ILD benefits from multidisciplinary discussion


28 Sep 2017

The TSANZ and Lung Foundation Australia have endorsed a position statement on the use of multidisciplinary meetings to improve diagnostic accuracy in interstitial lung disease (ILD).

The statement highlights the benefits of a standardised approach to the diagnosis of interstitial lung disease (ILD) with input from respiratory physicians, radiologists and pathologists.

A review of the evidence showed about half of cases referred to a multidisciplinary meeting resulted in a change in diagnosis and subsequent management – with more specific diagnoses and fewer cases of unclassifiable ILD.

Co-author Associate Professor Ian Glaspole, from the Alfred Hospital, told the limbic the position statement would guide new teams setting up their multidisciplinary approach.

 “Multidisciplinary team meetings have been available only in a few centres to date but the need for these meetings is increasing because of recognition of their improved diagnostic utility and also for much more pragmatic reasons in that a multidisciplinary diagnosis is required for prescription of anti-fibrotic therapy in Australia.”

He said all ILD cases benefited from multidisciplinary discussion, even those that might seem relatively obvious.

“Although individual clinicians often do diagnose IPF with high degrees of diagnostic confidence, when those same diagnoses are considered in a multidisciplinary meeting, a significant proportion of those diagnoses are changed.”

Medicare had recognised the value of multidisciplinary meetings with specific item numbers to fund them, he said.

Associate Professor Glaspole said the evidence suggested that even with well-characterised conditions such as IPF and connective tissue disease related ILD, there were still inconsistencies in diagnosis.

He added it was difficult to achieve true expertise in ILD because the conditions were so rare.

However diagnostic acumen could be improved by including physicians with more than 20 years experience, those attached to a university hospital and those who attended a weekly multidisciplinary meeting.

“And the other thing that improves the expertise of meetings is to link into multidisciplinary meetings that do have expertise though telehealth communications.”

He said as well as providing consensus on diagnosis, multidisciplinary meetings were useful for establishing initial management pathways and for further education in the diagnosis and management of ILD.

The position statement also highlighted the need for improved diagnostic techniques in ILD.

“For example, it’s often the case that patients often can’t undergo full workup to obtain histological diagnosis because they are too ill for surgical biopsy.”

Associate Professor Glaspole said an Australian study was underway to assess the utility of cryobiopsy as a less invasive alternative.

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