Histopathologic Assessment of Suspected Idiopathic Pulmonary Fibrosis: Where We Are and Where We Need to Go.

Accurate diagnosis of idiopathic pulmonary fibrosis (IPF) requires multidisciplinary diagnosis that includes clinical, radiologic, and often pathologic assessment. In 2018, the American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and the Latin American Thoracic Society (ATS/ERS/JRS/ALAT) and the Fleischner Society each published guidelines for the diagnosis of IPF, which include criteria for 4 categories of confidence of a histologic usual interstitial pneumonia (UIP) pattern. To (1) identify the role of the guidelines in pathologic assessment of UIP; (2) analyze the 4 guideline categories, including potential areas of difficulty; and (3) determine steps the Pulmonary Pathology Society and the greater pulmonary pathology community can take to improve current guideline criteria and histopathologic diagnosis of interstitial lung disease. Data were derived from the guidelines, published literature, and clinical experience. Both guidelines provide pathologists with a tool to relay to the clinician the likelihood that a biopsy represents UIP, and serve as an adjunct, not a replacement, for traditional histologic diagnosis. There are multiple challenges with implementing the guidelines, including (1) lack of clarity on the quantity and quality of histologic findings required, (2) lack of recognition that histologic features cannot be assessed independently, and (3) lack of guidance on how pathologists should incorporate clinical and radiographic information. Current criteria for "probable UIP" and "indeterminate for UIP" hinder accurate reflection of the likelihood of IPF. These challenges highlight the need for further morphologic-based investigations in the field of pulmonary pathology.

Smith ML ，Hariri LP ，Mino-Kenudson M ，Dacic S ，Attanoos R ，Borczuk A ，Colby TV ，Cooper W ，Jones KD ，Leslie KO ，Mahar A ，Larsen BT ，Cavazza A ，Fukuoka J ，Roden AC ，Sholl LM ，Tazelaar HD ，Churg A ，Beasley MB ... -  《-》

Practical application and validation of the 2018 ATS/ERS/JRS/ALAT and Fleischner Society guidelines for the diagnosis of idiopathic pulmonary fibrosis.

Shih AR ，Nitiwarangkul C ，Little BP ，Roop BW ，Nandy S ，Szabari MV ，Mercaldo N ，Mercaldo S ，Montesi SB ，Muniappan A ，Berigei SR ，Lynch DA ，Sharma A ，Hariri LP ... -  《RESPIRATORY RESEARCH》

Interobserver Agreement of Usual Interstitial Pneumonia Diagnosis Correlated With Patient Outcome.

Hashisako M ，Tanaka T ，Terasaki Y ，Uekusa T ，Achcar RD ，Aswad BI ，Bamefleh HS ，Capelozzi VL ，English JC ，Fabro AT ，Kataoka K ，Hayashi T ，Kondoh Y ，Taniguchi H ，Fukuoka J ... -  《-》

Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline.

Raghu G ，Remy-Jardin M ，Myers JL ，Richeldi L ，Ryerson CJ ，Lederer DJ ，Behr J ，Cottin V ，Danoff SK ，Morell F ，Flaherty KR ，Wells A ，Martinez FJ ，Azuma A ，Bice TJ ，Bouros D ，Brown KK ，Collard HR ，Duggal A ，Galvin L ，Inoue Y ，Jenkins RG ，Johkoh T ，Kazerooni EA ，Kitaichi M ，Knight SL ，Mansour G ，Nicholson AG ，Pipavath SNJ ，Buendía-Roldán I ，Selman M ，Travis WD ，Walsh S ，Wilson KC ，American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Society ... -  《-》

The histologic diagnosis of usual interstitial pneumonia of idiopathic pulmonary fibrosis. Where we are and where we need to go.

In the 50 years since its inception by Dr. Liebow, the diagnosis of usual interstitial pneumonia (UIP) by pathologists has changed significantly. This manuscript reviews the progressive history of the histologic diagnosis of UIP and summarizes the current state of histologic UIP and its relationship to the clinical syndrome idiopathic pulmonary fibrosis (IPF). Fibrotic lung disease mimics of UIP/IPF are reviewed and pearls for distinguishing these diseases from UIP/IPF are provided. Strategies for increasing the value of histologic assessment of biopsies in the setting of pulmonary fibrosis are also discussed.

Smith ML 《-》