Prognostic impact of typical and probable usual interstitial pneumonia pattern in idiopathic pulmonary fibrosis: is the debate about biopsy a Star Wars saga?

The diagnosis of interstitial lung diseases (ILDs) can be straightforward for some experienced experts without biopsy data, but not so straightforward to others. In the context of suspected idiopathic pulmonary fibrosis (IPF), accurate non-invasive diagnosis requires recognition of the hallmark usual interstitial pneumonia (UIP) pattern on imaging, obviating lung biopsy [1, 2]. When the imaging pattern is “probable UIP”, the need for histopathology confirmation of a UIP pattern in surgical lung biopsy (SLB) is often debated, despite concordance between expert groups that SLB is not mandated for IPF diagnosis when the clinical setting is appropriate and multidisciplinary discussion has taken place [1–3]. The debate about the benefit of performing a surgical lung biopsy in patients with the probable UIP pattern needs every case to be viewed on an individual basis. This editorial attempts to bring some clarity to treating physicians and confused patients. http://bit.ly/2Qk517r