Diagnostic and prognostic trajectories of ILDs after the MDD

The 2018 guidelines on the diagnosis of idiopathic pulmonary fibrosis (IPF) conditionally recommend multidisciplinary discussion (MDD) for diagnostic decision-making. However, limited data concerning the diagnostic impact of MDD on interstitial lung diseases (ILD) are available. The objective was to assess the impact of MDD on diagnostic trajectories (DT) and the prognosis of ILD patients. This prospective study enrolled all consecutive adult ILD patients referred for MDD to a tertiary academic center in San Antonio, TX, USA from January 2017 to May 2020. The subjects were followed during a 3-year follow-up period after the MDD. Patients were stratified into 3 groups according to the pre-MDD diagnosis: unspecified ILD, IPF, and not IPF and compared to the re-stratification post-MDD diagnosis into: unclassifiable ILD, IPF, and not IPF. The primary outcome was the percentage change in DT after the MDD discussion. A total of 201 ILD patients [61.7% male; mean (DS) age: 67.2 (10.4) years] were included in the study. The total DT change occurred in 122 (60.7%) patients. The DT changed in 40 (46.5%) patients in the IPF group and 8 (19.5%) in the non-IPF group (p-value = 0.0003). Patients with pre-MDD unspecified-ILD were classified as not-IPF in 32.4% (n=24), IPF in 23% (n=17) and unclassifiable-ILD in 44.6% (n=33) post-MDD. Considering the post-MDD diagnosis, differences in mortality were detected among the 3 groups (p=0.037). Our results suggest that MDD has a significant impact not only on the DT but also on the prognosis of patients with ILDs.