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

Simon L. F. Walsh, Athol U. Wells, Sujal R. Desai, V. Poletti, S. Piciucchi, A. Dubini, H. Nunes, D. Valeyre, P. Brillet, M. Kambouchner, A. Morais, J.M. Pereira, C.P. Souto Moura, J.C. Grutters, D.A. van den Heuvel, H.W. van Es, M.F. van Oosterhout, C.A. Seldenrijk, E. Bendstrup, F. RasmussenL.B. Madsen, Bibekbrata Gooptu, S. Pomplun, H. Taniguchi, J. Fukuoka, T. Johkoh, A.G. Nicholson, C. Sayer, L. Edmunds, J. Jacob, M.A. Kokosi, J.L. Myers, K.R. Flaherty, D. Hansell

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    Abstract

    Background To evaluate inter-multidisciplinary team agreement for the diagnosis of diffuse parenchymal lung disease (DPLD). Methods Seven multidisciplinary meetings (MDTMs) consisting of at least one clinician, radiologist and pathologist, from 7 different countries evaluated 70 cases of diffuse lung disease in a two-stage process. First, the clinician, radiologist and pathologist (when lung biopsy was performed) evaluated each case and chose likelihoods (censored at 5% and summing to 100% in each case) for each of their differential diagnoses, without inter-disciplinary consultation. A full MDTM with review of all clinical, radiologic and pathologic data followed this. Interobserver agreement and inter-MDTM agreement for diagnosis was calculated using Cohen's kappa coefficient or weighted kappa coefficient where appropriate. Findings Inter-MDTM agreement for first choice diagnoses was acceptable (κ = 0.50). Idiopathic pulmonary fibrosis made up 18% of all MDTM first choice diagnoses. Diagnostic likelihoods for MDTM differential diagnoses were converted to a 5-point scale (0 = condition not included in the differential diagnosis, 1 = low probability (5-25%), 2 = intermediate probability (30-65%), 3 = high probability (70-95%), and 4 = pathognomonic (100%)). Inter-MDTM agreement on diagnostic likelihoods was good for idiopathic pulmonary fibrosis (IPF) (κw = 0.71) and connective tissue disease related interstitial lung disease (CTD-ILD) (κw = 0.73), only moderate for non-specific interstitial pneumonia (NSIP) (κw = 0.42) and poor for hypersensitivity pneumonitis (HP) (κw = 0.29). MDTMs, clinicians and radiologists respectively gave high confidence diagnoses of IPF (>65% likelihood) in 77.3%, 64.6% and 66.3% of cases. The prognostic significance of a first choice diagnosis of IPF versus not IPF was evaluated for MDTMs, clinicians and radiologists. Greater prognostic significance was demonstrated for an MDTM diagnosis of IPF as compared to individual clinician's diagnosis of IPF in 5/7 MDTMs, radiologist's diagnosis of IPF in 4/7 MDTMs. Interpretation Agreement between MDTMs for diagnosis in diffuse lung disease is acceptable and good for a diagnosis of IPF. This is validated by the greater prognostic significance of an IPF diagnosis made by MDTMs as compared to individual clinicians or radiologists. Furthermore, MDTMs made the diagnosis of IPF with higher confidence and more frequently than clinicians or radiologists. MDTM agreement for diagnosis of NSIP and hypersensitivity pneumonitis is poor, indicating a need for international consensus on diagnostic criteria for these diseases.
    Original languageEnglish
    JournalThe Lancet Respiratory Medicine
    Early online date11 May 2016
    Publication statusE-pub ahead of print - 11 May 2016

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