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Abstract：
Background Decisions on the management of interstitial lung diseases (ILD) and prognostication require an accurate diagnosis. It has been proposed that multidisciplinary team (MDT) meetings for ILD (ILD-MDT) improve these decisions in challenging cases of ILD. However, most studies in this field have been based on the decisions of individual clinicians and there are few reports on the outcomes of the ILD-MDT approach. We therefore describe the experience of the ILD-MDT meetings at our institution. Methods A single-center retrospective review of the electronic health care records of patients discussed in the ILD-MDT meetings at our institution from February 2016 to January 2021 was performed. At out institution, at each ILD-MDT meeting, the referring pulmonologist presents the clinical history and the results of all relevant investigations including serology, blood gas analyses, lung function tests, bronchoscopy, and bronchoalveolar lavage. A radiologist then describes the imaging including serial computed tomography (CT) scans. When available, the findings on lung biopsy are presented by a pathologist. Subsequent discussions lead to a consensus on the diagnosis and further management. Results The study included 121 patients, comprising 71 (57%) males and 76 nonsmokers (62.8%), with a mean age of 65 years (range: 25-93 years). The average number of comorbidities was 2.4 (range: 0-7). Imaging-based diagnoses were usual interstitial pneumonia (UIP)/chronic hypersensitivity pneumonitis (CHP) in 32 (26%) patients, UIP in 20 (17%) patients, probable UIP in 27 (22%) patients, nonspecific interstitial pneumonia in 11 (9%) patients, and indeterminate interstitial lung abnormalities (ILA) in 10 (8%) patients. The most common consensus clinical diagnosis after an ILD-MDT discussion was chronic hypersensitivity pneumonitis/idiopathic pulmonary fibrosis in 17 patients (14%), followed by idiopathic pulmonary fibrosis and connective tissue disease associated interstitial lung disease in 16 patients (13%), CHP in 11 patients (9.1%), and ILA in 10 patients (8.4%). Only a 42 patients (35%) required surgical lung biopsy for confirmation of the diagnosis. Conclusion This study describes the characteristics of the patients discussed in the ILD-MDT meetings with emphasis on their clinical, radiological, and laboratory data to reach a diagnosis and management plan. The decisions on commencement of antifibrotics or immunosuppressive therapy for patients with various ILDs are also made during these ILD-MDT meetings. This descriptive study could help other health care professionals regarding the structure of their ILD-MDT meetings and with discussions about diagnostic and care decisions for diffused parenchymal lung disease patients.
摘要：
背景间质性肺病（ILD）的治疗和预后的决定需要准确的诊断。有人提议，ILD的多学科小组（MDT）会议（ILD-MDT）可以在具有挑战性的ILD案例中改善这些决策。然而,该领域的大多数研究都是基于个别临床医生的决定,关于ILD-MDT方法结果的报道很少.因此，我们描述了我们机构ILD-MDT会议的经验。方法对2016年2月至2021年1月在我院ILD-MDT会议上讨论的患者电子医疗记录进行单中心回顾性分析。在外面的机构，在每次ILD-MDT会议上，转诊的肺科医生提供临床病史和所有相关研究的结果，包括血清学，血气分析,肺功能检查,支气管镜检查,支气管肺泡灌洗.然后,放射科医师描述成像,包括串行计算机断层扫描(CT)扫描。如果可用,肺活检的发现由病理学家提供。随后的讨论导致对诊断和进一步管理的共识。结果研究共纳入121例患者,包括71名(57%)男性和76名不吸烟者(62.8%)，平均年龄65岁（范围：25-93岁）。合并症的平均数量为2.4（范围：0-7）。基于影像学的诊断为32例（26％）患者的普通间质性肺炎（UIP）/慢性过敏性肺炎（CHP），20例（17%）患者的UIP，27（22％）患者可能的UIP，11例（9%）患者的非特异性间质性肺炎，10例（8％）患者不确定间质性肺异常（ILA）。ILD-MDT讨论后最常见的共识临床诊断是17例患者（14％）的慢性过敏性肺炎/特发性肺纤维化，其次是特发性肺纤维化和结缔组织疾病相关的间质性肺病16例（13％），11名患者的CHP（9.1％），10例患者（8.4%）和ILA。只有42例患者（35％）需要手术肺活检以确认诊断。结论这项研究描述了在ILD-MDT会议上讨论的患者的特征，重点是他们的临床，放射学,和实验室数据以达成诊断和管理计划。在这些ILD-MDT会议期间，还决定对患有各种ILD的患者开始抗纤维化药物或免疫抑制治疗。这项描述性研究可以帮助其他医疗保健专业人员了解其ILD-MDT会议的结构，并讨论有关弥漫性实质性肺病患者的诊断和护理决策。
