Utility of a lung biopsy for the diagnosis of idiopathic pulmonary fibrosis
Utility of a lung biopsy for the diagnosis of idiopathic pulmonary fibrosis
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DOI：
10.1164/ajrccm.164.2.2101090
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发表时间：
2001-07-15
影响因子：
24.7
通讯作者：
Millard, M
中科院分区：
文献类型：
--
作者：
Hunninghake, GW;Zimmerman, MB;Millard, M
目前尚不清楚是否所有患者都需要外科肺活检来诊断特发性肺纤维化(IPF)。我们在8个转诊中心进行了一项盲法前瞻性研究。最初，通过临床病史和检查、经支气管镜活检和高分辨率肺部CT扫描对病例进行评估。转诊中心的肺科医生随后评估了他们对IPF诊断的确定性，并在手术肺活检之前提供了全面的诊断。肺活检被病理中心复查，91例患者中有54例接受了IPF的病理诊断。参考中心对IPF临床诊断的阳性预测值为80%。当由肺科医生(87%)或放射科医生(96%)核心复查病例时，自信的临床诊断的阳性预测价值更高。对于那些诊断不确定的患者和那些被认为不太可能患有IPF的患者，肺活检对诊断最重要。这些研究表明，有经验的肺科医生或放射科医生对IPF有信心的临床和放射学数据足以消除对肺活检的需要。当临床和放射学数据导致诊断不确定或患者被认为没有肺间质纤维化时，肺活检最有帮助。
It not known if a surgical lung biopsy is necessary in all patients for the diagnosis of idiopathic pulmonary fibrosis (IPF). We conducted a blinded, prospective study at eight referring centers. Initially, cases were evaluated by clinical history and examination, transbronchial biopsy, and high-resolution lung computed tomography scans. Pulmonologists at the referring centers then assessed their certainty of the diagnosis of IPF and provided an overall diagnosis, before surgical lung biopsy. The lung biopsies were reviewed by a pathology core and 54 of 91 patients received a pathologic diagnosis of IPF. The positive predictive value of a confident (certain) clinical diagnosis of IPF by the referring centers was 80%. The positive predictive value of a confident clinical diagnosis was higher, when the cases were reviewed by a core of pulmonologists (87%) or radiologists (96%). Lung biopsy was most important for diagnosis in those patients with an uncertain diagnosis and those thought unlikely to have IPF. These studies suggest that clinical and radiologic data that result in a confident diagnosis of IPF by an experienced pulmonologist or radiologist are sufficient to obviate the need for a lung biopsy. Lung biopsy is most helpful when clinical and radiologic data result in an uncertain diagnosis or when patients are thought not to have IPF.