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Transbronchial biopsy is useful in predicting UIP pattern

Sara Tomassetti1, Alberto Cavazza2, Thomas V Colby3, Jay H Ryu4, Oriana Nanni5, E Scarpi5, Paola Tantalocco1, Matteo Buccioli1, Alessandra Dubini6, Sara Piciucchi7, Claudia Ravaglia1, Christian Gurioli1, Gian Luca Casoni1, Carlo Gurioli1, Micaela Romagnoli1 and Venerino Poletti1*

Author Affiliations

1 Department of Diseases of the Thorax, Via C. Forlanini, Forlì, FC, 34-47121, ITALY

2 Department of Pathology, Arcispedale S Maria Nuova – IRCCS, Reggio Emilia, Italy

3 Department of Pathology , Mayo Clinic, Scottsdale, AZ, USA

4 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA

5 Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, FC, Italy

6 Department of Pathology, Forlì, Italy

7 Department of Radiology, Forlì, Italy

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Respiratory Research 2012, 13:96  doi:10.1186/1465-9921-13-96

Published: 29 October 2012

Abstract

Background

Usual interstitial pneumonia (UIP), is a necessary feature pathologically or radiologically for the diagnosis of idiopathic pulmonary fibrosis (IPF). The predictive value of transbronchial biopsy (TBB) in identifying UIP is currently unknown. The objective of this study is to assess the accuracy with which histopathologic criteria of usual interstitial pneumonia (UIP) can be identified in transbronchial biopsy (TBB) and to assess the usefulness of TBBx in predicting a the diagnosis of UIP pattern. We conducted a retrospective blinded and controlled analysis of TBB specimens from 40 established cases of UIP and 24 non-UIP interstitial lung diseases.

Results

Adequate TBB specimens were available in 34 UIP cases (85% of all UIP cases). TBB contained histopathologic criteria to suggest a UIP pattern (ie. at least one of three pathologic features of UIP present; patchy interstitial fibrosis, fibroblast foci, honeycomb changes) in 12 cases (30% of all UIP cases). Sensitivity, specificity, positive and negative predictive values for the two pathologists were 30% (12/40), 100% (24/24), 100% (12/12), 46% (24/52) and 30% (12/40), 92% (22/24), 86% (12/14), 55% (22/40) respectively. Kappa coefficient of agreement between pathologists was good (0.61, 95% CI 0.31-0.91). The likelihood of identifying UIP on TBB increased with the number and size of the TBB specimens.

Conclusion

Although sensitivity is low our data suggest that even modest amount of patchy interstitial fibrosis, fibroblast foci, honeycomb changes detected on TBB can be highly predictive of a UIP pattern. Conversely, the absence of UIP histopathologic criteria on TBB does not rule out UIP.

Keywords:
Bronchoscopy; Idiopathic pulmonary fibrosis; Interstitial lung diseases; Transbronchial biopsy; Usual interstitial pneumonia