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Twenty-four Indian referral centres discussed 127 anonymised ILD cases across 29 sessions (Feb 2024–Feb 2025) with pulmonologists, rotating thoracic radiologists, pulmonary pathologists and rheumatologists, plus international experts. Post-V-MDD CT diagnoses showed substantial concordance (κ=0.658), with overall 23% reclassification. Stability was highest for organising pneumonia, CTD-ILD and UIP, while HP and sarcoidosis reclassified 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Virtual multidisciplinary discussion across borders for interstitial lung disease: a prospective, multicentre study from  \nIndia, the UK, Greece and Sri Lanka. BMJ Open 2025;15:e110693 . doi:10 . 1136/ bmjopen-2025-110693  \n► Pre-publication history and additional supplemental material for this paper are available online. To view these files, please visit the journal online ([https://doi.org/10.1136/](https://doi.org/10.1136/)[ ](https://doi.org/10.1136/)[bmjopen-2025-110693](bmjopen-2025-110693)) .  \nReceived 11 September 2025 Accepted 15 December 2025  \n© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.  \nFor numbered affiliations see end of article.  \nCorrespondence to  \nDr Asmita Anilkumar Mehta; [asmitamehta@aims.amrita.edu](asmitamehta@aims.amrita.edu)  \nVirtual multidisciplinary discussion across borders for interstitial lung disease: a prospective, multicentre study from India, the UK, Greece and Sri Lanka  \nAsmita Anilkumar Mehta  ,1 Sujeet Rajan,2 Subin Ahmed,3 Bhavin Jankharia,4 Athol U Wells,5 Mithun CB,6 BVM Mohan,7 Vimal Raj,8 Ritu Kulshrestha,9 Pralhad Prabhudesai,10 Aparna Irodi,11 Lakshmi Priya Valathara Pradeep,12 Amila Rathnapala,13 KM Antoniou,14 Sharada Nagoti15  \nABSTRACT  \nObjectives To assess diagnostic concordance andreclassification following an India-led, multinational virtual multidisciplinary discussion (V-MDD) platform for interstitial lung disease (ILD) .  \nDesign Prospective, multicentre service-evaluation study.  \nSetting Twenty-four Indian referral centres connected through a secure virtual platform, with international faculty participation from the UK, Greece and Sri Lanka.  \nParticipants 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-VMDD 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  \nV-MDD CT diagnoses was substantial (κ=0 . 658; 95% CI 0.562 to 0. 754; p \u003C0 . 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.  \nConclusions The India-led, multinational V  \nMDD 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 resourcelimited and cross-border settings.  \nSTRENGTHS AND LIMITATIONS OF THIS STUDY   \n⇒ This study represents the first India-led, multinational virtual multidisciplinary discussion (V-MDD) platform for interstitial lung disease and demonstrates the feasibility and scalability of such a model within a low-and middle-income country context.  \n⇒ The inclusion of multiple centres across India and  \n127 real-world interstitial lung disease (ILD) cases ensured representation of a broad spectrum of disease subtypes and referral patterns.  \n⇒ The balanced expert composition—incorporating pulmonologists, thoracic radiologists, pulmonary pathologists, rheumatologists and international faculty—facilitated comprehensive case evaluation and minimised ","cbCaitZFj6S2uXLp","https://ap.wps.com/l/cbCaitZFj6S2uXLp","pdf",1974547,"English","# Abstract\n# Strengths and limitations of this study\n# Introduction","[{\"question\":\"What was the objective of the India-led virtual multidisciplinary discussion (V-MDD) study?\",\"answer\":\"To assess diagnostic concordance and reclassification following an India-led multinational V-MDD platform for interstitial lung disease (ILD).\"},{\"question\":\"How was the study conducted and who participated in each V-MDD session?\",\"answer\":\"Twenty-four Indian referral centres discussed 127 anonymised ILD cases across 29 sessions (Feb 2024–Feb 2025), with ≥4 pulmonologists, two pulmonary pathologists, rotating thoracic radiologists, and rheumatologists, plus international experts.\"},{\"question\":\"How much did diagnoses change after the V-MDD review?\",\"answer\":\"Overall, 23% of cases were reclassified after discussion, with greatest stability for organising pneumonia, CTD-ILD and UIP and the highest reclassification rates for hypersensitivity pneumonitis and sarcoidosis.\"}]","Virtual multidisciplinary discussion across borders for interstitial lung disease - a prospective, multicentre study from India, the UK, Greece and Sri Lanka | PDF",1790671362,23]