Reevaluating diagnosis in interstitial lung disease with a second multidisciplinary discussion

Area of Science:

• Pulmonology
• Radiology
• Pathology

Background:

• International guidelines emphasize multidisciplinary discussion (MDD) for interstitial lung disease (ILD) diagnosis.
• Initial ILD diagnoses are often provisional and require re-evaluation.
• Limited literature exists on the role of follow-up MDD in clinical practice.

Purpose of the Study:

• To assess the impact of a second multidisciplinary discussion (MDD2) on the diagnostic accuracy of interstitial lung disease (ILD).
• To evaluate changes in diagnosis and confidence levels after a one-year follow-up period.

Main Methods:

• Patients underwent an initial MDD (MDD1) with assigned confidence levels.
• A second MDD (MDD2) was performed one year later, incorporating updated clinical and radiological information.
• Changes in diagnosis and confidence levels between MDD1 and MDD2 were analyzed.

Main Results:

• Twenty-five percent (13/52) of patients had their ILD diagnosis revised at MDD2.
• Revisions were common in initially unclassifiable ILD or low-confidence diagnoses.
• Diagnostic changes were often linked to antigen exposure or avoidance, leading to a revised diagnosis of hypersensitivity pneumonitis (HP).

Conclusions:

• Periodic reassessment through MDD is vital for improving ILD diagnostic accuracy.
• Longitudinal clinical and radiological evaluation is significant for diagnostic revision, even without rebiopsy.
• Follow-up MDD enhances diagnostic precision in interstitial lung diseases.