NAVIGATING PF
Tissue Sample Tests
IPF can often be diagnosed with a HRCT scan alone, but if fibrosis is caused by other types
of ILD (or when IPF is present but the HRCT alone doesn’t give enough information to make
a diagnosis of IPF), a tissue sample may be needed to ensure the correct diagnosis. In these
cases, a small amount of lung tissue is needed to accurately diagnose PF, which is collected
via a tissue biopsy. There are different methods for obtaining lung tissue biopsies, including:
• Bronchoscopy: During a bronchoscopy, a thin flexible tube is placed through the
nose or mouth to collect cells, fluid, or tissue samples from your lungs.
• Bronchoalveolar lavage: This procedure is done in conjunction with a
bronchoscopy. A small amount of saline (salt water) is placed into the lungs and
then retrieved to obtain cells and secretions from the air sacs in the lungs. This by
itself does not provide any pieces of lung tissue.
• Endoscopic Lung Biopsy: This procedure is performed by passing small probes
through a channel in the bronchoscopy that can obtain small pieces of tissue.
Transbronchial Biopsy is one type of procedure that uses a small forceps to obtain
tissue, and a newer procedure called Cryoscopic Lung Biopsy is being used by
many centers and involves freezing lung tissue with a small probe and then pulling
the tissue out through the bronchoscopy.
• Video-assisted thoracoscopic surgery (VATS): In this minimally invasive
procedure, a small tube with a tiny camera on the end is inserted through the
ribs and chest into the lungs to obtain slightly larger tissue samples to look for
scarring. This is done in the operating room and sometimes requires an overnight
stay in the hospital.
• Thoracotomy: During this procedure, a surgeon makes an incision in the chest
wall to directly access and remove a sample from the lung. This is done in the
operating room and requires an overnight stay in the hospital. This procedure
has the highest complication rate of all the methods that can be used to obtain a
biopsy of the lung.
Your doctor will decide if a biopsy is necessary and which procedure offers the best way to
obtain the tissue samples needed to diagnose your condition.
Other Tests
14
• Tuberculosis (TB) test: TB has many of the same symptoms as PF. Your doctor
may want to do a skin or blood test to rule TB out.
• Esophagram: Sometimes disorders of the esophagus, particularly gastroesophageal
reflex disease (GERD), occur at the same time as PF. A number of tests can be used
to see if the esophagus is functioning properly, and it can be important for your
doctor to determine if you have such an underlying medical condition.
• Blood tests: Blood testing to assess liver and kidney function can help your
doctor understand if there are any other certain underlying medical conditions
present. Other blood tests that screen for autoimmune conditions (such as joint
disorders like rheumatoid arthritis or scleroderma) are often performed when
physicians are trying to make a specific PF diagnosis.