The use of pretest probability increases the value of high-resolution CT in diagnosing usual interstitial pneumonia.
The use of pretest probability increases the value of high-resolution CT in diagnosing usual interstitial pneumonia.
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DOI：
10.1136/thoraxjnl-2016-209671
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发表时间：
2017-05
期刊：
影响因子：
10
通讯作者：
Ley B
中科院分区：
文献类型：
--
作者：
Brownell R;Moua T;Henry TS;Elicker BM;White D;Vittinghoff E;Jones KD;Urisman A;Aravena C;Johannson KA;Golden JA;King TE Jr;Wolters PJ;Collard HR;Ley B
最近的研究表明，在诊断特发性肺纤维化（IPF）时，高分辨率CT（HRCT）扫描的非确定性模式提供了足够的诊断特异性，可以放弃手术肺活检。本研究的目的是确定非确定性HRCT模式的检测特征，以确定组织病理学普通型间质性肺炎（UIP）。从两个学术ILD中心确定了活检证实的间质性肺病（ILD）和非确定性HRCT扫描的患者。在独立的队列中推导并验证了HRCT模式作为手术肺活检UIP预测因子的测试特征。在衍生队列中，64/385（17%）例患者在HRCT上可能存在UIP模式; 321/385（83%）例患者与UIP模式不一致。在衍生队列中，113/385例（29%）患者具有组织病理学UIP模式。可能的UIP模式的特异性为91.2%（95%CI 87.2%至94.3%），阳性预测值（PPV）为62.5%（95%CI 49.5%至74.3%）。年龄、性别和牵引性支气管扩张总分的增加改善了PPV。与UIP模式不一致表明PPV较差（22.7%，95% CI 18.3%至27.7%）。验证队列的HRCT模式特异性几乎相同（92.7%，95% CI 82.4%至98.0%）。验证队列中UIP模式的患病率显著较高，改善了HRCT模式的PPV。结论HRCT上可能的UIP模式对手术肺活检的UIP具有高度特异性，但PPV高度依赖于基础患病率。将临床和影像学特征添加到HRCT上可能的UIP模式中，可以提供足够的组织病理学UIP概率，以改变临床决策。
Recent studies have suggested that non-definitive patterns on high-resolution CT (HRCT) scan provide sufficient diagnostic specificity to forgo surgical lung biopsy in the diagnosis of idiopathic pulmonary fibrosis (IPF). The objective of this study was to determine test characteristics of non-definitive HRCT patterns for identifying histopathological usual interstitial pneumonia (UIP). Patients with biopsy-proven interstitial lung disease (ILD) and non-definitive HRCT scans were identified from two academic ILD centres. Test characteristics for HRCT patterns as predictors of UIP on surgical lung biopsy were derived and validated in independent cohorts. In the derivation cohort, 64/385 (17%) had possible UIP pattern on HRCT; 321/385 (83%) had inconsistent with UIP pattern. 113/385 (29%) patients had histopathological UIP pattern in the derivation cohort. Possible UIP pattern had a specificity of 91.2% (95% CI 87.2% to 94.3%) and a positive predictive value (PPV) of 62.5% (95% CI 49.5% to 74.3%) for UIP pattern on surgical lung biopsy. The addition of age, sex and total traction bronchiectasis score improved the PPV. Inconsistent with UIP pattern demonstrated poor PPV (22.7%, 95% CI 18.3% to 27.7%). HRCT pattern specificity was nearly identical in the validation cohort (92.7%, 95% CI 82.4% to 98.0%). The substantially higher prevalence of UIP pattern in the validation cohort improved the PPV of HRCT patterns. Conclusions A possible UIP pattern on HRCT has high specificity for UIP on surgical lung biopsy, but PPV is highly dependent on underlying prevalence. Adding clinical and radiographic features to possible UIP pattern on HRCT may provide sufficient probability of histopathological UIP across prevalence ranges to change clinical decision-making.
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影响因子：
4.3
作者：
Salisbury, Margaret L.;Xia, Meng;Flaherty, Kevin R.
通讯作者：
Flaherty, Kevin R.
影响因子：
24.3
作者：
Ryerson, Christopher J.;Urbania, Thomas H.;Collard, Harold R.
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影响因子：
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作者：
Raghu, G;Mageto, YN;Godwin, JD
通讯作者：
Godwin, JD
DOI：
10.1164/rccm.2009-040gl
发表时间：
2011-03-15
影响因子：
24.7
作者：
Raghu, Ganesh;Collard, Harold R.;Schuenemann, Holger J.
通讯作者：
Schuenemann, Holger J.
DOI：
10.1164/ajrccm.164.2.2101090
发表时间：
2001-07-15
影响因子：
24.7
作者：
Hunninghake, GW;Zimmerman, MB;Millard, M
通讯作者：
Millard, M