Idiopathic interstitial pneumonia: what is the effect of a multidisciplinary approach to diagnosis?

Abstract:

: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.

authors

Flaherty KR,King TE Jr,Raghu G,Lynch JP 3rd,Colby TV,Travis WD,Gross BH,Kazerooni EA,Toews GB,Long Q,Murray S,Lama VN,Gay SE,Martinez FJ

doi

10.1164/rccm.200402-147OC

keywords:

subject

Has Abstract

pub_date

2004-10-15 00:00:00

pages

904-10

issue

8

eissn

1073-449X

issn

1535-4970

pii

200402-147OC

journal_volume

170

pub_type

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