The Evolving Concept of the Multidisciplinary Approach in the Diagnosis and Management of Interstitial Lung Diseases

Abstract

Background: Interstitial lung diseases (ILDs) are a group of heterogeneous diseases characterized by inflammation and/or fibrosis of the lung interstitium, leading to a wide range of clinical manifestations and outcomes. Over the years, the literature has demonstrated the increased diagnostic accuracy and confidence associated with a multidisciplinary approach (MDA) in assessing diseases involving lung parenchyma. This approach was recently emphasized by the latest guidelines from the American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Association for the diagnosis of ILDs. Methods: In this review, we will discuss the role, composition, and timing of multidisciplinary diagnosis (MDD) concerning idiopathic pulmonary fibrosis, connective tissue disease associated with ILDs, hypersensitive pneumonia, and idiopathic pneumonia with autoimmune features, based on the latest recommendations for their diagnosis. Results: The integration of clinical, radiological, histopathological, and, often, serological data is crucial in the early identification and management of ILDs, improving patient outcomes. Based on the recent endorsement of transbronchial cryo-biopsy in idiopathic pulmonary fibrosis guidelines, an MDA helps guide the choice of the sampling technique, obtaining the maximum diagnostic performance, and avoiding the execution of more invasive procedures such as a surgical lung biopsy. A multidisciplinary team should include pulmonologists, radiologists, pathologists, and, often, rheumatologists, being assembled regularly to achieve a consensus diagnosis and to review cases in light of new features. Conclusions: The literature highlighted that an MDA is essential to improve the accuracy and reliability of ILD diagnosis, allowing for the early optimization of therapy and reducing the need for invasive procedures. The multidisciplinary diagnosis of ILDs is an ongoing and dynamic process, often referred to as a “working diagnosis”, involving the progressive integration and re-evaluation of clinical, radiological, and histological features.

Advances in Diagnostics and Management of Respiratory System Diseases

“…The authors emphasise that an MDD is essential to improve the accuracy of ILD diagnosis, enabling the optimisation of invasive procedures (e.g., transbronchial cryobiopsy) and improved therapy. In conclusion, the manuscript supported the fact that the MDD has been involved in achieving a continuous and dynamic process, often referred to as a ‘working diagnosis’, which involves the progressive integration and re-evaluation of clinical, radiological and histological features [ 7 ]. The aim of the third article was to perform a systematic review to evaluate the overall benefits of lung ultrasound (LUS) examination using high-resolution computed tomography (HRCT) as the gold standard for assessing the presence of interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) [ 8 ].…”

“…The second article is an interesting review in which the authors discuss the role, composition and timing of multidisciplinary diagnosis (MDD) with regard to IPF, interstitial lung disease (ILD), hypersensitivity pneumonitis and idiopathic pneumonia with autoimmune features, based on the most recent recommendations for the diagnosis of these complex diseases [ 7 ]. The authors emphasise that an MDD is essential to improve the accuracy of ILD diagnosis, enabling the optimisation of invasive procedures (e.g., transbronchial cryobiopsy) and improved therapy.…”

Multidisciplinary Approach to the Diagnosis of Idiopathic Interstitial Pneumonias: Focus on the Pathologist’s Key Role

“…The latest ATS/ERS/JRS/ALAT Clinical Practice Guideline highlights the value of multidisciplinary discussion in the choice of the best biopsy technique. Although surgical lung biopsy (SLB), especially video-assisted thoracic surgery (VATS), provides the best tissue samples for strict diagnosis, other biopsy techniques, such as bronchoscopic lung cryobiopsy (BLC) and transbronchial biopsy (TBB), may be effectively performed [223]. SLB is considered the gold standard diagnostic procedure to establish the histopathologic pattern of specific type of ILD, allowing a definitive diagnosis in almost 90% of clinical-radiologically suspected IPF [224,225].…”

The association between patient preoperative disposition and outcomes after diagnostic lung biopsy

“…Most of the literature surrounding changes to medical therapy after DLB rely on data collected during the late 1990s and early 2000s ( 9 ). These might represent outdated data as imaging and laboratory bloodwork have advanced significantly since then ( 10 ), and evolving literature suggests that a multidisciplinary approach towards diagnosing interstitial lung disease is more effective than any single modality alone ( 11 ). Additionally, definitions used to characterize changes in medical therapy were not standardized amongst studies.…”