Interstitial Lung disease (ILD) is a group of pulmonary diseases resulting from inflammation and scarring of the lung, said Tanmay Panchabhai, MD, FCCP, noting the cause of this inflammation is broad and variable.
These diseases tend to have common symptoms and physical findings but have different treatments and outcomes. The confidence in diagnosing ILD has significantly increased with the introduction of multidisciplinary discussion (MDD) that is nothing but assembling an ILD pulmonologist, radiologist, and pathologist in one room and asking them to discuss their opinions about a case, added Debasis Sahoo, MD, FCCP.
In the session Multidisciplinary Consensus in Diagnostic Dilemmas in ILD: A Case-Based Approachon Wednesday at 7:30 am in room 212 of the convention center, the duo will try to replicate MDD by sharing some complex cases with world-renowned ILD physicians and pathologists to depict how the discussion progresses to a diagnosis and helps in management of the case. The session will show a series of complex cases, where attendees will get to see approaches to these cases, live discussion by an expert panel, with discussion on differential diagnosis, imaging findings and management of these cases, closure with pathology confirming the diagnosis and management, and follow-up that has been done with these patients. Dr. Panchabhai, chair of the session, and Dr. Sahoo, co-chair, explain more:
Why are physicians seeing an uptick of patients with ILD?
Dr. Sahoo: Awareness and education of these rare diseases have led to increased recognition of them. There are more than 100 causes of ILD, which include exposure-related disease, connective tissue-related, vasculitis-related, infection-related, drug-related, and idiopathic (when we don’t know the cause) are a few to name.
Why is there a dilemma between whether you should biopsy or not during the diagnostic process and to determine the prognosis of the disease?
Dr. Panchabhai: Every procedure has its risks and benefits, which include bleeding, infection, pneumothorax, or exacerbation of the disease. In some patients the disease is way too advanced that the risk from anesthesia and procedure itself outweigh the benefits. Ideally, tissue diagnosis to support the clinical diagnosis would be helpful in every case. As we are learning more about ILD, our confidence in diagnosing some ILDs based on radiological pattern is quite high, so we may not need lung biopsies in most cases anymore. The dilemma whether to biopsy or not exists when the radiological pattern is not in sync with the clinical picture.
Why is a multidisciplinary approach important to diagnosing and managing ILD?
Dr. Sahoo: Accurate diagnosis is key to the diagnosis, therapy, and prognosis in patients with ILD. When the disease group includes such a broad group of diagnoses with similar presentations, the diagnosis can get very challenging. As the evidence has grown, dynamic multidisciplinary discussion has become the gold standard for diagnosing ILD. It is easier managing these patients once a consensus diagnosis has been achieved by ensuring the opinions and expertise of all involved specialties are taken into consideration.
What do you do if there is no consensus diagnosis?
Dr. Panchabhai:There are always a few cases even after intense debate and review at the ILD multidisciplinary discussion when consensus is not achieved. In such cases, an honest discussion with the patient that provides information as to why a consensus could not be achieved and what are the most likely differential diagnoses is key. Treatment recommendations should then be based on the most likely diagnosis with a plan to closely follow response and revisit and re-discuss these cases back in the ILD MDD with more data to reach a confident diagnosis.