New radiological diagnostic criteria: impact on idiopathic pulmonary fibrosis diagnosis

Extract

The American Thoracic Society (ATS), European Respiratory Society (ERS), Japanese Respiratory Society (JRS) and Latin American Thoracic Society (ALAT) recently released a new clinical practice guideline (ATS/ERS/JRS/ALAT2018) for idiopathic pulmonary fibrosis (IPF) with simultaneously proposed diagnostic criteria by the Fleischner Society [1, 2]. Both diagnostic algorithms agree on most diagnostic steps, with divergent recommendations on the position of surgical lung biopsy (SLB): ATS/ERS/JRS/ALAT2018 [2] recommends SLB in most patients with a probable usual interstitial pneumonia (UIP) pattern on high-resolution computed tomography (HRCT) (conditional recommendation), whereas the Fleischner Society proposes to forgo SLB in patients with a definite or probable UIP HRCT pattern, presenting in the right clinical context [3, 4]. We aimed to quantify the impact of the previous approach (ATS/ERS/JRS/ALAT2011) [5] and the two new diagnostic approaches [1, 2] on real-life clinical practice, with assessment of radiological interrater agreement, diagnostic test characteristics, and prognostic validity of the diverging radiological diagnoses for a multidisciplinary IPF diagnosis in our cohort.