Hunninghake G W, Zimmerman M B, Schwartz D A, King T E, Lynch J, Hegele R, Waldron J, Colby T, Müller N, Lynch D, Galvin J, Gross B, Hogg J, Toews G, Helmers R, Cooper J A, Baughman R, Strange C, Millard M
Department of Medicine, University of Iowa and Veterans Affairs Medical Center, Iowa City, IA 52242, USA.
Am J Respir Crit Care Med. 2001 Jul 15;164(2):193-6. doi: 10.1164/ajrccm.164.2.2101090.
It is not known if a surgical lung biopsy is necessary in all patients for the diagnosis of idiopathic pulmonary fibrosis (IPF). We conducted a blinded, prospective study at eight referring centers. Initially, cases were evaluated by clinical history and examination, transbronchial biopsy, and high-resolution lung computed tomography scans. Pulmonologists at the referring centers then assessed their certainty of the diagnosis of IPF and provided an overall diagnosis, before surgical lung biopsy. The lung biopsies were reviewed by a pathology core and 54 of 91 patients received a pathologic diagnosis of IPF. The positive predictive value of a confident (certain) clinical diagnosis of IPF by the referring centers was 80%. The positive predictive value of a confident clinical diagnosis was higher, when the cases were reviewed by a core of pulmonologists (87%) or radiologists (96%). Lung biopsy was most important for diagnosis in those patients with an uncertain diagnosis and those thought unlikely to have IPF. These studies suggest that clinical and radiologic data that result in a confident diagnosis of IPF by an experienced pulmonologist or radiologist are sufficient to obviate the need for a lung biopsy. Lung biopsy is most helpful when clinical and radiologic data result in an uncertain diagnosis or when patients are thought not to have IPF.
对于所有特发性肺纤维化（IPF）患者的诊断而言，外科肺活检是否必要尚不清楚。我们在八个转诊中心开展了一项盲法前瞻性研究。最初，通过临床病史与检查、经支气管活检以及高分辨率肺部计算机断层扫描对病例进行评估。转诊中心的肺科医生在进行外科肺活检之前，先评估他们对IPF诊断的确定性，并给出总体诊断。肺活检由病理核心团队进行复查，91例患者中有54例获得了IPF的病理诊断。转诊中心对IPF做出有把握（确定）的临床诊断的阳性预测值为80%。当由一组肺科医生（87%）或放射科医生（96%）复查病例时，有把握的临床诊断的阳性预测值更高。肺活检对于诊断不明确以及那些被认为不太可能患有IPF的患者最为重要。这些研究表明，由经验丰富的肺科医生或放射科医生做出有把握的IPF诊断的临床和放射学数据足以避免进行肺活检的必要性。当临床和放射学数据导致诊断不明确或患者被认为没有IPF时，肺活检最有帮助。
