Abstract
BackgroundUsual interstitial pneumonia (UIP), is a necessary feature pathologically or radiologically for the diagnosis of idiopathic pulmonary fibrosis (IPF). The predictive value of transbronchial biopsy (TBB) in identifying UIP is currently unknown. The objective of this study is to assess the accuracy with which histopathologic criteria of usual interstitial pneumonia (UIP) can be identified in transbronchial biopsy (TBB) and to assess the usefulness of TBBx in predicting a the diagnosis of UIP pattern. We conducted a retrospective blinded and controlled analysis of TBB specimens from 40 established cases of UIP and 24 non-UIP interstitial lung diseases.ResultsAdequate TBB specimens were available in 34 UIP cases (85% of all UIP cases). TBB contained histopathologic criteria to suggest a UIP pattern (ie. at least one of three pathologic features of UIP present; patchy interstitial fibrosis, fibroblast foci, honeycomb changes) in 12 cases (30% of all UIP cases). Sensitivity, specificity, positive and negative predictive values for the two pathologists were 30% (12/40), 100% (24/24), 100% (12/12), 46% (24/52) and 30% (12/40), 92% (22/24), 86% (12/14), 55% (22/40) respectively. Kappa coefficient of agreement between pathologists was good (0.61, 95% CI 0.31-0.91). The likelihood of identifying UIP on TBB increased with the number and size of the TBB specimens.ConclusionAlthough sensitivity is low our data suggest that even modest amount of patchy interstitial fibrosis, fibroblast foci, honeycomb changes detected on TBB can be highly predictive of a UIP pattern. Conversely, the absence of UIP histopathologic criteria on TBB does not rule out UIP.
Highlights
Idiopathic Pulmonary Fibrosis (IPF) is a progressive and lethal form of interstitial lung disease (ILD) of unknown etiology [1,2]
Current opinion generally militates against the use of transbronchial biopsy (TBB) for diagnosing usual interstitial pneumonia (UIP), but some physicians still rely on TBB and bronchoalveolar lavage (BAL) in the evaluation of patients with suspected idiopathic pulmonary fibrosis (IPF), in those at high surgical risk [8,9,10,11]
Patient characteristics Among 40 UIP cases 37 were “definite” IPF and 3 were “possible” IPF according to current guidelines [1]
Summary
Idiopathic Pulmonary Fibrosis (IPF) is a progressive and lethal form of interstitial lung disease (ILD) of unknown etiology [1,2]. Two retrospective and unblinded studies, including that of Berbescu et al showed that TBB specimens may display the histologic features of UIP [12,13] Katzenstein recently reported their experience that, in the proper clinical context and with adequate tissue sampling, TBB can support a diagnosis of UIP in 43% of cases (9/22)”. The objective of this study is to assess the accuracy with which histopathologic criteria of usual interstitial pneumonia (UIP) can be identified in transbronchial biopsy (TBB) and to assess the usefulness of TBBx in predicting a the diagnosis of UIP pattern. We conducted a retrospective blinded and controlled analysis of TBB specimens from 40 established cases of UIP and 24 non-UIP interstitial lung diseases
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