9
Figure 2. Diagnostic Algorithm for IPF
a
Patients with a radiological pattern of probable UIP can be diagnosed as IPF following MDD
without confirmation by lung biopsy in the appropriate clinical setting (e.g., 60 years old, male,
smoker). BAL may be appropriate in some patients with a probable UIP pattern.
b
BAL may be performed before MDD in some patients evaluated in experienced centers.
c
TBLC may be preferred to SLB in centers with appropriate expertise and/or in some patient
populations, as described in the text. A subsequent SLB may be justified in some patients with a
nondiagnostic TBLC.
Patient suspected of having IPF
Potential cause/associated condition
Indeterminate for UIP
or alternate diagnosis
Surgical
lung biopsy
(SLB)
c
BAL
b
± TBLC
c
IPF Alternative diagnosis
UIP or
probable UIP
a
Confirmation of
specific diagnosis
(including with HRCT)
Chest HRCT pattern
Multidisciplinary discussion (MDD)
MDD
NO
NO
YES
YES
