A Review of the Multidisciplinary Diagnosis of Interstitial Lung Diseases: A Retrospective Analysis in a Single UK Specialist Centre

Abstract

The accurate diagnosis and management of individuals with interstitial lung diseases (ILDs) poses an interesting challenge in clinical practice. A multidisciplinary team (MDT) approach is considered the gold standard. This is a single-centre retrospective review spanning a five-year period. We assessed the accuracy of prior ILD diagnosis, the methodology used to establish a correct diagnosis and how an MDT approach affected subsequent management. Our data supports an MDT approach in an experienced specialist ILD centre. We have demonstrated that diagnosis is often changed after an MDT review and that this impacts the subsequent management. Our results demonstrate that an MDT approach to diagnosis 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 50% of cases after MDT discussion. 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.

Keywords: diagnosis; idiopathic pulmonary fibrosis; interstitial lung disease; multidisciplinary team.

Figure 1

The initial reasons for referral to the interstitial lung disease multidisciplinary meeting.

Figure 2

The multidisciplinary discussion and diagnosis of interstitial lung disease of unknown classification: (a) The modalities used to make the diagnosis in 2005–2008; (b) The reasons why biopsy was not performed when diagnosis was made by CT imaging; (c) The modalities used to make the diagnosis in 2011–2013; (d) The reasons why biopsy was not performed if diagnosis was made by CT imaging alone.

Figure 3

The modalities utilised to make a multidisciplinary diagnosis of idiopathic pulmonary fibrosis in 2005–2008 and 2011–2013.

Figure 4

The multidisciplinary diagnosis of idiopathic pulmonary fibrosis. (a) The accuracy of diagnosis of idiopathic pulmonary fibrosis in 2005–2008 and 2011–2013; (b) The diagnosis of fibrotic NSIP in 2005–2008 and why biopsy was not performed; (c) The diagnosis of fibrotic NSIP in 2011–2013 and why biopsy was not performed.