Practical application and validation of the 2018 ATS/ERS/JRS/ALAT and Fleischner Society guidelines for the diagnosis of idiopathic pulmonary fibrosis.
Respir Res
; 22(1): 124, 2021 Apr 26.
Article
em En
| MEDLINE
| ID: mdl-33902572
ABSTRACT
BACKGROUND:
Accurate diagnosis of idiopathic pulmonary fibrosis (IPF) is essential to inform prognosis and treatment. In 2018, the ATS/ERS/JRS/ALAT and Fleischner Society released new diagnostic guidelines for usual interstitial pneumonitis (UIP)/IPF, adding Probable UIP as a CT category based on prior studies demonstrating this category had relatively high positive predictive value (PPV) for histopathologic UIP/Probable UIP. This study applies the 2018 ATS/ERS/JRS/ALAT and Fleischner Society guidelines to determine test characteristics of CT categories in academic clinical practice.METHODS:
CT and histopathology were evaluated by three thoracic radiologists and two thoracic pathologists. Comparison of consensus categorization by the 2018 ATS and Fleischner Society guidelines by CT and histopathology was performed.RESULTS:
Of patients with CT UIP, 87% (PPV, 95% CI 60-98%) had histopathologic UIP with 97% (CI 90-100%) specificity. Of patients with CT Probable UIP, 38% (PPV, CI 14-68%) had histopathologic UIP and 46% (PPV, CI 19-75%) had either histopathologic UIP or Probable UIP, with 88% (CI 77-95%) specificity. Patients with CT Indeterminate and Alternative Diagnosis had histopathologic UIP in 27% (PPV, CI 6-61%) and 21% (PPV, CI 11-33%) of cases with specificities of 90% (CI 80-96%) and 25% (CI 16-37%). Interobserver variability (kappa) between radiologists ranged 0.32-0.81.CONCLUSIONS:
CT UIP and Probable UIP have high specificity for histopathologic UIP, and CT UIP has high PPV for histopathologic UIP. PPV of CT Probable UIP was 46% for combined histopathologic UIP/Probable UIP. Our results indicate that additional studies are needed to further assess and refine the guideline criteria to improve classification performance.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Tomografia Computadorizada por Raios X
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Guias de Prática Clínica como Assunto
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Fibrose Pulmonar Idiopática
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Pulmão
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article