Idiopathic interstitial pneumonia - What is the effect of a multidisciplinary approach to diagnosis?
Idiopathic interstitial pneumonia - What is the effect of a multidisciplinary approach to diagnosis?
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DOI：
10.1164/rccm.200402-147oc
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发表时间：
2004-10-15
影响因子：
24.7
通讯作者：
Martinez, FJ
中科院分区：
文献类型：
--
作者：
Flaherty, KR;King, TE;Martinez, FJ
目前的指南建议临床医生、放射科医生和病理学家共同努力做出特发性间质性肺炎的诊断。三名临床医生、两名放射科医生和两名病理学家回顾了 58 例连续疑似特发性间质性肺炎的病例。每个参与者都按顺序获得信息，并被要求记录他们的诊断印象和每一步的置信度。从评审开始到结束，观察者间的一致性得到了改善。在提供组织病理学信息后，放射科医生比临床医生更频繁地改变他们的诊断印象。一般来说，随着提供的信息越多，给定诊断的置信度就会提高，并且具有高置信度的诊断更有可能与最终的病理共识诊断一致。 30例病理学家最终一致诊断为特发性肺纤维化。在提供组织病理学信息之前，临床医生确定了 75% 的病例，放射科医生确定了 48% 的病例。组织病理学信息对最终诊断影响最大，特别是当最初的临床/放射学诊断不是特发性肺纤维化时。我们的结论是，临床医生、放射科医生和病理学家之间的动态互动提高了观察者间的一致性和诊断信心。
Current guidelines recommend that the clinician, radiologist, and pathologist work together to establish a diagnosis of idiopathic interstitial pneumonia. Three clinicians, two radiologists, and two pathologists reviewed 58 consecutive cases of suspected idiopathic interstitial pneumonia. Each participant was provided information in a sequential manner and was asked to record their diagnostic impression and level of confidence at each step. Interobserver agreement improved from the beginning to the end of the review. After the presentation of histopathologic information, radiologists changed their diagnostic impression more often than did clinicians. In general, as more information was provided the confidence level for a given diagnosis improved, and the diagnoses rendered with a high level of confidence were more likely congruent with the final pathologic consensus diagnosis. The final consensus pathologist diagnosis was idiopathic pulmonary fibrosis in 30 cases. Clinicians identified 75% and radiologists identified 48% of these cases before presentation of the histopathologic information. Histopathologic information has the greatest impact on the final diagnosis, especially when the initial clinical/radiographic diagnosis is not idiopathic pulmonary fibrosis. We conclude that dynamic interactions between clinicians, radiologists, and pathologists improve interobserver agreement and diagnostic confidence.