Lung biopsy in patients with suspected idiopathic pulmonary fibrosis and probable interstitial pneumonia on the CT scan

Introduction: The latest idiopathic pulmonary fibrosis (IPF) diagnostic guidelines show controversial opinions regarding the need to biopsy (ATS / ERS / JSR / ALAT) or not (Fleischner) in those patients with probable usual interstitial pneumonia (UIP) on the high-resolution chest CT scan (HRCT). Objective: To describe the usefulness of lung biopsy in patients with suspected IPF and probable UIP on HRCT in our environment. Methodology: We analysed all patients with suspected IPF and probable UIP on HRCT, evaluated in our Multidisciplinary team (MDT) for the last 5 years, in which lung biopsy was also available (cryobiopsy or surgical). According to the latest international guidelines radiological UIP was defined as a peripheral reticular pattern predominant in lower lobes with bronchiectasis but without honeycombing. The patients had a complete study for interstitial lung disease (clinical history, respiratory function tests, blood analysis, HRCT, echocardiogram, bronchoalveolar lavage (BAL) and lung biopsy). The MDT diagnosis was considered as the gold standard. Results: Twenty two patients were included (15M / 7F, 68 ± 9 years, 2 active smokers, 14 former smokers and 6 non-smokers, FVC 84 ± 21% ref, FEV1 / FVC 80 ± 8%, DLCO 56 ± 14%. Lung biopsy (cryobiopsy 14 patients; surgical biopsy 13 patients [in 5 patients both types of biopsy were performed]) was compatible with UIP in 20 cases and with hypersensitivity pneumonitis in 2. MDT performed the IPF diagnosis in 20 patients (91%). Conclusions: Our results show a high diagnostic yield of HRCT in those patients with probable UIP and suspected IPF. Lung biopsy might be avoided in these patients.