Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Respir Investig. 2024 Nov;62(6):1027-1033. doi: 10.1016/j.resinv.2024.08.015. Epub 2024 Sep 4.
The importance of multidisciplinary discussion (MDD) for diagnosing interstitial lung disease (ILD) is emphasized by several international guidelines. While initial diagnoses are often provisional and require periodic re-evaluation, there is a lack of literature regarding the role of follow-up MDD in clinical practice.
From September 2020 to January 2022, patients underwent an initial MDD (MDD1) based on clinical, radiological, and pathological evaluations. Each diagnosis was assigned a confidence level. One year later, a second MDD (MDD2) was conducted for re-evaluation, based on subsequent clinical and radiological information. Changes in diagnosis and confidence levels between MDD1 and MDD2 were assessed.
Among 52 patients enrolled in both MDDs, the diagnosis for 13 (25%) was revised at MDD2. Of these, 10 patients were initially diagnosed with unclassifiable ILD, and 3 received a low confidence diagnosis of either idiopathic pulmonary fibrosis or idiopathic nonspecific interstitial pneumonia. The most common diagnostic revision was due to the deterioration after antigen exposure or improvement after antigen avoidance, which resulted in a revised diagnosis of HP at MDD2.
Our findings underscore the importance of periodic reassessment of MDD to improve the accuracy of ILD diagnosis. This study highlights the significance of longitudinal clinical and radiological evaluation for diagnostic revision, even in situations when rebiopsy is not feasible.
国际多项指南均强调了多学科讨论（MDD）对于诊断间质性肺疾病（ILD）的重要性。虽然初始诊断通常是暂定的，需要定期重新评估，但在临床实践中，关于随访 MDD 的作用的文献却很少。
本研究于 2020 年 9 月至 2022 年 1 月期间纳入了 52 名患者，他们均基于临床、影像学和病理学评估进行了首次 MDD（MDD1）。每个诊断都被分配了一个置信级别。一年后，根据后续的临床和影像学信息，进行了第二次 MDD（MDD2）进行重新评估。评估 MDD1 和 MDD2 之间诊断和置信水平的变化。
在接受了两次 MDD 的 52 名患者中，有 13 名（25%）的诊断在 MDD2 时被修正。其中，10 名患者最初被诊断为未分类的 ILD，3 名患者被诊断为特发性肺纤维化或特发性非特异性间质性肺炎的低置信度诊断。最常见的诊断修正归因于抗原暴露后的恶化或抗原回避后的改善，导致在 MDD2 时修正为 HP 的诊断。
我们的研究结果强调了定期重新评估 MDD 以提高 ILD 诊断准确性的重要性。本研究突出了即使在无法进行再次活检的情况下，进行纵向临床和影像学评估对诊断修正的重要性。
