Nationwide cloud-based integrated database of idiopathic interstitial pneumonias for multidisciplinary discussion

Abstract

Multidisciplinary discussion (MDD) requiring close communication between specialists (clinicians, radiologists and pathologists) is the gold standard for the diagnosis of idiopathic interstitial pneumonias (IIPs). However, MDD by specialists is not always feasible because they are often separated by time and location. An online database would facilitate data sharing and MDD. Our aims were to develop a nationwide cloud-based integrated database containing clinical, radiological and pathological data of patients with IIPs along with a web-based MDD system, and to validate the diagnostic utility of web-based MDD in IIPs.Clinical data, high-resolution computed tomography images and lung biopsy slides from patients with IIPs were digitised and uploaded to separate servers to develop a cloud-based integrated database. Web-based MDD was performed using the database and video-conferencing to reach a diagnosis.Clinical, radiological and pathological data of 524 patients in 39 institutions were collected, uploaded and incorporated into the cloud-based integrated database. Subsequently, web-based MDDs with a pulmonologist, radiologist and pathologist using the database and video-conferencing were successfully performed for the 465 cases with adequate data. Overall, the web-based MDD changed the institutional diagnosis in 219 cases (47%). Notably, the MDD diagnosis yielded better prognostic separation among the IIPs than did the institutional diagnosis.This is the first study of developing a nationwide cloud-based integrated database containing clinical, radiological and pathological data for web-based MDD in patients with IIPs. The database and the web-based MDD system that we built made MDD more feasible in practice, potentially increasing accurate diagnosis of IIPs.

FIGURE 1

Schema of the development of the cloud-based integrated database including clinical radiological and pathological data, and web-based multidisciplinary discussion (MDD) using the cloud-based integrated database. HRCT: high-resolution computed tomography. The data centre included three servers, one each for clinical, radiological (HRCT DICOM files) and pathological (whole-slide files) data. Each type of data was uploaded to each web server separately and registered with the appropriate case identification numbers. For web-based MDD, the clinician, radiologist and pathologist referred to the data and evaluated the case based on the information in the database by themselves. They then discussed the case with each other via video-conferencing to reach an MDD diagnosis. The final diagnosis was recorded in the cloud-based database. ^#: interlinked by the case identification number.

FIGURE 2

Chest high-resolution computed tomography (HRCT) and lung biopsy specimen in the cloud-based integrated database. Representative images of a) chest HRCT, and images of a whole slide of a lung biopsy specimen at b) low magnification and c) high magnification.

FIGURE 3

Study flowchart. IIP: idiopathic interstitial pneumonia; HRCT: high-resolution computed tomography; ILD: interstitial lung disease. Among 524 cases uploaded into the cloud-based integrated database, 26 patients had an institutional diagnosis of an ILD other than IIPs (e.g. chronic hypersensitivity pneumonitis or connective tissue disease-related ILD). Of the 498 patients with IIPs as in institutional diagnosis, 33 had insufficient HRCT data, pathology data and/or prognostic data, and were excluded, leaving 465 patients with an institutional diagnosis of IIPs for analysis.

FIGURE 4

Chord diagram comparing institutional diagnoses (left) and multidisciplinary discussion (MDD) diagnoses (right). IPF: idiopathic pulmonary fibrosis; iNSIP: idiopathic nonspecific interstitial pneumonia; COP: cryptogenic organising pneumonia; DIP: desquamative interstitial pneumonia; RB-ILD: respiratory bronchiolitis-interstitial lung disease; iPPFE: pleuroparenchymal fibroelastosis; LIP: lymphoid interstitial pneumonia.

FIGURE 5

Kaplan–Meier survival curves for patients with idiopathic interstitial pneumonias in the cohort subdivided by a) institutional diagnoses and b) multidisciplinary discussion (MDD) diagnoses. DIP: desquamative interstitial pneumonia; RB-ILD: respiratory bronchiolitis-interstitial lung disease; COP: cryptogenic organising pneumonia; iNSIP: idiopathic nonspecific interstitial pneumonia; IPF: idiopathic pulmonary fibrosis; iPPFE: idiopathic pleuroparenchymal fibroelastosis. Lymphoid interstitial pneumonia was excluded because no patient was diagnosed with this disease during the MDD.