How was the management of patients scheduled for surgical biopsy through a multidisciplinary approach to the diagnosis of interstitial lung diseases? Was a pathological diagnosis alone enough?

Abstract

OBJECTIVE: The present study examines the clinical and radiological findings and pathological diagnoses of patients undergoing surgical biopsy with an multidisciplinary team (MDT) decision and investigates whether final diagnoses change on the reevaluated of pathological diagnoses at MDT meetings. MATERIALS AND METHODS: A total of 416 patients were discussed at MDT meetings held at the University of Health Sciences Istanbul Sureyyapasa Chest Diseases and Thoracic, Surgery Training and Research Hospital January between January 2016 and May 2019, with surgical biopsy decisions made for 50 (12%) patients. RESULTS: Among the 50 patients, 26 (52%) were female, with a mean age of 53 ± 12 years. The most common locations of the surgical biopsy were the right lung (n = 27, 54%), lower lobe (n = 38, 76%) and single lobe (n = 35, 70%). A definitive pathological diagnosis was established in 41 (82%) patients following the biopsy. The most common diagnoses were usual interstitial pneumonia (UIP; n = 19, 38%), sarcoidosis (n = 11, 22%), unclassifiable fibrosis (n = 9, 18%), (non-specific interstitial pneumonia; n = 5, 10%), (hypersensitivity pneumonitis; n = 2, 4%) and others (n = 4, 8%), respectively. Diagnoses of 13 (26%) such patients were revised. The revision was most common in the unclassifiable fibrosis and UIP subgroups. The radiological appearance was classified based on the high-resolution computed tomography parameters for idiopathic pulmonary fibrosis (IPF). The final diagnosis was IPF in eight of 14 patients with “probable” diagnoses, all four patients with “indeterminate” diagnoses and three of the 28 patients with “alternative” diagnoses. CONCLUSION: Diagnosing interstitial lung diseases is difficult, and while surgical biopsy provides the most definitive diagnosis, it is not enough by itself. IPF may vary in radiology. Patients diagnosed with UIP and unclassifiable fibrosis after biopsy should be reevaluated, and the final diagnosis should be established through a multidisciplinary approach.