A multidisciplinary team approach to diagnosis and management of interstitial lung diseases (ILD) is considered gold standard and an integral part of ILD management and guidelines.The accurate diagnosis and management of individuals with ILDs poses an interesting challenge in clinical practice. This is a single center retrospective review of electronic patient letters and multidisciplinary team (MDT) records spanning a five and half year time period. In this study we assessed the accuracy of prior ILD diagnosis, the methodology used to establish a correct diagnosis and how an MDT approach to diagnosis affected subsequent management.
Our results demonstrate that a multidisciplinary approach to diagnosis within a single specialist ILD center can establish a diagnosis in the majority of cases when prior diagnosis is uncertain (76%). We also show that a prior diagnosis of idiopathic pulmonary fibrosis is deemed inaccurate in over fifty percent of cases after MDT discussion. Other ILD diagnoses fair better with an inaccurate prior diagnosis in a third of cases. Over time we demonstrate an increased utilisation of combined lung biopsy and radiological imaging to establish a diagnosis. However when diagnosis was deemed uncertain on radiological imaging alone, biopsy was seldom possible due to factors such as poor lung function or presence of comorbidities deeming biopsy as too high risk.
Our data supports an MDT approach in an experienced specialised ILD center. We have demonstrated that diagnosis is often changed after an MDT review and that this impacts on subsequent management. We have shown that during diagnostic uncertainty the considered gold standard of proceeding to a lung biopsy is not always feasible due to disease severity and comorbidities. In these circumstances an MDT approach to diagnosis of ILDs combines clinical data with serial lung function and disease behavior, with or without responses to previous treatment trials to establish an accurate expert diagnosis.
Published on: Nov 9, 2015 Pages: 18-22