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New radiological diagnostic criteria: impact on idiopathic pulmonary fibrosis diagnosis

Manuela Funke-Chambour, Sabina A. Guler, Thomas Geiser, Andreas Christe, Johannes Heverhagen, Alexander Pöllinger, Adrian Huber, Lukas Ebner
European Respiratory Journal 2019 54: 1900905; DOI: 10.1183/13993003.00905-2019
Manuela Funke-Chambour
1Dept of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
2Dept for BioMedical Research, University of Bern, Bern, Switzerland
4Both authors contributed equally
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  • For correspondence: manuela.funke-chambour@insel.ch
Sabina A. Guler
1Dept of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
4Both authors contributed equally
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Thomas Geiser
1Dept of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
2Dept for BioMedical Research, University of Bern, Bern, Switzerland
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Andreas Christe
3Dept of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Johannes Heverhagen
3Dept of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Alexander Pöllinger
3Dept of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Adrian Huber
3Dept of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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  • ORCID record for Adrian Huber
Lukas Ebner
3Dept of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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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.

Abstract

Divergent recommendations and guidelines exist for IPF. Comparison of existing guidelines indicates IPF was diagnosed with better sensitivity and preserved specificity with Fleischner recommendations compared with current clinical practice guidelines. http://bit.ly/2ozH9la

Footnotes

  • Conflict of interest: M. Funke-Chambour reports grants from Roche, Boehringer Ingelheim, and Intermune (limited grant for initial cohort study set up), during the conduct of the study.

  • Conflict of interest: S.A. Guler has nothing to disclose.

  • Conflict of interest: T. Geiser has nothing to disclose.

  • Conflict of interest: A. Christe has nothing to disclose.

  • Conflict of interest: J. Heverhagen has nothing to disclose.

  • Conflict of interest: A. Pöllinger has nothing to disclose.

  • Conflict of interest: A. Huber has nothing to disclose.

  • Conflict of interest: L. Ebner has nothing to disclose.

  • Support statement: Boehringer Ingelheim, F. Hoffmann-La Roche and Intermune provided an unrestricted grant for the initial cohort study. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Received May 6, 2019.
  • Accepted June 28, 2019.
  • Copyright ©ERS 2019
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New radiological diagnostic criteria: impact on idiopathic pulmonary fibrosis diagnosis
Manuela Funke-Chambour, Sabina A. Guler, Thomas Geiser, Andreas Christe, Johannes Heverhagen, Alexander Pöllinger, Adrian Huber, Lukas Ebner
European Respiratory Journal Nov 2019, 54 (5) 1900905; DOI: 10.1183/13993003.00905-2019

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New radiological diagnostic criteria: impact on idiopathic pulmonary fibrosis diagnosis
Manuela Funke-Chambour, Sabina A. Guler, Thomas Geiser, Andreas Christe, Johannes Heverhagen, Alexander Pöllinger, Adrian Huber, Lukas Ebner
European Respiratory Journal Nov 2019, 54 (5) 1900905; DOI: 10.1183/13993003.00905-2019
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