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Multidisciplinary Approach to Diagnosis of IPF
Diagnosing IPF: Multidisciplinary discussions
Multidisciplinary discussions are recommended for diagnosing IPF
The ATS/ERS/JRS/ALAT guidelines recommend using an MDD to evaluate all cases of suspected IPF that do not have a definite diagnosis by evaluating clinical and radiologic evidence alone1,2
1. Raghu G et al. Am J Respir Crit Care Med. 2018;198(5):e44-e68. 2. Raghu G et al. Am J Respir Crit Care Med. 2011;183(6):788-824.
2
MDD, multidisciplinary discussion.
Multidisciplinary discussions improve diagnostic confidence
An MDD involves a panel of ILD experts including clinicians, radiologists, and pathologists familiar with IPF who discuss the full array of findings to come to a consensus diagnosis2-4
Prior to holding an MDD, there is often disagreement on a diagnosis, even among ILD experts5,6
2. Raghu G et al. Am J Respir Crit Care Med. 2011;183(6):788-824. 3. ATS. Am J Respir Crit Care Med. 2002;165:277-304. 4. Lynch DA et al. Lancet. 2018;6(2):138-153. 5. Flaherty KR et al. Am J Respir Crit Care Med. 2004;170(8):904-910. 6. Tomassetti S et al. Am J Respir Crit Care Med. 2016; 193(7):745-752.
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ILD, interstitial lung disease.
Multidisciplinary discussions are only used once a patient has a suspected ILD
MDDs are the standard for diagnosing ILDs7
2. Raghu G et al. Am J Respir Crit Care Med. 2011;183(6):788-824. 7. du Bois RM. Eur Respir Rev. 2012;21(124):141-146.
4
When clinical and radiologic evidence alone are not conclusive, biopsy and MDD are critical for a diagnosis
When HRCT scans do not show a UIP pattern, SLB is indicated to provide a definitive diagnosis of IPF or other ILD1,2,4
Cases that warrant taking a biopsy should be evaluated in an MDD1,2,4
1. Raghu G et al. Am J Respir Crit Care Med. 2018;198(5):e44-e68. 2. Raghu G et al. Am J Respir Crit Care Med. 2011;183(6):788-824. 4. Lynch DA et al. Lancet. 2018;6(2):138-153.
SLB comes with risks and can be contraindicated for much of this population1
5
HRCT, high-resolution computed tomography; SLB, surgical lung biopsy.
MDDs synthesize all the data to produce a consensus diagnosis
An MDD involves taking the full sum of evidence (clinical, HRCT, and histopathologic findings) into account to help the panel determine whether the findings point to IPF or another pathology1,2,4,8
Clinical
findings
Radiologic
findings
Histopathologic
findings
+
+
+
Expert opinion
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1. Raghu G et al. Am J Respir Crit Care Med. 2018;198(5):e44-e68. 2. Raghu G et al. Am J Respir Crit Care Med. 2011;183(6):788-824. 4. Lynch DA et al. Lancet. 2018;6(2):138-153.
8. Larsen BT et al. Arch Pathol Lab Med. 2012;136(10):1234-1241.
Suspected Case of IPF
Histopathology
UIP
Probable UIP
Indeterminate for UIP
Alternative Diagnosis
HRCT results
UIP
IPF
IPF
IPF
Not IPF
Probable UIP
IPF
IPF
IPF Likely
Not IPF
Indeterminate for UIP
IPF
IPF Likely
Indeterminate
Not IPF
Alternative Diagnosis
IPF (likely) or non-IPF
Not IPF
Not IPF
Not IPF
Combinations of radiologic and pathologic data can point to a diagnosis1
1. Raghu G et al. Am J Respir Crit Care Med. 2018;198(5):e44-e68. 2. Raghu G et al. Am J Respir Crit Care Med. 2011;183(6):788-824. 4. Lynch DA et al. Lancet. 2018;6(2):138-153. 9. ATS. Am J Respir Crit Care Med. 2000;161(2 Pt 1):646-64.
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Summary
1. Raghu G et al. Am J Respir Crit Care Med. 2018;198(5):e44-e68. 2. Raghu G et al. Am J Respir Crit Care Med. 2011;183(6):788-824. 4. Lynch DA et al. Lancet. 2018;6(2):138-153.
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References
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