The impact of bronchoalveolar lavage on the diagnosis of undifferentiated interstitial lung disease alongside a multidisciplinary discussion.

IF 3.5 3区 医学 Q2 RESPIRATORY SYSTEM Chronic Respiratory Disease Pub Date : 2023-01-01 DOI:10.1177/14799731231196581
Wafa B Khan, Harry M Gallagher, Dilip Jayasimhan, Michael Dray, Catherina L Chang
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Abstract

Background and objective: Cellular analysis of bronchoalveolar lavage (BAL) fluid may aid diagnosis in patients with undifferentiated interstitial lung disease (ILD). The utility of this test in the diagnostic process in conjunction with a multidisciplinary discussion (MDD) is not known. We aim to assess and compare interobserver agreement and diagnostic confidence before and after presenting BAL results in an ILD-MDD.

Methods: Patients undergoing investigations for ILD at Waikato Hospital were recruited. At the ILD-MDD two respiratory physicians and one respiratory radiologist participated in the discussion, and their diagnosis and diagnostic confidence were assessed at four sequential time points. Assessors were blinded to each others diagnosis and diagnostic confidence scores. The four sequential time points were (1) after clinical and radiology presentation; (2) after subsequent MDD; (3) after reviewing BAL results; (4) after final MDD with all results. Interobserver agreements were calculated using Fleiss κ statistic.

Results: 36 patients were recruited, and 77.8% were male. In the first step, the interobserver agreement was substantial κ = 0.622 (95% CI 0.47-0.77), improving in step 2 following MDD to κ = 0.78 (95% CI 0.624-0.935), in step 3 κ = 0.776 (95% CI 0.614-0.937) and step 4 achieved almost perfect agreement of κ = 0.969 (95% CI 0.828-1.11). The diagnostic confidence for individual and group diagnosis increased with the presentation of BAL with and without multidisciplinary MDD.

Conclusion: We found that BAL cellular analysis improves interobserver agreement and confidence in diagnosis following MDD, thus aiding decision-making in cases with undifferentiated ILD.

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支气管肺泡灌洗对未分化间质性肺病诊断的影响及多学科讨论。
背景与目的:支气管肺泡灌洗液的细胞分析有助于诊断未分化间质性肺病(ILD)。该测试在诊断过程中与多学科讨论(MDD)结合使用的效用尚不清楚。我们的目的是评估和比较在ILD-MDD中呈现BAL结果前后观察者之间的一致性和诊断置信度。方法:招募在怀卡托医院接受ILD调查的患者。在ILD-MDD,两名呼吸科医生和一名呼吸科放射科医生参与了讨论,并在四个连续的时间点评估了他们的诊断和诊断可信度。评估者对彼此的诊断和诊断置信度得分视而不见。四个连续的时间点是(1)在临床和放射学表现之后;(2) 在随后的MDD之后;(3) 在审查BAL结果之后;(4) 在最终MDD之后,所有结果。使用Fleissκ统计量计算观察者之间的一致性。结果:36例患者为男性,占77.8%。在第一步中,观察者之间的一致性为κ=0.622(95%CI 0.47-0.77),在MDD后的第二步中改善为κ=0.78(95%CI 0.624-0.935),在步骤3κ=0.76(95%CI 0.614-0.937)和步骤4中,κ=0.969(95%CI 0.828-1.11)几乎完全一致。个体和组诊断的诊断置信度随着伴有和不伴有多学科MDD的BAL的出现而增加。结论:我们发现BAL细胞分析提高了观察者对MDD诊断的一致性和信心,从而有助于未分化ILD病例的决策。
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来源期刊
Chronic Respiratory Disease
Chronic Respiratory Disease RESPIRATORY SYSTEM-
CiteScore
5.90
自引率
7.30%
发文量
47
审稿时长
11 weeks
期刊介绍: Chronic Respiratory Disease is a peer-reviewed, open access, scholarly journal, created in response to the rising incidence of chronic respiratory diseases worldwide. It publishes high quality research papers and original articles that have immediate relevance to clinical practice and its multi-disciplinary perspective reflects the nature of modern treatment. The journal provides a high quality, multi-disciplinary focus for the publication of original papers, reviews and commentary in the broad area of chronic respiratory disease, particularly its treatment and management.
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