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Idiopathic Interstitial Pneumonia

What Is the Effect of a Multidisciplinary Approach to Diagnosis?

Division of Pulmonary and Critical Care Medicine and Department of Radiology, University of Michigan Health System, and Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan; University of California, San Francisco, San Francisco, California; University of Washington, Seattle, Washington; Mayo Clinic, Scottsdale, Arizona; and Armed Forces Institute of Pathology, Washington, DC

Correspondence and requests for reprints should be addressed to Fernando J. Martinez, M.D., M.S., 3916 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0360. E-mail: fmartine{at}umich.edu

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.

Key Words: diagnosis • nonspecific interstitial pneumonia • usual interstitial pneumonia

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