Biglia Caroline, Ghaye Benoît, Reychler Gregory, Koenig Sandra, Yildiz Halil, Lacroix Valérie, Tamirou Farah, Hoton Delphine, Pieters Thierry, Froidure Antoine
Pneumology department, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.
Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Belgium.
Sarcoidosis Vasc Diffuse Lung Dis. 2019;36(2):108-115. doi: 10.36141/svdld.v36i2.8107. Epub 2019 May 1.
The guidelines on idiopathic pulmonary fibrosis (IPF) diagnosis established the crucial role of multidisciplinary discussion (MDD) in the diagnosis of interstitial lung diseases (ILD). However, real-life evaluation of MDD remains scarce. Our aim was to study the impact of a well-structured MDD on etiological assessment, diagnosis, and management of ILD.
We collected and analysed all relevant data on patients concerning diagnosis and treatment before and after MDD during the year 2017.
One hundred fifty patients were included in the analysis. MDD had a significant impact on management: 42% of diagnoses were revised and the number of unclassifiable ILD was significantly reduced. Lung biopsy was performed in 26 patients (12 cryobiopsies and 14 surgical biopsies). The most prevalent diagnoses were connective-tissue disease associated ILD (32%), idiopathic pulmonary fibrosis (23%), hypersensitivity pneumonitis (13%) and granulomatous ILD (7%). MDD led to a change or initiation of treatment in 55% of cases. Nine patients were evaluated for transplantation, 23 patients were screened for academic or sponsored clinical trials and an 8-fold increase in rehabilitation inclusion was observed.
Our results confirm the benefits of MDD on ILD management and diagnosis. MDD also facilitates access to non-pharmacological therapies and clinical trials.
特发性肺纤维化(IPF)诊断指南确立了多学科讨论(MDD)在间质性肺疾病(ILD)诊断中的关键作用。然而,对MDD的实际评估仍然很少。我们的目的是研究结构化良好的MDD对ILD病因评估、诊断和管理的影响。
我们收集并分析了2017年MDD前后患者的所有相关诊断和治疗数据。
150例患者纳入分析。MDD对管理有显著影响:42%的诊断被修订,无法分类的ILD数量显著减少。26例患者进行了肺活检(12例冷冻活检和14例手术活检)。最常见的诊断是结缔组织病相关ILD(32%)、特发性肺纤维化(23%)、过敏性肺炎(13%)和肉芽肿性ILD(7%)。MDD导致55%的病例治疗发生改变或开始治疗。9例患者接受了移植评估,23例患者接受了学术或赞助临床试验筛查,康复纳入率提高了8倍。
我们的结果证实了MDD对ILD管理和诊断的益处。MDD还便于获得非药物治疗和临床试验。