Flaherty et al. (2004) [12] | 58 | Three pulmonologists, two radiologists and two pathologists |
| No information provided |
Flaherty et al. (2007) [9] | 39 | Clinicians, radiologists and pathologists |
An interactive approach between clinicians, radiologists and pathologists improved interobserver agreement at both community and academic sites Interobserver agreement was higher in academic centres (κw=0.55–0.71) than within community centres (κw=0.32–0.44)
| No information provided |
Mittoo et al. (2009) [91] | 114 | Evaluation at an ILD clinic |
| No information provided |
Castelino et al. (2011) [92] | 50 | Concurrent evaluation of patients with ILD by a pulmonologist and a rheumatologist |
Of the patients with a final diagnosis of CTD-ILD, 28% were referred with a diagnosis of IPF 36% of CTD-ILD patients had their diagnosis changed to an alternate CTD-ILD
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Walsh et al. (2016) [10] | 70 patients included in the final study cohort | Clinician, pathologist and radiologist |
| No information provided |
Chaudhuri et al. (2016) [42] | 318 | Two respiratory physicians, one radiologist, one pathologist, one specialist nurse, one MDT coordinator and one ILD pharmacist |
Consensus diagnosis made in 57/75 (76%) of unclassifiable ILDs IPF diagnoses were correct in 50/107 (47%) cases and incorrect in 57/107 (53%) cases Other ILD diagnoses were correct in 91/136 (67%) cases and incorrect in 45/136 (33%) cases
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IPF: MDT discussion resulted in a change of treatment for 50% of patients (53/107) (stopping immunosuppressant therapies and initiating pirfenidone) Other ILDs: MDT discussion resulted in a change of treatment in 39% (53/136) of cases (starting or discontinuing immunosuppressant therapies)
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Tomassetti et al. (2016) [28] | 117 | Two clinicians, two radiologists and two pathologists |
| No information provided |
Jo et al. (2016) [46] | 90 | One pulmonologist, one rheumatologist, one radiologist, one pathologist and one immunologist |
CTD-ILD: diagnoses increased from 10% to 21% HP: diagnoses increased from 3% to 16% IPF: 7 patients with unclassifiable ILD or NSIP had diagnosis changed to IPF
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Recommendation for CS use decreased from 36% to 28% (p=0.26) Recommendation for nonsteroid immunosuppression increased from 10% to 17% (p=0.16) Recommendation for pulmonary vasodilators increased from 0% to 4% (p=0.046) Recommendation for antifibrotic therapy increased from 3% to 21% (p=0.0002) Recommendation for clinical trials increased from 0% to 3% (p=0.08) Recommendation for oxygen increased from 6% to 10% (p=0.046)
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Burge et al. (2017) [93] | 71 | Pathologists, radiologists, clinicians and a clinical nurse specialist |
| No information provided |
De Sadeleer et al. (2018) [45] | 938 | Experts in pulmonology, radiology and histopathology (and other specialities when needed) | MDT discussions provided a definite diagnosis in 80.5% of the cases MDT discussions changed the diagnosis in 191 patients with a pre-MDD diagnosis (41.9%)
Sarcoidosis (n=82): 62% confirmed by MDT, 6% changed by MDT Other ILD (n=31): 39% confirmed by MDT, 23% changed by MDT IPF (n=326): 38% confirmed by MDT, 6% changed by MDT CTD-ILD (n=60): 27% confirmed by MDT, 20% changed by MDT Drug-/exposure-related ILD (n=42): 26% confirmed by MDT, 21% changed by MDT Non-ILD (n=65): 22% confirmed by MDT, 37 changed by MDT HP (n=77): 21% confirmed by MDT, 31% changed by MDT COP (n=17): 18% confirmed by MDT, 18% changed by MDT RB-ILD/DIP (n=22): 14% confirmed by MDT, 18% changed by MDT iNSIP (n=33): 12% confirmed by MDT, 27% changed by MDT
| No information provided |
Levi et al. (2018) [94] | 60 | MDT of pulmonologists, radiologists, pathologists and rheumatologists | Rheumatologist assessment following routine MDT diagnosis led to:
| No information provided |
Biglia et al. (2019) [15] | 150 | Two pulmonologists, one chest radiologist, one rheumatologist, one surgeon and one histopathologist | Total: 42% of diagnoses were revised between pre-MDD and post-MDD, leading to a significant reduction in unclassifiable ILD
IPF: diagnoses increased from seven to 35 cases HP: diagnoses increased from 11 to 20 cases Unclassifiable: diagnoses decreased from 56 to 15 cases (p<0.0001)
| MDD led to a change or initiation of treatment in 54% of cases |
Fujisawa et al. (2019) [82] | 524 | One pulmonologist, one radiologist and one pathologist | MDT resulted in a change in diagnosis for 219 patients (47%)
IPF (n=227): 59 cases (26%) were reclassified as unclassifiable IIPs, while 151 (67%) were confirmed as IPF iNSIP: 42 cases (43%) were recategorised as unclassifiable IIPs, 17 (17%) as IPF and three (3%) as CTD-ILD
| No information provided |
Grewal et al. (2019) [84] | 209 internal patients 91 external patients | Pulmonologists, radiologists and pathologists | Internal patients
IPF (n=54): diagnosis changed in 33% of patients iNSIP (n=4): diagnosis changed in 75% of patients HP (n=21): diagnosis changed in 14% of patients CTD-ILD (n=15): diagnosis changed in 20% of patients Other ILD (n=11): diagnosis changed in 27% of patients Unclassifiable (n=104): diagnosis changed in 43% of patients External patients
IPF (n=12): diagnosis changed in 42% of patients iNSIP (n=6): diagnosis changed in 100% of patients HP (n=10): diagnosis changed in 40% of patients CTD-ILD (n=6): diagnosis changed in 50% of patients Other ILD (n=10): diagnosis changed in 40% of patients Unclassifiable (n=47): diagnosis changed in 36% of patients
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Internal patients
Antifibrotic (n=7): treatment changed in 14% of patients CS (n=14): treatment changed in 86% of patients SSA (n=9): treatment changed in 11% of patients CS and SSA (n=12): treatment changed in 17% of patients No treatment (n=167): treatment changed in 49% of patients External patients
Antifibrotic (n=2): treatment changed in 50% of patients CS (n=11): treatment changed in 73% of patients SSA (n=2): treatment not changed in patients CS and SSA (n=1): treatment changed in 100% of patients No treatment (n=75): treatment changed in 36% of patients
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Han et al. (2019) [54] | 56 | Four pulmonologists, one radiologist and one pathologist |
| No information provided |
Tirelli et al. (2020) [95] | 119 | Six pulmonologists, three rheumatologists, two radiologists and one pathologist |
| No information provided |
Ageely et al. 2020 [96] | 126 | Respirologists, one registered nurse, one thoracic pathologist and one thoracic radiologist | MDD altered the diagnosis in 37% (47/126) of cases
IPF: diagnoses increased from 24 to 34 cases HP: diagnoses increased from 20 to 21 cases Sarcoidosis: diagnoses decreased from four cases to one case Nonspecified ILD: diagnoses decreased from 52 to 0 cases IPAF: diagnoses increased from 0 to five cases Unclassifiable ILD: diagnoses increased from 0 to 27 cases No ILD: diagnoses increased from 0 to six cases
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Management was changed in 39% (50/126) of patients Among concordant pre-MDT and post-MDT diagnoses, management was changed in 46% (24/52) of cases
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De Lorenzis, 2020 [97] | 151 |
Minimal attendance: two pulmonologists, two chest radiologists and one pathologist Extended MDT meeting: included two extra rheumatologists
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The agreement between rheumatologists and pulmonologists was moderate for the detection of autoimmunity test positivity (κw=0.475, p<0.001) and family history of SARD (κw=0.491, p<0.001), and fair for the identification of extrapulmonary symptoms (κw=0.225, p=0.064) or routine laboratory abnormalities consistent with SARD (κw=0.101, p=0.081) The agreement between rheumatologist and extended MDT for the identification of ILD progression was moderate (κw=0.436, p<0.001)
| Therapeutic strategy changed in 72 patients (55.5%) following the extended MDT (with rheumatologists)
Immunosuppressive drug (cyclophosphamide, azathioprine or mycophenolate mofetil with or without prednisone) prescribed in 50/72 (40.3%) patients Other immunosuppressants (rituximab or tocilizumab) prescribed in 13/72 (10.3%) patients Antifibrotic treatment (nintedanib or pirfenidone) prescribed in 9/72 (7.3%) patients
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