Chest
Volume 153, Issue 6, June 2018, Pages 1416-1423
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Original Research: Diffuse Lung Disease
Diagnostic Ability of a Dynamic Multidisciplinary Discussion in Interstitial Lung Diseases: A Retrospective Observational Study of 938 Cases

https://doi.org/10.1016/j.chest.2018.03.026Get rights and content

Background

The advice of a dynamic multidisciplinary discussion (MDD) is believed to be important in the diagnosis of interstitial lung diseases (ILDs). However, to what extent MDD diagnoses differ from the preliminary diagnoses before formal workup and MDD (preMDD diagnoses) is still insufficiently studied.

Methods

We compared preMDD and MDD diagnoses in patients discussed at the Leuven University Hospitals MDDs between January 2005 and December 2015.

Results

Of 938 consecutive patients discussed in an MDD, 755 (80.5%) received a specific diagnosis. From the 183 patients with unclassifiable ILD, 150 patients (16.0%) received suggestions concerning further investigations to establish a definite diagnosis. In 191 patients (41.9% of patients with a preMDD diagnosis), the MDD changed the diagnosis. In 384 patients (79.5% of patients without preMDD diagnosis), MDD provided a diagnosis when the referring physician did not. MDD diagnosis showed a trend toward better prognostic discrimination between idiopathic pulmonary fibrosis and other ILDs compared with preMDD diagnosis (Harrell C-index, 0.666 vs 0.631; P = .08), which was particularly clear in patients with discordant MDD and preMDD diagnoses (hazard ratio, 2.68 vs 0.84; P = .012 vs .768).

Conclusions

The MDD provided a definite diagnosis in 80.5% of presented cases, suggesting further investigations in almost all others. Given the high number of patients without preMDD diagnosis, the rate of change in preMDD diagnoses (41.9% of patients with a preMDD diagnosis) probably is an underestimation. The better prognostic discrimination among ILDs by using MDD indicates the added value of MDD in ILD.

Section snippets

Patient Selection

Data were collected from all patients referred to our tertiary academic center for multidisciplinary expert discussion between January 2005 and December 2015. Criteria for inclusion in this study were availability of the MDD report and of referring documents, HRCT images, and histopathologic data (if biopsy had been performed). If a case was discussed more than once, the final diagnosis after the last MDD was considered.

Multidisciplinary Discussion

Referring physicians were requested to provide all relevant data available

MDD Diagnostic Ability

Between January 2005 and December 2015, 938 patients were discussed in an MDD. The patients’ mean age was 60.8 years (range, 14-90 years), and 65.2% of the patients were men. Evolution of the patient numbers that were discussed yearly is shown in e-Figure 1.

The number of diagnoses within each diagnostic category is presented in Table 1: 690 patients (73.6%) received a diagnosis within the ILD spectrum, with IPF as the most prevalent entity (326 diagnoses [34.8%]); 65 patients (6.9%) were had

Discussion

This study shows that MDD was able to provide a confident diagnosis in 80.5% of patients, providing suggestions concerning further workup in almost all others. Discrepancy between preMDD diagnosis and MDD diagnosis was remarkable. In 41.9% of patients with a preMDD diagnosis, the MDD diagnosis differed from the preMDD diagnosis: in 25.9% another ILD entity was diagnosed, and in 16.0% the disease entity was classified as (temporarily) unclassifiable ILD because further investigations were deemed

Conclusions

The MDD diagnosed a specific ILD entity in 80.5% of patients and provided advice concerning additional investigations in almost all patients with unclassifiable disease. The MDD changed the preMDD diagnosis in 41.9% of patients with a preMDD diagnosis, probably being an underestimation given the high number of patients without a preMDD diagnosis (51.5% of total cohort). Finally, MDD probably resulted in a better prognostic separation of IPF vs other ILDs compared with preMDD diagnosis. Hence,

Acknowledgments

Author contributions: L. J. D. S. takes full responsibility for the content of the manuscript, including the data and analysis. L. J. D. S. has made substantial contributions concerning the literature search, study design, data collection, data analysis, data interpretation, writing, tables, and figures. C. M. made substantial contributions concerning data collection and data analysis. J. B., H. S., J. A. V., E. K. V., B. W., E. D. L., J. L. L., B. N., D. V. R., G. M. V., and A. U. W. made

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    FUNDING/SUPPORT: This study was funded by the Research Foundation—Flanders and the University Hospitals Leuven [Grant 1.8.325.12N] to Dr Wuyts.

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