{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T10:55:44Z","timestamp":1792580144278,"version":"4.5.0"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2019,11,1]],"date-time":"2019-11-01T00:00:00Z","timestamp":1572566400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>The level of diagnostic likelihood at which physicians prescribe antifibrotic therapy without requesting surgical lung biopsy (SLB) in patients suspected of idiopathic pulmonary fibrosis (IPF) is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine how often physicians advocate SLB in patient subgroups defined by IPF likelihood and risk associated with SLB, and to identify the level of diagnostic likelihood at which physicians prescribe antifibrotic therapy with requesting SLB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An international cohort of respiratory physicians evaluated 60 cases of interstitial lung disease, giving:1) differential diagnoses with diagnostic likelihood;2) a decision on the need for SLB; and3) initial management. Diagnoses were stratified according to diagnostic likelihood bands described by Ryerson and colleagues.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>A total of 404 physicians evaluated the 60 cases (24,240 physician\u2013patient evaluations). IPF was part of the differential diagnosis in 9,958\/24,240 (41.1%) of all physician\u2013patient evaluations. SLB was requested in 8.1%, 29.6%, and 48.4% of definite, provisional high-confidence and provisional low-confidence diagnoses of IPF, respectively. In 63.0% of provisional high-confidence IPF diagnoses, antifibrotic therapy was prescribed without requesting SLB. No significant mortality difference was observed between cases given a definite diagnosis of IPF (90\u2013100% diagnostic likelihood) and cases given a provisional high-confidence IPF diagnosis (hazard ratio, 0.97;P\u2009=\u20090.65; 95% confidence interval, 0.90\u20131.04).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Most respiratory physicians prescribe antifibrotic therapy without requesting an SLB if a provisional high-confidence diagnosis or \u201cworking diagnosis\u201d of IPF can be made (likelihood\u2009\u2265\u200970%). SLB is recommended in only a minority of patients with suspected, but not definite, IPF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201903-0493oc","type":"journal-article","created":{"date-parts":[[2019,6,26]],"date-time":"2019-06-26T10:56:25Z","timestamp":1561546585000},"page":"1146-1153","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":68,"title":["Diagnostic Likelihood Thresholds That Define a Working Diagnosis of Idiopathic Pulmonary Fibrosis"],"prefix":"10.1093","volume":"200","author":[{"given":"Simon L. F.","family":"Walsh","sequence":"first","affiliation":[{"name":"National Heart and Lung Institute, Imperial College, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5258-0228","authenticated-orcid":false,"given":"David J.","family":"Lederer","sequence":"additional","affiliation":[{"name":"Department of Medicine and"},{"name":"Department of Epidemiology, Columbia University Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Ryerson","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Kolb","sequence":"additional","affiliation":[{"name":"Department of Medicine and"},{"name":"Department of Pathology and Molecular Medicine, Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toby M.","family":"Maher","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College, London, United Kingdom"},{"name":"National Institute of Health Research Respiratory Clinical Research Facility and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Nusser","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Summit Hospital, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venerino","family":"Poletti","sequence":"additional","affiliation":[{"name":"Department of Diseases of the Thorax, Ospedale G. B. Morgagni, Forl\u00ec, Italy"},{"name":"Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Richeldi","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Carattere Scientifico, Universit\u00e0 Cattolica del Sacro Cuore, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Vancheri","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Diseases, University-Hospital \u201cPoliclinico\u201d Vittorio Emanuele, University of Catania, Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret L.","family":"Wilsher","sequence":"additional","affiliation":[{"name":"Auckland District Health Board, University of Auckland, Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerina M.","family":"Antoniou","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juergen","family":"Behr","sequence":"additional","affiliation":[{"name":"Department of Medicine V, University of Munich and Asklepios Fachkliniken Gauting, Comprehensive Pneumology Center, member of the German Center for Lung Research [DZL], Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Bendstrup","sequence":"additional","affiliation":[{"name":"Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin K.","family":"Brown","sequence":"additional","affiliation":[{"name":"National Jewish Health, Denver, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamera J.","family":"Corte","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Cottin","sequence":"additional","affiliation":[{"name":"National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, UMR 754, Claude Bernard University Lyon 1, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Crestani","sequence":"additional","affiliation":[{"name":"APHP, Hopital Bichat, Service de Pneumologie A, Universit\u00e9 Paris Diderot, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin R.","family":"Flaherty","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian N.","family":"Glaspole","sequence":"additional","affiliation":[{"name":"Alfred Health\u2013Allergy, Immunology, and Respiratory Medicine, the Alfred Hospital, Melbourne, 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Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg, member of the DZL, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerri A.","family":"Johannson","sequence":"additional","affiliation":[{"name":"University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett","family":"Ley","sequence":"additional","affiliation":[{"name":"Kaiser Permanente San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando J.","family":"Martinez","sequence":"additional","affiliation":[{"name":"Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Molina-Molina","sequence":"additional","affiliation":[{"name":"University Hospital of Bellvitge, IDIBELL-CIBERES, Barcelona, 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