HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fishbein, M. C. Search for Related Content PubMed PubMed Citation Articles by Fishbein, M. C.

Diagnosis: To Biopsy or Not to Biopsy^*

Assessing the Role of Surgical Lung Biopsy in the Diagnosis of Idiopathic Pulmonary Fibrosis

^* From the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Correspondence to: Michael C. Fishbein, MD, Professor of Pathology and Medicine, Chief, Autopsy Service, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095; e-mail: mfishbein{at}mednet.ucla.edu

Idiopathic pulmonary fibrosis (IPF) is a chronic disorder that is associated with a poorer prognosis than subacute idiopathic interstitial pneumonias (IIPs). IPF can be differentiated from other IIPs on the basis of its histologic pattern of usual interstitial pneumonia (UIP). Although a surgical lung biopsy specimen showing a UIP pattern is required for the definitive diagnosis of IPF, clinical criteria can be used in the absence of a lung biopsy specimen to make a likely diagnosis of IPF. The predictive value of these criteria largely depends on the expertise of the clinician and radiologist, but considerable interobserver variability exists even when evaluations are performed by experts in the field. Moreover, these criteria lead to misdiagnosis in about 25 to 35% of cases. Interobserver variability is reduced and diagnostic accuracy is improved in cases in which a diagnosis is made with a high degree of confidence. Diagnostic accuracy is also higher when the diagnosis is made by a core group of experts rather than by a referring center. The decision on whether or not to perform a surgical lung biopsy is difficult. It is clearly indicated in cases in which clinical or radiologic findings are atypical or when the diagnosis is made with a low degree of certainty.

Key Words: idiopathic interstitial pneumonia • idiopathic pulmonary fibrosis • interobserver variability • interstitial lung disease • surgical lung biopsy

This article has been cited by other articles:

				I. Noth and F. J. Martinez Recent Advances in Idiopathic Pulmonary Fibrosis Chest, August 1, 2007; 132(2): 637 - 650. [Abstract] [Full Text] [PDF]

				J. H. Park, D. K. Kim, D. S. Kim, Y. Koh, S.-D. Lee, W. S. Kim, W. D. Kim, and S. I. Park Mortality and risk factors for surgical lung biopsy in patients with idiopathic interstitial pneumonia Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1115 - 1119. [Abstract] [Full Text] [PDF]