Table 1 Unanswered questions in ILD diagnosis and sources of confusion and controversy.
From: Usual interstitial pneumonia: a clinically significant pattern, but not the final word
Is UIP a diagnosis or merely a pattern? |
Is pathology the gold standard for a diagnosis of UIP? |
Does a diagnosis of UIP imply a diagnosis of IPF? |
How does one “prove” the etiology of a given case of UIP? |
What should be done when radiologic and pathologic findings are discordant? |
Should biopsy interpretation be influenced by clinical and imaging findings? |
What histologic features reliably distinguish etiologies of fibrotic ILD? |
What is the threshold for number or extent of granulomas/interstitial inflammation/airway-centered changes/etc. to issue an alternate non-UIP diagnosis? |
Can UIP be diagnosed at an earlier stage, and if so, what terminology should be used? |
Does UIP indicate a specific pathobiology, or simply a common disease endpoint (cf. hepatic cirrhosis)? |
When does organizing pneumonia or acute lung injury argue against UIP, or suggest acute exacerbation of UIP of IPF? |
How should the broader histologic context influence interpretation of an individual histologic feature? |
