Abstract

Introduction
NICE recommends MDT presentation of all patients with suspected ILD. Any benefit of representation post VATS biopsy is unknown.

Methods
Our hospital (BHH) provides a regional service for thoracic surgery. All VATS lung biopsies for interstitial lung diseases carried out in 2013 were identified. They were presented post surgery at the ILD MDT where their history, physiology, immunology, original CTs and pathology were reviewed by a fully constituted MDT team including ILD specialist histopathologists, radiologists, clinicians and CNS’. The MDT diagnosis was compared with the original specialist pulmonary histopathology report.

Results
71 patients had qualifying VATS biopsies in 2013. In 21 patients (30%) the MDT diagnosis differed significantly from the original histology report. In a further 12 patients the MDT altered a probable to a definite diagnosis. In 3 patients the MDT reduced the confidence of the histological diagnosis. Hypersensitivity pneumonitis was diagnosed much more confidently by the MDT than the histologist alone. The interpretation of necrotising granuloma was a particular problem from the histology alone; the MDT confirming diagnoses of rheumatoid lung, sarcoidosis or no ILD. It was also possible to achieve specific diagnoses in 5 patients whose biopsies were reported as non-specific fibrosis; NSIP (2), UIP (2), HP (1), and in 2 in whom the original report was resolving pneumonia (both HP). In 10/21 patients there was sufficient evidence to classify the UIP as IPF (7), collagen vascular disease UIP (1), chronic HP UIP (1), and drug induced UIP (1). There was often insufficient exposure and immunological data for the MDT to further characterise UIP and NSIP.

Conclusions
The post biopsy MDT changed the diagnosis in 30% compared with the histology report alone. An ILD MDT review with the combination of radiology and pathology and an expert team provided significant extra benefit in terms of a precise diagnosis in patients biopsied with interstitial lung disease in whom the referring physician thought that a diagnosis was not possible without a biopsy. This is not surprising as the histologist is limited by sampling, the radiologist by resolution, and both by the lack of physiology, exposure history and immunology.

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