IPF Patients May Not Need Biopsies

New research suggests that clinical and radiological results should provide a confident diagnosis in individuals suspected to have idiopathic pulmonary fibrosis (IPF), which may free these patients from having to undergo biopsies.

Currently, international guidelines recommend that a biopsy be taken to confirm diagnosis when IPF is suspected in patients that display no sign of usual interstitial pneumonia (UIP), the characteristic honeycomb scarring pattern associated with idiopathic pulmonary fibrosis. A team of investigators led by researchers at the University of Washington sought to determine whether IPF—for which there is currently no cure—could be accurately diagnosed in patients who do not exhibit UIP from high-resolution computed tomography (HRCT), without the need for a biopsy.

To do so, the team showed HRCT scans of 315 patients to expert radiologists and pathologists. These patients had previously been suspected of IPF, but presented with little or no visible honeycombing. The experts were able to diagnose with 94 percent accuracy the patients who had IPF but whose scans exhibited little or no scarring. Researchers were aware that the experts’ diagnoses were accurate, as they also had access to results of the patients’ biopsies.

Study authors note that the findings indicate that surgical lung biopsy may not be necessary to reach a diagnosis of IPF when a team of multidisciplinary experts at regional centers work together to interpret possible UIP patterns on high-resolution CT scans in patients suspected to have IPF. The researchers caution, however, that results in day-to-day clinical settings may differ, given the retrospective nature of the study and the way cases were selected. Patients enrolled in the study were a highly selected cohort suspected of having IPF and referred to regional sites for consideration of participation in a clinical trial.

Ganesh Raghu, MD, FCCP, FACP, adjunct professor of medicine and lab medicine in the division of pulmonary and critical care medicine at the University of Washington, and lead study author, advises primary care physicians to “become familiar with clinical manifestations of interstitial lung disease, idiopathic interstitial pneumonias, and idiopathic pulmonary fibrosis.”

Primary care practitioners should also “familiarize themselves with the clinical features of IPF,” he says, adding that physicians should “promptly refer [patients suspected of having IPF] to regional experts experienced [in] management of interstitial lung disease for an accurate diagnosis.”

Reference

Raghu G, Lynch D, et al. Diagnosis of idiopathic pulmonary fibrosis with high-resolution CT in patients with little or no radiological evidence of honeycombing: secondary analysis of a randomised, controlled trial. The Lancet Respiratory Medicine. 2014.