The revised ATS/ERS/JRS/ALAT diagnostic criteria for idiopathic pulmonary fibrosis (IPF) - practical implications

Respiratory Research

Table 4 Combination of high-resolution computed tomography and surgical lung biopsy for the diagnosis of ipf (requires multidisciplinary discussion) [2]

HRCT Pattern	Surgical Lung Biopsy Pattern (When Performed)		Diagnosis of IPF?*
UIP	UIP	}	YES
	Probable UIP
	Possible IUP
	Nonclassifiable fibrosis ^†
	Not UIP		No
Possible UIP	UIP	}	YES
	Probable UIP
	Possible UIP	}	Probable^‡
	Nonclassifiable fibrosis
	Not UIP		No
Inconsistent with UIP	UIP		Possible^‡
	Probable UIP	}	No
	Possible UIP
	Nonclassifiable fibrosis
	Not UIP

* The accuracy of the diagnosis of IPF increases with multidisciplinary discussion (MDD). This is particularly relevant in cases in which the radiologic and histopathologic patterns are discordant (e.g., HRCT is inconsistent with UIP and histopathology is UIP). There are data to suggest that the accuracy of diagnosis is improved with MDD among interstitial lung disease experts compared to clinician-specialists in the community setting; timely referral to interstitial lung disease experts is encouraged.
†Nonclassifiable fibrosis: Some biopsies may reveal a pattern of fibrosis that does not meet the above criteria for UIP pattern and the other idiopathic interstitial pneumonias. These biopsies may be termed ‘‘nonclassifiable fibrosis.’’
Multidisciplinary discussion should include discussions of the potential for sampling error and a re-evaluation of adequacy of technique of HRCT. NOTE: In cases with an ‘‘inconsistent with UIP’’ HRCT pattern and a ‘‘UIP’’ surgical lung biopsy pattern, the possibility of a diagnosis of IPF still exists and clarification by MDD among interstitial lung disease experts is indicated.

ISSN: 1465-993X