Real-World Management and Outcomes of Probable and Indeterminate UIP Patterns on HRCT: A Retrospective Cohort Study and Implications for the 2022 IPF Guideline
- 1Department of Chest Diseases, Ankara University Faculty of Medicine, Cebeci, 06590 Ankara, Turkey
- 2Department of Biostatistics, Ankara University Faculty of Medicine, Cebeci, 06590 Ankara, Turkey
- 3Department of Radiology, Ankara University Faculty of Medicine, Cebeci, 06590 Ankara, Turkey
Abstract
Background: The 2018 ATS/ERS/JRS/ALAT guideline conditionally recommended surgical lung biopsy (SLB) for patients with probable or indeterminate usual interstitial pneumonia (UIP) patterns on high-resolution computed tomography (HRCT). This study assessed the real-world use of this recommendation and outcomes of patients with probable or indeterminate UIP. Methods: HRCT scans of 1255 patients with interstitial lung disease (ILD) followed between 2012–2021 were retrospectively reviewed. A total of 185 patients met the inclusion criteria. We re-evaluated the HRCT scans and classified them through multidisciplinary discussion (MDD) involving one thoracic radiologist, one pulmonary pathologist, one rheumatologist, and at least three pulmonologists specializing in ILD. We analyzed clinical features, biopsy rates, final diagnoses, and survival outcomes. Results: SLB was performed in 10.8% of patients and met the predefined criteria for clinical biopsy success in 50%. Among patients with probable UIP who were ultimately diagnosed with IPF, 32 of 38 (84.2%) received the diagnosis without SLB. The remaining six (15.8%) underwent SLB, of whom five met predefined criteria for clinical biopsy success. Final diagnoses included IPF (23.8%), hypersensitivity pneumonitis (16.8%), and connective tissue disease-associated ILD (16.2%). Crude mortality proportions did not differ significantly between the probable and indeterminate UIP groups (p = 0.173). However, time-to-event analyses demonstrated shorter survival in the probable UIP group (log-rank p = 0.019), and probable UIP was associated with a higher mortality hazard after adjustment for age, sex, and smoking history (adjusted HR 1.91, 95% CI 1.06–3.42; p = 0.030). This association was attenuated and no longer statistically significant after additional adjustment for cardiovascular disease (adjusted HR 1.71,95% CI 0.93–3.14; p = 0.082). Conclusions: These findings support an individualized, multidisciplinary diagnostic approach and are consistent with the diagnostic flexibility introduced in the 2022 IPF guideline.
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BibTeX
@article{serin2026realworld,
title = {{Real-World Management and Outcomes of Probable and Indeterminate UIP Patterns on HRCT: A Retrospective Cohort Study and Implications for the 2022 IPF Guideline}},
author = {Gulce Cansu Serin and Ebru Dumlupınar and Caglar Uzun and Ozlem Ozdemir Kumbasar},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207786},
url = {https://www.mdpi.com/2077-0383/15/20/7786},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Real-World Management and Outcomes of Probable and Indeterminate UIP Patterns on HRCT: A Retrospective Cohort Study and Implications for the 2022 IPF Guideline
AU - Gulce Cansu Serin
AU - Ebru Dumlupınar
AU - Caglar Uzun
AU - Ozlem Ozdemir Kumbasar
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207786
UR - https://www.mdpi.com/2077-0383/15/20/7786
AB - Background: The 2018 ATS/ERS/JRS/ALAT guideline conditionally recommended surgical lung biopsy (SLB) for patients with probable or indeterminate usual interstitial pneumonia (UIP) patterns on high-resolution computed tomography (HRCT). This study assessed the real-world use of this recommendation and outcomes of patients with probable or indeterminate UIP. Methods: HRCT scans of 1255 patients with interstitial lung disease (ILD) followed between 2012–2021 were retrospectively reviewed. A total of 185 patients met the inclusion criteria. We re-evaluated the HRCT scans and classified them through multidisciplinary discussion (MDD) involving one thoracic radiologist, one pulmonary pathologist, one rheumatologist, and at least three pulmonologists specializing in ILD. We analyzed clinical features, biopsy rates, final diagnoses, and survival outcomes. Results: SLB was performed in 10.8% of patients and met the predefined criteria for clinical biopsy success in 50%. Among patients with probable UIP who were ultimately diagnosed with IPF, 32 of 38 (84.2%) received the diagnosis without SLB. The remaining six (15.8%) underwent SLB, of whom five met predefined criteria for clinical biopsy success. Final diagnoses included IPF (23.8%), hypersensitivity pneumonitis (16.8%), and connective tissue disease-associated ILD (16.2%). Crude mortality proportions did not differ significantly between the probable and indeterminate UIP groups (p = 0.173). However, time-to-event analyses demonstrated shorter survival in the probable UIP group (log-rank p = 0.019), and probable UIP was associated with a higher mortality hazard after adjustment for age, sex, and smoking history (adjusted HR 1.91, 95% CI 1.06–3.42; p = 0.030). This association was attenuated and no longer statistically significant after additional adjustment for cardiovascular disease (adjusted HR 1.71,95% CI 0.93–3.14; p = 0.082). Conclusions: These findings support an individualized, multidisciplinary diagnostic approach and are consistent with the diagnostic flexibility introduced in the 2022 IPF guideline.
SN - 2077-0383
ER -