Idiopathic interstitial pneumonia: what is the effect of a multidisciplinary approach to diagnosis?
Current guidelines recommend that the clinician, radiologist, and pathologist work together to establish a diagnosis of idiopathic interstitial pneumonia. Three clinicians, two radiologists, and two pathologists reviewed 58 consecutive cases of suspected idiopathic interstitial pneumonia. Each participant was provided information in a sequential manner and was asked to record their diagnostic impression and level of confidence at each step. Interobserver agreement improved from the beginning to the end of the review. After the presentation of histopathologic information, radiologists changed their diagnostic impression more often than did clinicians. In general, as more information was provided the confidence level for a given diagnosis improved, and the diagnoses rendered with a high level of confidence were more likely congruent with the final pathologic consensus diagnosis. The final consensus pathologist diagnosis was idiopathic pulmonary fibrosis in 30 cases. Clinicians identified 75% and radiologists identified 48% of these cases before presentation of the histopathologic information. Histopathologic information has the greatest impact on the final diagnosis, especially when the initial clinical/radiographic diagnosis is not idiopathic pulmonary fibrosis. We conclude that dynamic interactions between clinicians, radiologists, and pathologists improve interobserver agreement and diagnostic confidence.
Flaherty
Kevin R
KR
Division of Pulmonary and Critical Care Medicine, Department of Radiology, University of Michigan Health System, 3916 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0360, USA.
King
Talmadge E
TE
Raghu
Ganesh
G
Lynch
Joseph P
JP
Colby
Thomas V
TV
Travis
William D
WD
Gross
Barry H
BH
Kazerooni
Ella A
EA
Toews
Galen B
GB
Long
Qi
Q
Murray
Susan
S
Lama
Vibha N
VN
Gay
Steven E
SE
Martinez
Fernando J
FJ
D003937:Diagnosis, Differential; D006801:Humans; D008168:Lung / Q000473:pathology; D017563:Lung Diseases, Interstitial / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D015588:Observer Variation; D018579:Patient Selection; D011658:Pulmonary Fibrosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D012017:Referral and Consultation; D014057:Tomography, X-Ray Computed / Q000379:methods