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• W2891516401 abstract "Multidisciplinary team discussion (MDD) has become the gold standard in the diagnostic process of interstitial lung disease (ILD), although the landmark study by Flaherty et al,1Flaherty K.R. King Jr., T.E. Raghu G. et al.Idiopathic interstitial pneumonia: what is the effect of a multidisciplinary approach to diagnosis?.Am J Respir Crit Care Med. 2004; 170: 904-910Crossref PubMed Scopus (480) Google Scholar which had excellent methodology, involved a relatively small number of patients and physicians. In a recent issue of CHEST (June 2018), De Sadeleer et al2De Sadeleer L.J. Meert C. Yserbyt J. et al.Diagnostic ability of a dynamic multidisciplinary discussion in interstitial lung diseases: a retrospective observational study of 938 cases.Chest. 2018; 153: 1416-1423Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar demonstrate that MDD changes the diagnosis in around 40% of patients, suggests a first-choice diagnosis in nearly 80% of cases previously considered unclassifiable, and better discriminates prognosis between idiopathic pulmonary fibrosis and other ILDs. These clear benefits of MDD, as well as the relatively new requirements in some countries for MDD diagnosis to access antifibrotic therapies, are contributing to the vast increase in the number of ILD MDD meetings globally; however, there is great variation between MDDs across their structure and diagnostic concordance. Although it is clear that MDD improves interobserver agreement and diagnostic confidence,3Walsh S.L. Wells A.U. Desai S.R. et al.Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study.Lancet Respir Med. 2016; 4: 557-565Abstract Full Text Full Text PDF PubMed Scopus (268) Google Scholar likely through improved communication or the acquisition of a so-called “common language” between the different components of the group, MDD has intrinsic defects and pitfalls. This language per se is not a guarantee of science and/or good clinical practice. The role of the interaction between language and scientific methods within a group has been demonstrated by the Vienna Circle, a group of philosophers and scientists who met regularly from 1924 to 1936; they acquired a common language, yet their conclusions were based on cogent logics rather than on votes (and majority). Diagnostic agreement, diagnostic confidence, and prediction of outcome not only depend on the scientific methods applied by the group, however, but also on its clinical expertise. In medicine, and especially in ILD, the quality of the diagnostic process is highly dependent on the volume of activity and on the accuracy of the clinical information gathered. As an example, identifying an environmental exposure relevant to hypersensitivity pneumonitis, detecting subtle signs of connective tissue disease, or carefully evaluating disease behavior over time are notoriously challenging and time-consuming exercises, not to mention the potential value of good-quality BAL differential cell count. Furthermore, as with any group discussion, MDD outperforms individuals, but personal interaction may lead to unbalanced discussion, especially when the doctors’ skills and expertise within the group differ significantly.4Kurvers R.H. Herzog S.M. Hertwig R. et al.Boosting medical diagnostics by pooling independent judgments.Proc Natl Acad Sci U S A. 2016; 113: 8777-8782Crossref PubMed Scopus (73) Google Scholar The study by De Sadeleer et al2De Sadeleer L.J. Meert C. Yserbyt J. et al.Diagnostic ability of a dynamic multidisciplinary discussion in interstitial lung diseases: a retrospective observational study of 938 cases.Chest. 2018; 153: 1416-1423Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar emphasizes the importance of the MDD process; however, it also underlines that patients with ILD should be evaluated in expert centers by physicians with adequate clinical experience and scientific background. In their study, were all patients seen by a clinician experienced in ILD belonging to the expert center? Whether comparable results would have been obtained, had the MDD not included expert ILD clinicians, radiologists, and pathologists, remains unclear, and a minimum standard for MDD should be considered. Future prospective studies should address the added value of the MDD process vs early referral of patients to expert centers, which is a constant request from patients with ILD and from patient associations.5Bonella F. Wijsenbeek M. Molina-Molina M. et al.European IPF Patient Charter: unmet needs and a call to action for healthcare policymakers.Eur Respir J. 2016; 47: 597-606Crossref PubMed Scopus (77) Google Scholar Diagnostic Ability of a Dynamic Multidisciplinary Discussion in Interstitial Lung Diseases: A Retrospective Observational Study of 938 CasesCHESTVol. 153Issue 6PreviewThe advice of a dynamic multidisciplinary discussion (MDD) is believed to be important in the diagnosis of interstitial lung diseases (ILDs). However, to what extent MDD diagnoses differ from the preliminary diagnoses before formal workup and MDD (preMDD diagnoses) is still insufficiently studied. Full-Text PDF ResponseCHESTVol. 154Issue 3PreviewWe thank Drs Cottin et al1 for their interesting comments after reading our study about the diagnostic ability of the multidisciplinary dynamic discussion (MDD). We believe the issues raised are valid and could direct further research in the field of the role of MDDs in diagnosing interstitial lung diseases (ILDs). We were intrigued by their reasoning about the underlying drivers leading to superior diagnostic ability of an expert MDD and whereas this should be interpreted as based on interdisciplinary discussion or based on individual expertise. Full-Text PDF" @default.
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• W2891516401 title "Should Patients With Interstitial Lung Disease Be Seen by Experts?" @default.
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