Diagnosis of Idiopathic Pulmonary Fibrosis in a Possible Usual Interstitial Pneumonia Pattern: a meta-analysis

Heekyung Kim,Jin Mo Goo,Hyunsook Hong,Soon Ho Yoon,Seokyung Hahn

doi:10.1038/s41598-018-34230-z

Heekyung Kim, Jin Mo Goo + Show 3 more

Open Access

https://doi.org/10.1038/s41598-018-34230-z

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Abstract

This study aimed to determine whether a surgical lung biopsy is essential for IPF diagnosis with the possible UIP CT pattern. We performed literature searches of the MEDLINE and EMBASE databases and included studies that conducted a radiologic-pathologic evaluation of IPF according to the 2011 guideline. Outcomes were pooled using a random-effects model. Twelve studies were included. Pooled proportions of IPF for a UIP pattern were 99% (95%CI, 93% to 100%; I2 = 51.7%) and for a possible UIP pattern were 94% (scenario inclusive of probable IPF; 95%CI, 87% to 99%; I2 = 82.9%) and 88% (scenario exclusive of probable IPF; 95%CI, 79% to 95%; I2 = 82.7%). The pooled percentage difference in the proportion of IPF between the UIP and possible UIP patterns was −2% (95%CI, −4% to 1%; I2 = 0.0%) in the former scenario and 4% (95%CI, 0% to 8%; I2 = 0.1%) in the latter scenario. The proportion of IPF with the possible UIP pattern was moderately correlated with the prevalence of IPF (correlation coefficient, 0.605; 95%CI, 0.550–0.860). There was a negligible pooled percentage difference in the proportion of IPF between the UIP and possible UIP patterns, indicating that IPF diagnosis can be confirmed without biopsy in suspected IPF cases with the possible UIP pattern.

Highlights

This study aimed to determine whether a surgical lung biopsy is essential for Idiopathic pulmonary fibrosis (IPF) diagnosis with the possible usual interstitial pneumonia (UIP) CT pattern
No obvious asymmetries were observed and P values for Egger’s test were 0.6131 and 0.7268 (Supplementary Data 4). This meta-analysis revealed that a pooled percentage difference in proportions of IPF diagnosis was negligible between the CT UIP and possible UIP pattern: −2% (95%CI, −4% to 1%) if possible UIP cases probably having IPF had IPF in 100% of cases
When we assumed that possible UIP cases probably having IPF were not IPF at all, the pooled percentage difference between the patterns was marginal (4%; 95%CI, 0% to 8%)

Summary

Introduction

This study aimed to determine whether a surgical lung biopsy is essential for IPF diagnosis with the possible UIP CT pattern. There was a negligible pooled percentage difference in the proportion of IPF between the UIP and possible UIP patterns, indicating that IPF diagnosis can be confirmed without biopsy in suspected IPF cases with the possible UIP pattern. IPF can be diagnosed without a pathologic confirmation in patients with the UIP pattern on HRCT scan because it exclusively indicates IPF, while a surgical lung biopsy is recommended for the possible or inconsistent with UIP patterns. If a reticular abnormality with subpleural basal predominance is highly indicative of IPF regardless of presence of honeycombing, a surgical lung biopsy can be omitted in patients with the possible UIP pattern[9] as with the UIP pattern. Studies to determine whether the surgical lung biopsy is essential for IPF diagnosis in patients with the possible UIP pattern on HRCT scan

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