Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, India.
Department of Pharmacology, Narayana Hrudayalaya Foundations, Bengaluru, India.
Clin Respir J. 2021 Jul;15(7):761-769. doi: 10.1111/crj.13358. Epub 2021 Mar 23.
The inflammation and fibrosis in diffuse parenchymal lung diseases (DPLDs) in varied proportions give rise to different patterns in radiology and histopathology. The radiological pattern on CT of the thorax most often allows us to make a diagnosis with varying levels of confidence, to optimize management. With a multidisciplinary team bringing the strengths of their individual domains of knowledge, clinical, radiological, histopathological, and in many cases rheumatological, the level of confidence in making this diagnosis increases, often to the stage where the diagnosis is most often right, is concordant with the diagnosis achieved at histopathology and therefore obviates the need for lung biopsy which carries its own costs and risks of complications. Our study emphasizes the role of the multidisciplinary team (MDT) in the management of DPLDs at a tertiary care referral center.
Every case of DPLD presenting to our pulmonology department was discussed in an MDT meeting before subjecting them to any diagnostic intervention or therapy. A clinico-radiological diagnosis was made according to the 2002 ATS/ERS guidelines initially. Later an official ATS/ERS/JRS/ALAT statement on idiopathic pulmonary fibrosis and a 2013 ATS/ERS consensus for the classification and diagnosis of idiopathic interstitial pneumonia was used. The concordance in our study was defined as the percentage of histopathological diagnoses that were identical to the clinico-radiological MDT diagnosis prior to the biopsy.
A total of 434 patients with DPLDs were evaluated. The MDT suggested biopsy for only 38.7% (168/434) patients since the pattern was very clear in 266 (61.3%) cases. As not all patients consented to undergo the biopsy procedure when recommended, histopathology was obtained in 102 patients. The histological diagnosis was concordant with the initial MDT diagnosis in 80.3% (82/102) of samples. On an individual basis, connective tissue disease-interstitial lung disease and sarcoidosis showed the best concordance (87%). In idiopathic non-specific interstitial pneumonitis (NSIP) cases, the histopathological diagnosis concurred in only 53.3% (8/15), out of which 8 were NSIP, 4 were usual interstitial pneumonia, and 3 were reported as inadequate sampling on histopathology.
The MDT plays a crucial role in the diagnosis of DPLDs. Not every pattern requires biopsy confirmation. However, an idiopathic non-specific interstitial pneumonitis diagnosis by the MDT should probably be better confirmed by biopsy.
弥漫性实质性肺疾病（DPLD）的炎症和纤维化以不同比例导致放射学和组织病理学上的不同模式。胸部 CT 的放射学模式通常使我们能够做出具有不同置信度的诊断，从而优化管理。通过多学科团队发挥各自领域知识的优势，包括临床、放射学、组织病理学，在许多情况下还包括风湿病学，使诊断的置信度提高，通常达到诊断准确率很高的程度，与组织病理学诊断相符，因此避免了肺活检的需要，肺活检本身就存在成本和并发症风险。我们的研究强调了多学科团队（MDT）在三级转诊中心管理 DPLD 中的作用。
我们呼吸科的每一例 DPLD 患者在接受任何诊断干预或治疗之前都在 MDT 会议上进行了讨论。最初根据 2002 年 ATS/ERS 指南做出临床放射学诊断。后来，使用了关于特发性肺纤维化的正式 ATS/ERS/JRS/ALAT 声明和 2013 年 ATS/ERS 特发性间质性肺炎分类和诊断共识。我们研究中的一致性定义为活检前组织病理学诊断与临床放射学 MDT 诊断完全一致的百分比。
共评估了 434 例 DPLD 患者。MDT 仅建议对 38.7%（168/434）的患者进行活检，因为 266 例（61.3%）患者的模式非常清晰。由于并非所有患者都同意在建议时进行活检，因此仅对 102 例患者进行了组织学检查。组织学诊断与初始 MDT 诊断在 80.3%（82/102）的样本中一致。在单独的基础上，结缔组织病-间质性肺疾病和结节病的一致性最好（87%）。在特发性非特异性间质性肺炎（NSIP）病例中，组织病理学诊断仅在 53.3%（8/15）的病例中与 MDT 诊断相符，其中 8 例为 NSIP，4 例为寻常间质性肺炎，3 例为组织病理学报告为样本不足。
MDT 在 DPLD 的诊断中起着至关重要的作用。并非每种模式都需要活检证实。然而，MDT 诊断的特发性非特异性间质性肺炎可能最好通过活检来证实。
