Department of Respiratory Medicine, Waikato District Health Board, Hamilton, New Zealand.
Department of Pathology, Waikato District Health Board, Hamilton, New Zealand.
Chron Respir Dis. 2023 Jan-Dec;20:14799731231196581. doi: 10.1177/14799731231196581.
Cellular analysis of bronchoalveolar lavage (BAL) fluid may aid diagnosis in patients with undifferentiated interstitial lung disease (ILD). The utility of this test in the diagnostic process in conjunction with a multidisciplinary discussion (MDD) is not known. We aim to assess and compare interobserver agreement and diagnostic confidence before and after presenting BAL results in an ILD-MDD.
Patients undergoing investigations for ILD at Waikato Hospital were recruited. At the ILD-MDD two respiratory physicians and one respiratory radiologist participated in the discussion, and their diagnosis and diagnostic confidence were assessed at four sequential time points. Assessors were blinded to each others diagnosis and diagnostic confidence scores. The four sequential time points were (1) after clinical and radiology presentation; (2) after subsequent MDD; (3) after reviewing BAL results; (4) after final MDD with all results. Interobserver agreements were calculated using Fleiss κ statistic.
36 patients were recruited, and 77.8% were male. In the first step, the interobserver agreement was substantial κ = 0.622 (95% CI 0.47-0.77), improving in step 2 following MDD to κ = 0.78 (95% CI 0.624-0.935), in step 3 κ = 0.776 (95% CI 0.614-0.937) and step 4 achieved almost perfect agreement of κ = 0.969 (95% CI 0.828-1.11). The diagnostic confidence for individual and group diagnosis increased with the presentation of BAL with and without multidisciplinary MDD.
We found that BAL cellular analysis improves interobserver agreement and confidence in diagnosis following MDD, thus aiding decision-making in cases with undifferentiated ILD.
支气管肺泡灌洗液（BAL）的细胞分析可能有助于诊断未分化间质性肺疾病（ILD）患者。该测试在与多学科讨论（MDD）结合进行诊断过程中的效用尚不清楚。我们旨在评估和比较在ILD-MDD 中呈现 BAL 结果前后观察者间的一致性和诊断信心。
招募在怀卡托医院接受ILD 检查的患者。在ILD-MDD 中，两名呼吸科医生和一名呼吸放射科医生参与了讨论，并在四个连续时间点评估了他们的诊断和诊断信心。评估者对彼此的诊断和诊断信心评分均不知情。四个连续的时间点是：（1）临床和放射学表现后；（2）随后的 MDD 后；（3）审查 BAL 结果后；（4）所有结果的最终 MDD 后。使用 Fleiss κ 统计量计算观察者间的一致性。
共招募了 36 名患者，其中 77.8%为男性。在第一步中，观察者间的一致性为中等κ=0.622（95%置信区间 0.47-0.77），在 MDD 后的第二步中提高到κ=0.78（95%置信区间 0.624-0.935），在第三步中κ=0.776（95%置信区间 0.614-0.937），第四步达到几乎完美的一致性κ=0.969（95%置信区间 0.828-1.11）。随着 BAL 细胞分析的呈现，无论是在 MDD 前后，个体和群体诊断的诊断信心都有所提高。
我们发现 BAL 细胞分析可提高 MDD 后观察者间的一致性和诊断信心，从而有助于诊断未分化的ILD 病例。
