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Войти в исследования BMJ open · 2025
Virtual multidisciplinary discussion across borders for interstitial lung disease: a prospective, multicentre study from India, the UK, Greece and Sri Lanka.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Mehta Asmita Anilkumar, Rajan Sujeet, Ahmed Subin, Jankharia Bhavin, Wells Athol U, Cb Mithun, Mohan Bvm, Raj Vimal, Kulshrestha Ritu, Prabhudesai Pralhad, Irodi Aparna, Valathara Pradeep Lakshmi Priya, Rathnapala Amila, Antoniou K M, Nagoti Sharada
Аннотация
OBJECTIVES: To assess diagnostic concordance and reclassification following an India-led, multinational virtual multidisciplinary discussion (V-MDD) platform for interstitial lung disease (ILD).
DESIGN: Prospective, multicentre service-evaluation study.
SETTING: Twenty-four Indian referral centres connected through a secure virtual platform, with international faculty participation from the UK, Greece and Sri Lanka.
PARTICIPANTS: A total of 127 anonymised ILD cases discussed across 29 V-MDD sessions (February 2024-February 2025). Each panel included ≥4 pulmonologists, two pulmonary pathologists, one of three rotating thoracic radiologists and one of two rheumatologists, along with international experts.
RESULTS: The cohort (mean age 52.6±16.1 years; 53.5% female (68/127)) most frequently presented with dyspnoea (82.6%) and cough (73.2%). Pre-V-MDD diagnoses included hypersensitivity pneumonitis (HP) and sarcoidosis as distinct disease entities, and usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP) as radiological patterns, along with connective tissue disease (CTD)-ILD and other ILDs. Concordance between pre- and post-V-MDD CT diagnoses was substantial (κ=0.658; 95% CI 0.562 to 0.754; p <0.001). Histopathology concordance was similarly high (κ=0.861 for HP; κ=0.650 for other ILDs). Overall, 23% of cases were reclassified following discussion. Diagnostic stability was greatest for organising pneumonia, CTD-ILD and UIP pattern, whereas HP and sarcoidosis showed the highest reclassification rates.
CONCLUSIONS: The India-led, multinational V-MDD model demonstrated substantial diagnostic concordance and refined nearly one-quarter of ILD diagnoses. This virtual, scalable framework expands access to subspecialty expertise and offers a practical blueprint for standardising ILD care in resource-limited and cross-border settings.
DESIGN: Prospective, multicentre service-evaluation study.
SETTING: Twenty-four Indian referral centres connected through a secure virtual platform, with international faculty participation from the UK, Greece and Sri Lanka.
PARTICIPANTS: A total of 127 anonymised ILD cases discussed across 29 V-MDD sessions (February 2024-February 2025). Each panel included ≥4 pulmonologists, two pulmonary pathologists, one of three rotating thoracic radiologists and one of two rheumatologists, along with international experts.
RESULTS: The cohort (mean age 52.6±16.1 years; 53.5% female (68/127)) most frequently presented with dyspnoea (82.6%) and cough (73.2%). Pre-V-MDD diagnoses included hypersensitivity pneumonitis (HP) and sarcoidosis as distinct disease entities, and usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP) as radiological patterns, along with connective tissue disease (CTD)-ILD and other ILDs. Concordance between pre- and post-V-MDD CT diagnoses was substantial (κ=0.658; 95% CI 0.562 to 0.754; p <0.001). Histopathology concordance was similarly high (κ=0.861 for HP; κ=0.650 for other ILDs). Overall, 23% of cases were reclassified following discussion. Diagnostic stability was greatest for organising pneumonia, CTD-ILD and UIP pattern, whereas HP and sarcoidosis showed the highest reclassification rates.
CONCLUSIONS: The India-led, multinational V-MDD model demonstrated substantial diagnostic concordance and refined nearly one-quarter of ILD diagnoses. This virtual, scalable framework expands access to subspecialty expertise and offers a practical blueprint for standardising ILD care in resource-limited and cross-border settings.