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Histologist's original opinion compared with multidisciplinary team in determining diagnosis in interstitial lung disease
  1. PS Burge,
  2. J Reynolds,
  3. S Trotter,
  4. GA Burge,
  5. G Walters
    1. Interstitial Lung Disease Service, Birmingham Heartlands Hospital, Birmingham, UK
    1. Correspondence to Professor PS Burge, Interstitial Lung Disease Service, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK; sherwood.burge{at}doctors.org.uk

    Abstract

    Guidelines recommend that multidisciplinary interstitial lung disease meeting (ILD MDT) decisions become the gold standard for diagnosis, replacing the histologist from this position, and identify this as requiring supportive evidence. We have compared diagnoses from lung biopsy material made by expert histologists with the subsequent consensus opinion from a properly constituted ILD MDT in 71 consecutive patients referred to a regional thoracic unit. MDT changed the original histological diagnoses in 30% (95% CI 19.3% to 41.6%) and strengthened the diagnoses from probable to confident in a further 17% (95% CI 9.1% to 27.7%). The assessment of hypersensitivity pneumonitis, non-necrotising granulomas and organising pneumonia accounted for the majority of the changes.

    • Hypersensitivity pneumonitis
    • Histology/Cytology
    • Idiopathic pulmonary fibrosis
    • Interstitial Fibrosis
    • Rheumatoid lung disease
    • Sarcoidosis

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    Footnotes

    • Collaborators Specialist Radiology team for interstitial lung disease (ILD): JR, Dr Madava Djearaman, Dr Shahid Hussain and Dr Ed Hoey. Specialist histology team for ILD: Dr ST, Dr Gerald Langman, Sherin Payyappilly and Praba Naidoo. Thoracic surgeons supporting lung biopsy service: Mr Maninder Kalkat, Mr Richard Steyn, Mr Pala Rajesh, Mr Ehab Bishay and Professor Babu Naidu. Clinical team: PSB, GW, Dr Salman Ghani, Dr Dimitrina Petkova, Dr Alastair Robertson, Dr J Jayakumar and GAB.

    • Contributors All authors are core members of the ILD multidisciplinary team and have contributed to the paper. Others with lesser contributions are acknowledged.

    • Competing interests None.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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