Reevaluating diagnosis in interstitial lung disease with a second multidisciplinary discussion

IF 2.4 Q2 RESPIRATORY SYSTEM
Yuki Iijima , Haruhiko Furusawa , Takashi Yamana , Sho Shibata , Tsuyoshi Shirai , Tsukasa Okamoto , Tomoya Tateishi , Takuya Adachi , Susumu Kirimura , Yasunari Miyazaki
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引用次数: 0

Abstract

Background

The importance of multidisciplinary discussion (MDD) for diagnosing interstitial lung disease (ILD) is emphasized by several international guidelines. While initial diagnoses are often provisional and require periodic re-evaluation, there is a lack of literature regarding the role of follow-up MDD in clinical practice.

Methods

From September 2020 to January 2022, patients underwent an initial MDD (MDD1) based on clinical, radiological, and pathological evaluations. Each diagnosis was assigned a confidence level. One year later, a second MDD (MDD2) was conducted for re-evaluation, based on subsequent clinical and radiological information. Changes in diagnosis and confidence levels between MDD1 and MDD2 were assessed.

Results

Among 52 patients enrolled in both MDDs, the diagnosis for 13 (25%) was revised at MDD2. Of these, 10 patients were initially diagnosed with unclassifiable ILD, and 3 received a low confidence diagnosis of either idiopathic pulmonary fibrosis or idiopathic nonspecific interstitial pneumonia. The most common diagnostic revision was due to the deterioration after antigen exposure or improvement after antigen avoidance, which resulted in a revised diagnosis of HP at MDD2.

Conclusions

Our findings underscore the importance of periodic reassessment of MDD to improve the accuracy of ILD diagnosis. This study highlights the significance of longitudinal clinical and radiological evaluation for diagnostic revision, even in situations when rebiopsy is not feasible.

通过第二次多学科讨论重新评估间质性肺病的诊断
背景一些国际指南强调了多学科讨论(MDD)对诊断间质性肺病(ILD)的重要性。虽然初步诊断通常是临时性的,需要定期重新评估,但目前还缺乏有关后续 MDD 在临床实践中作用的文献。方法从 2020 年 9 月到 2022 年 1 月,患者根据临床、放射学和病理学评估结果接受了初步 MDD(MDD1)。每项诊断都有一个置信度。一年后,根据后续的临床和放射学信息进行第二次 MDD(MDD2),以进行重新评估。结果在参加两次 MDD 的 52 名患者中,有 13 名患者(25%)的诊断在 MDD2 时被修改。其中,10 名患者最初被诊断为无法分类的 ILD,3 名患者被低置信度诊断为特发性肺纤维化或特发性非特异性间质性肺炎。最常见的诊断修正是由于抗原暴露后病情恶化或避开抗原后病情好转,结果在 MDD2 时被修正为 HP 诊断。结论我们的研究结果强调了定期重新评估 MDD 以提高 ILD 诊断准确性的重要性。本研究强调了纵向临床和放射学评估对诊断修正的重要性,即使在无法进行重新活检的情况下也是如此。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Respiratory investigation
Respiratory investigation RESPIRATORY SYSTEM-
CiteScore
4.90
自引率
6.50%
发文量
114
审稿时长
64 days
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