Diagnostic and prognostic implications of 2018 guideline for the diagnosis of idiopathic pulmonary fibrosis in clinical practice

Abstract

The purpose of this study was to evaluate the implications of the 2018 updated guideline for the diagnosis of idiopathic pulmonary fibrosis (IPF) in clinical practice compared to 2011 guideline. This study involved 535 patients including 339 IPF and 196 non-IPF, and we retrospectively evaluated CT classifications of usual interstitial pneumonia (UIP) by two guidelines. Interobserver agreement of 2018 criteria showed moderate reliability (κ = 0.53) comparable to 2011 (κ = 0.56) but interobserver agreement for probable UIP was fair (κ = 0.40). CT pattern of indeterminate for UIP was associated with better prognosis compared with the other groups (adjusted hazard ratio [HR] = 0.36, p < 0.001). Compared to possible UIP, probable UIP demonstrated a lower positive predictive value (PPV, 62.9% vs 65.8%). In analysis of patients with CT patterns of non-definite UIP, diagnosing IPF when CT pattern showed probable UIP with lymphocyte count ≤ 15% in BAL fluid, and either male sex or age ≥ 60 years showed a high specificity of 90.6% and a PPV of 80.8% in the validation cohort. The 2018 criteria provide better prognostic stratification than the 2011 in patients with possible UIP. BAL fluid analysis can improve the diagnostic certainty for IPF diagnosis in patients with probable UIP CT pattern.

The impact of deep learning reconstruction in low dose computed tomography on the evaluation of interstitial lung disease

“…In our study, there were cases in which both IR and DLM were suggestive of such results (Figs 2 and 3 ). Another possible reason for the discrepant diagnoses is that the reported interobserver agreement in diagnosing UIP pattern is not high ranging 0.40–0.69 [ 3 , 6 , 34 ]. The diagnostic agreement between the two radiologists in this study was substantial; however, variability may have influenced the diagnosis.…”

Diagnostic and prognostic biomarkers for progressive fibrosing interstitial lung disease

“…According to the guidelines related to IPF, lymphocyte counts in the BALF of patients with IPF are lower than those in patients with non-IPF interstitial pneumonia [22]. Takei et al reported that the differential lymphocyte count in the BALF was a prognostic factor for acute exacerbation in patients with chronic fibrosing IIPs [23].…”