Chest
Original Research: Diffuse Lung DiseaseDiagnostic Ability of a Dynamic Multidisciplinary Discussion in Interstitial Lung Diseases: A Retrospective Observational Study of 938 Cases
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.