The characterisation of interstitial lung disease multidisciplinary team meetings: a global study

Abstract

Multidisciplinary team (MDT) diagnosis of interstitial lung disease (ILD) has been proposed as a gold standard, but there are no formal recommendations for MDT process or composition and limited knowledge regarding prevalence in routine practice.We performed a systematic evaluation of ILD diagnostic practice across a range of healthcare settings around the world. Electronic questionnaires were distributed across all global regions via society and collaborators networks.Responses from 457 unique centres across 64 countries were included in the analysis. Of the 350 (76.6%) centres holding formal meetings, the majority held face-to-face MDT meetings (80%), for a minimum of 30 min (93%), and discussed diagnosis (96.9%) and patient management (94.9%) at the meetings. Compared with non-academic and academic non-ILD centres, ILD academic centres reported a higher ILD caseload, held more formal MDT meetings, and were more likely to include histopathology and rheumatology specialists in their diagnostic team. Of the centres holding MDT meetings, 5.5% routinely discussed all new cases at such meetings.An MDT approach to ILD diagnosis is consistently interpreted and widely implemented across a range of routine care settings around the world. This observation will inform future ILD diagnostic agreement studies and diagnostic pathway recommendations.

Cryobiopsy Compared with Surgical Lung Biopsy in ILD: Reply to Maldonado et al., Froidure et al., Bendstrup et al., Agarwal et al., Richeldi et al., Rajchgot et al., and Quadrelli et al.

“…Although adopted worldwide, there are no formal recommendations for an MDA process or its composition. Thus, a “minimum MDA standard” is still hard to define (6), and the low agreement among MDAs for ILDs other than idiopathic pulmonary fibrosis remains a concern (7). As concerns our study, a 1-year follow-up diagnostic review of all 21 patients in the article (often seen as an acceptable gold standard) demonstrated perfect agreement with diagnoses as published; no later changes in diagnosis/management were observed.…”

Multidisciplinary Evaluation of Interstitial Lung Diseases: New Opportunities Linked to Rheumatologist Involvement

“…The official ATS/ERS/JRS/ALAT clinical practice guidelines recommend a dynamic process of MDT in the management of ILD since individual decisions on complex cases may increase the risk of delayed diagnosis, inappropriate treatment or unnecessary additional diagnostic testing [4]. Although one ILD case out of five can be related to SARD, a recent systematic evaluation of diagnostic ILD practice around the world showed that only 37.1% of MDT cases include a rheumatologist [5]. The clinical impact of this practice is still largely unknown.…”

“…Multidisciplinary team (MDT) evaluation has been proposed as the gold standard [4] in the management of ILD. Nonetheless, there are no formal recommendations for its composition and working process [5]. Even if current guidelines consider it mandatory to exclude a systemic autoimmune rheumatic disease (SARD) in any newly diagnosed ILD, a rheumatologist is not routinely involved in MDT.…”

Cardiopulmonary Exercise Testing in Patients With Interstitial Lung Disease

“…ILD diagnosis is established by a multidisciplinary team of respirologists, chest radiologists, and lung pathologists based on a combination of clinical information derived from pulmonary function tests, chest imaging, and lung tissue histology (Richeldi et al, 2019). CPET data are not a requirement for a multidisciplinary diagnosis of ILD but may be used to inform patient management.…”