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The aim of this procedure is to recognize observations classical of the UIP pattern, and
to differentiate them from the less particular patterns present in other idiopathic interstitial
pneumonias. The radiological reading should employ descriptive terminology based on the
radiological–pathological correlation to prevent descriptive and conceptual issues, as
suggested by the Fleischner Society (Hansell et al., 2008).
It was determined by the official 2011 ATS/ERS/JRS/ALAT consensus (Raghu et al.,
2011) that in HRCT, the conclusive diagnosis of UIP is based on the recognition of four
“classical” observations: (1) lung collaboration should have subpleural and basal
predominance, (2) existence of evident reticulation, (3) presence of honeycombing
with/without traction bronchiectasis/bronchiolectasis and (4) describe the deprivation of
observations contemplated to exclude a UIP pattern.
The occurrence of ground glass opacities should be nonexistent or least.
Honeycombing, created by groups of thin-walled cysts, subpleural with a diameter between 3
and 10 mm, is a crucial observation for precisely diagnosing the UIP pattern. The diagnosis
of a possible UIP pattern by HRCT in the absence of noticeable honeycombing; in such cases,
the conclusive diagnosis of UIP should be done by biopsy. Lung biopsy can be ignored only
when the HRCT exhibits a definitive pattern, classical of UIP. The positive prognostic value
of HRCT in the diagnosis of UIP is 90%–100%. A UIP pattern can also be recognized in
asbestosis, chronic hypersensitivity pneumonitis and few connective tissue diseases (Churg et
al., 2006). HRCT also authorizes the existence of related comorbidities (pulmonary
hypertension, emphysema, lung cancer), which may describe the clinical expansion of the
disease, to be evaluated. Apart from idiopathic interstitial pneumonias, other diffuse lung
diseases can also be determined by HRCT. It is suggested by the 2011 official
ATS/ERS/JRS/ALAT consensus that the diagnosis of idiopathic interstitial pneumonias can
be based on the consensus between the clinician, radiologist and pathologist (Raghu et al.,
2011).
2.2.8.4 Histopathological Pattern
The surgical lung biopsy is done as the conclusive diagnosis in the case if the HRCT
does not manifest a conclusive design of typical UIP. The sample for biopsy are acquired
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