背景:一些国际指南强调了多学科讨论(MDD)对诊断间质性肺病(ILD)的重要性。虽然初步诊断通常是临时的,需要定期重新评估,缺乏关于随访MDD在临床实践中的作用的文献.
方法:从2020年9月至2022年1月,患者根据临床,放射学,和病理评估。每个诊断被分配一个置信水平。一年后,进行了第二次MDD(MDD2)重新评估,基于随后的临床和放射学信息。评估了MDD1和MDD2之间的诊断和置信水平的变化。
结果:在这两种MDD的52名患者中,13例(25%)的诊断在MDD2时进行了修正.其中,10例患者最初被诊断为不可分类的ILD,3例接受了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.最常见的诊断修订是由于抗原暴露后的恶化或抗原回避后的改善,这导致了MDD2时HP的修订诊断。
结论:我们的发现强调了定期重新评估MDD对提高ILD诊断准确性的重要性。这项研究强调了纵向临床和放射学评估对诊断修订的意义。即使在重新活检不可行的情况下。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.