital, Tenri 6328552, Japan. 5. Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai 5918555, Japan. 6. Department of Radiology and Center for Diagnostic Imaging, Kurume University School of Medicine, Kurume 8300011, Japan. 7. Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ 85054, USA. 8. Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama 2360051, Japan. 9. Clinical Research Center, National Hospital Organization Kinki Chuo-Chest Medical Center, Sakai 5918555, Japan. 10. Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto 4898642, Japan. 11. Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo 1438541, Japan. 12. Department of Respiratory Medicine, Tenri Hospital, Tenri 6328552, Japan. 13. Department of Medicine, Division of Pulmonary Medicine, Jichi Medical University, Simotsuke 3290498, Japan.
Abstract
OBJECTIVE: To reevaluate idiopathic pulmonary fibrosis (IPF) cases which had surgical lung biopsy (SLB) for diagnosis of usual interstitial pneumonia (UIP), and examine the influence of computed tomography (CT) findings and clinical information based on diagnostic certainty. METHODS: Ninety-five cases with multidisciplinary diagnoses of IPF were identified from eight institutions. All cases had SLB. Two expert chest radiologists and five expert pulmonologists used a 5-point scale to grade their level of certainty in the diagnosis of a radiological pattern of UIP or a clinical diagnosis of IPF (level 1 "definitely no" to level 5 "definitely yes"). Radiologists independently evaluated thin-section CT images and pulmonologists independently assessed clinical information. The two groups then discussed their diagnosis to obtain a final consensus, and listed alternative diagnoses. Changes in the level of certainty during the diagnostic process were investigated. RESULTS: The level of certainty for IPF was judged as low (level 1 or 2) in 32 cases (34%) by radiologists and in three cases (3%) by pulmonologists; in the final consensus 39 cases (41%) were judged as low. Chronic hypersensitivity pneumonitis (CHP), interstitial pneumonia associated with collagen tissue diseases (CTD-IP), and idiopathic nonspecific interstitial pneumonia (idiopathic NSIP) were listed as alternative diagnoses. CONCLUSIONS: In this retrospective series, some cases that had UIP confirmed on SLB for IPF diagnosis were classified into a low-level certainty group by expert chest radiologists and pulmonologists. When a diagnosis of IPF is made, the possibility of CHP, CTD-IP, and idiopathic NSIP must be also considered.
OBJECTIVE: To reevaluate idiopathic pulmonary fibrosis (IPF) cases which had surgical lung biopsy (SLB) for diagnosis of usual interstitial pneumonia (UIP), and examine the influence of computed tomography (CT) findings and clinical information based on diagnostic certainty. METHODS: Ninety-five cases with multidisciplinary diagnoses of IPF were identified from eight institutions. All cases had SLB. Two expert chest radiologists and five expert pulmonologists used a 5-point scale to grade their level of certainty in the diagnosis of a radiological pattern of UIP or a clinical diagnosis of IPF (level 1 "definitely no" to level 5 "definitely yes"). Radiologists independently evaluated thin-section CT images and pulmonologists independently assessed clinical information. The two groups then discussed their diagnosis to obtain a final consensus, and listed alternative diagnoses. Changes in the level of certainty during the diagnostic process were investigated. RESULTS: The level of certainty for IPF was judged as low (level 1 or 2) in 32 cases (34%) by radiologists and in three cases (3%) by pulmonologists; in the final consensus 39 cases (41%) were judged as low. Chronic hypersensitivitypneumonitis (CHP), interstitial pneumonia associated with collagen tissue diseases (CTD-IP), and idiopathic nonspecific interstitial pneumonia (idiopathic NSIP) were listed as alternative diagnoses. CONCLUSIONS: In this retrospective series, some cases that had UIP confirmed on SLB for IPF diagnosis were classified into a low-level certainty group by expert chest radiologists and pulmonologists. When a diagnosis of IPF is made, the possibility of CHP, CTD-IP, and idiopathic NSIP must be also considered.
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