Multidisciplinary team obviates biopsy in most patients with diffuse parenchymal lung diseases - a retrospective study from India.

Murali Mohan, Bangalore Venkataraman; Tousheed, Syed Zulkharnain; Manjunath, Poojaramuddanahally Hanumantharayappa; Ravichandra, Malapaka Ramakrishna; Ranganatha, Ramanjaneya; Annapandian, Vellaichamy M; Kumar, M Hemanth; Chandrasekar, Sagar

INTRODUCTION The inflammation and fibrosis in diffuse parenchymal lung diseases (DPLDs) in varied proportions gives rise to different patterns on radiology and histopathology. The radiological pattern on CT of the thorax most often allows us to make a diagnosis with varying levels of confidence, to optimize management. With a multidisciplinary team bringing the strengths of their individual domains of knowledge, clinical, radiological, histopathological and in many cases rheumatological, the level of confidence in making this diagnosis increases, often to the stage where the diagnosis is most often right, is concordant with the diagnosis achieved at histopathology and therefore obviates the need for lung biopsy which carries its own costs and risks of complications. Our study emphasizes the role of the Multidisciplinary team (MDT) in the management of DPLDs at a tertiary care referral center. MATERIALS AND METHODS Every case of DPLD presenting to our pulmonology department was discussed in an MDT meeting before subjecting them to any diagnostic intervention or therapy. A clinico-radiological diagnosis was made according to the 2002 ATS/ERS guidelines initially. Later an official ATS/ERS/JRS/ALAT statement on idiopathic pulmonary fibrosis and 2013 ATS/ERS consensus for the classification and diagnosis of idiopathic interstitial pneumonia was used. The concordance in our study was defined as the percentage of histopathological diagnoses that were identical to the clinico-radiological MDT diagnosis prior to the biopsy. RESULTS A total of 434 patients with DPLDs were evaluated. The MDT suggested biopsy for only 38.7% (168 / 434) patients since the pattern was very clear in 266 (61.3%) cases. As not all patients cionsented to undergo the biopsy procedure when recommended, histopathology was obtained in 102 patients. The histological diagnosis was concordant with the initial MDT diagnosis in 80.3% (82 / 102) of samples. On an individual basis CTD-ILD and sarcoidosis showed the best concordance (87%). In idiopathic NSIP cases, the histopathological diagnosis concurred in only 53.3% (8 / 15), out of which 8 were NSIP, 4 were UIP and 3 were reported as inadequate sampling on histopathology. CONCLUSION The MDT plays a crucial role in the diagnosis of DPLDs. Not every pattern requires biopsy confirmation. However, an iNSIP diagnosis by the MDT should probably be better confirmed by biopsy.