Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study

Walsh, Simon L.F.; Wells, Athol U.; Desai, Sujal R.; Poletti, Venerino; Piciucchi, Sara; Dubini, Alessandra; Nunès, Hilario; Valeyre, Dominique; Brillet, Pierre Yves; Kambouchner, Marianne; Morais, António; Pereira, José Miguel; Moura, Conceição Souto; Grutters, Jan C.; Heuvel, Daniel A. van den; Es, Hendrik W. van; Oosterhout, Matthijs F. van; Seldenrijk, Cornelis A.; Bendstrup, Elisabeth; Rasmussen, Finn; Madsen, Line Bille; Gooptu, Bibek; Pomplun, Sabine; Taniguchi, Hiroyuki; Fukuoka, Junya; Johkoh, Takeshi; Nicholson, Andrew G.; Sayer, Charlie; Edmunds, Lilian; Jacob, Joseph; Kokosi, Maria; Myers, Jeffrey L.; Flaherty, Kevin R.; Hansell, David M.

doi:10.1016/s2213-2600(16)30033-9

Cited by 372 publications

(302 citation statements)

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“…In these patients, the diagnosis of connective tissue disease-related ILD is usually straightforward and might spuriously increase overall diagnostic agreement [15].…”

Section: Case Collectionmentioning

confidence: 99%

“…The scoring protocol has been described previously [15]. For each case, physicians were required to select up to five differential diagnoses and provide a diagnostic likelihood (censored at 5% and summing to 100% in each case) from a drop-down menu of diffuse lung diseases (supplementary table A3) based upon their diagnostic confidence.…”

Section: Scoring Protocolmentioning

confidence: 99%

“…Therefore, the diagnostic accuracy of clinicians acting in isolation is of practical importance. In the absence of a reference standard, one approach to evaluating the diagnostic skills of clinicians is to examine separations in mortality between patients diagnosed with IPF and those diagnosed with other ILDs, a method used in a recent study of multidisciplinary diagnosis [15]. The most accurate discrimination between IPF and non-IPF diagnoses should, in principle, provide the greatest separation in outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: an international case–cohort study

et al. 2017

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We conducted an international study of idiopathic pulmonary fibrosis (IPF) diagnosis among a large group of physicians and compared their diagnostic performance to a panel of IPF experts.A total of 1141 respiratory physicians and 34 IPF experts participated. Participants evaluated 60 cases of interstitial lung disease (ILD) without interdisciplinary consultation. Diagnostic agreement was measured using the weighted kappa coefficient (κw). Prognostic discrimination between IPF and other ILDs was used to validate diagnostic accuracy for first-choice diagnoses of IPF and were compared using the C-index.A total of 404 physicians completed the study. Agreement for IPF diagnosis was higher among expert physicians (κw=0.65, IQR 0.53–0.72, p<0.0001) than academic physicians (κw=0.56, IQR 0.45–0.65, p<0.0001) or physicians with access to multidisciplinary team (MDT) meetings (κw=0.54, IQR 0.45–0.64, p<0.0001). The prognostic accuracy of academic physicians with >20 years of experience (C-index=0.72, IQR 0.0–0.73, p=0.229) and non-university hospital physicians with more than 20 years of experience, attending weekly MDT meetings (C-index=0.72, IQR 0.70–0.72, p=0.052), did not differ significantly (p=0.229 and p=0.052 respectively) from the expert panel (C-index=0.74 IQR 0.72–0.75).Experienced respiratory physicians at university-based institutions diagnose IPF with similar prognostic accuracy to IPF experts. Regular MDT meeting attendance improves the prognostic accuracy of experienced non-university practitioners to levels achieved by IPF experts.

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“…In these patients, the diagnosis of connective tissue disease-related ILD is usually straightforward and might spuriously increase overall diagnostic agreement [15].…”

Section: Case Collectionmentioning

confidence: 99%

Section: Scoring Protocolmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: an international case–cohort study

et al. 2017

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“…However, in many cases, making a confident diagnosis of HP is hampered by marginal test results, nonspecific HRCT features and perhaps most importantly, the lack of internationally agreed diagnostic guidelines for the disease. These difficulties were brought into sharp relief by a recent study of multidisciplinary practice that reported miserable diagnostic agreement (weighted κ-coefficient (κw)=0.29) between expert multidisciplinary groups assigning a diagnosis of HP to a set of standardised cases drawn from a tertiary referral centre for diffuse lung diseases [2]. In contrast, interobserver agreement for idiopathic pulmonary fibrosis (IPF) was good (κw=0.71), reflecting the positive impact evidence-based guidelines have on diagnostic performance.…”

mentioning

confidence: 99%

“…For these reasons, radiological diagnosis should be validated against outcome. This approach has been used in an international study of multidisciplinary IPF diagnosis and to verify the diagnostic accuracy of a novel Deep Learning algorithm for classifying fibrotic lung disease on HRCT [2,16]. It is also an approach endorsed by the Standards for Reporting of Diagnostic Accuracy initiative [17,18].…”

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confidence: 99%

Radiological diagnosis of interstitial lung disease: is it all about pattern recognition?

Walsh

Kolb

2018

Eur Respir J

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@ERSpublicationsRadiological diagnosis of ILD is pattern-based and linked to underlying histology. The future of radiological diagnosis in ILD may be the identification of disease behaviour-based radiological phenotypes that predict disease outcome. http://ow.ly/Dg0Q30l4Rh8 Hypersensitivity pneumonitis (HP) is a complex fibroinflammatory lung condition that arises from repeated exposure, usually to aerosolised organic antigens, in sensitised individuals. Although HP is a well-recognised clinical entity, the underlying mechanisms that drive disease progression are poorly understood.Making a diagnosis of HP depends on the presence of variable combinations of clinical features, including the presence of serum antibodies to inciting antigens, lymphocytosis on bronchoalveolar lavage, compatible features on high-resolution computed tomography (HRCT) and if available, the presence of loosely formed granuloma in a bronchiolocentric location on lung biopsy [1]. However, in many cases, making a confident diagnosis of HP is hampered by marginal test results, nonspecific HRCT features and perhaps most importantly, the lack of internationally agreed diagnostic guidelines for the disease. These difficulties were brought into sharp relief by a recent study of multidisciplinary practice that reported miserable diagnostic agreement (weighted κ-coefficient (κw)=0.29) between expert multidisciplinary groups assigning a diagnosis of HP to a set of standardised cases drawn from a tertiary referral centre for diffuse lung diseases [2]. In contrast, interobserver agreement for idiopathic pulmonary fibrosis (IPF) was good (κw=0.71), reflecting the positive impact evidence-based guidelines have on diagnostic performance. Adding to these challenges, HP is highly variable in its presentation, response to antigen avoidance and treated course in individual patients. The response to the "HP challenge" has been a groundswell of research focused on disentangling the complexities of HP diagnosis, all of which aim squarely at developing a case definition for HP that can be readily applied in routine clinical practice. This effort has resulted in diagnostic algorithms for HP that combine salient clinical variables with HRCT features and clinical perspectives, recommending different but similar diagnostic approaches to HP [3][4][5].HRCT plays a central role in the evaluation of patients with diffuse lung diseases and often has a significant impact on subsequent management decisions including the need for lung biopsy. Historically, radiological diagnosis has been inextricably linked to histopathology. The first systematic studies of computed tomography in diffuse lung disease began in the mid-1980s and the development of HRCT in the early 1990s was followed by more than 10 years of HRCT-pathology correlative studies that bridged

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Phage Immunoprecipitation‐Sequencing Reveals CDHR5 Autoantibodies in Select Patients With Interstitial Lung Disease

Upadhyay,

Yoon,

Vazquez

et al. 2024

ACR Open Rheumatology

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ObjectiveInterstitial lung diseases (ILDs) are a heterogeneous group of disorders that can develop in patients with connective tissue diseases. Establishing autoimmunity in ILD impacts prognosis and treatment. Patients with ILD are screened for autoimmunity by measuring antinuclear autoantibodies, rheumatoid factors, and other nonspecific tests. However, this approach may miss autoimmunity that manifests as autoantibodies to tissue antigens not previously defined in ILD.MethodsWe use Phage Immunoprecipitation‐Sequencing (PhIP‐Seq) to conduct an autoantibody discovery screen of patients with ILD and controls. We screened for novel autoantigen candidates using PhIP‐Seq. We next developed a radio‐labeled binding assay and validated the leading candidate in 398 patients with ILD recruited from two academic medical centers and 138 blood bank individuals that formed our reference cohort.ResultsPhIP‐Seq identified 17 novel autoreactive targets, and machine learning classifiers derived from these targets discriminated ILD serum from controls. Among the 17 candidates, we validated CDHR5 and found CDHR5 autoantibodies in patients with rheumatologic disorders and importantly, patients not previously diagnosed with autoimmunity. Using survival and transplant free–survival data available from one of the two centers, patients with CDHR5 autoantibodies showed worse survival compared with other patients with connective tissue disease ILD.ConclusionWe used PhIP‐Seq to define a novel CDHR5 autoantibody in a subset of select patients with ILD. Our data complement a recent study showing polymorphisms in the CDHR5‐IRF7 gene locus strongly associated with titer of anticentromere antibodies in systemic sclerosis, creating a growing body of evidence suggesting a link between CDHR5 and autoimmunity.

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Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study

Abstract: National Institute of Health Research, Imperial College London.

Cited by 372 publications

References 26 publications

Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: an international case–cohort study

Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: an international case–cohort study

Radiological diagnosis of interstitial lung disease: is it all about pattern recognition?

Phage Immunoprecipitation‐Sequencing Reveals CDHR5 Autoantibodies in Select Patients With Interstitial Lung Disease

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