TY - JOUR
T1 - Variable radiological lung nodule evaluation leads to divergent management recommendations
AU - Lung Nodule Evaluation Group
AU - Nair, Arjun
AU - Bartlett, Emily C.
AU - Walsh, Simon L.F.
AU - Wells, Athol U.
AU - Navani, Neal
AU - Hardavella, Georgia
AU - Bhalla, Sanjeev
AU - Calandriello, Lucio
AU - Devaraj, Anand
AU - Goo, Jin Mo
AU - Klein, Jeffrey S.
AU - MacMahon, Heber
AU - Schaefer-Prokop, C. M.
AU - Seo, Joon Beom
AU - Sverzellati, Nicola
AU - Desai, Sujal R.
AU - Ahlfors, Fredrik
AU - Bastos, Andréa
AU - Behr, Julien
AU - Benes, Jiri
AU - Bozovic, Gracijela
AU - Buzan, Maria Teodora
AU - Castañer, Eva
AU - Chaves, Marcelo
AU - Choi, Yo Won
AU - Dalpiaz, Giorgia
AU - David, Sarojini
AU - De Jong, Pim A.
AU - Dournes, Gael
AU - Eberhard, Matthias
AU - Escuissato, Dante
AU - Farchione, Alessandra
AU - Flors, Lucia
AU - Franchi, Paola
AU - Frauenfelder, Thomas
AU - Fujimoto, Kiminori
AU - Gatti, Marco
AU - Gavelli, Giampaolo
AU - Grgic, Aleksandar
AU - Haine, Louise
AU - Haramati, Linda
AU - Hartman, Thomas
AU - Hartmann, Ieneke
AU - Hering, Jan Philipp
AU - Herpels, Vincent
AU - Herráez, Inmaculada
AU - Hobbs, Susan
AU - Hochhegger, Bruno
AU - Hursoy, Nur
AU - Ozawa, Yoshiyuki
N1 - Publisher Copyright:
© ERS 2018.
PY - 2018
Y1 - 2018
N2 - Radiological evaluation of incidentally detected lung nodules on computed tomography (CT) influences management. We assessed international radiological variation in 1) pulmonary nodule characterisation; 2) hypothetical guideline-derived management; and 3) radiologists' management recommendations. 107 radiologists from 25 countries evaluated 69 CT-detected nodules, recording: 1) first-choice composition (solid, part-solid or ground-glass, with percentage confidence); 2) morphological features; 3) dimensions; 4) recommended management; and 5) decision-influencing factors. We modelled hypothetical management decisions on the 2005 and updated 2017 Fleischner Society, and both liberal and parsimonious interpretations of the British Thoracic Society 2015 guidelines. Overall agreement for first-choice nodule composition was good (Fleiss' κ=0.65), but poorest for partsolid nodules (weighted κ 0.62, interquartile range 0.50-0.71). Morphological variables, including spiculation (κ=0.35), showed poor-to-moderate agreement (κ=0.23-0.53). Variation in diameter was greatest at key thresholds (5 mm and 6 mm). Agreement for radiologists' recommendations was poor (κ=0.30); 21% disagreed with the majority. Although agreement within the four guideline-modelled management strategies was good (κ=0.63-0.73), 5-10% of radiologists would disagree with majority decisions if they applied guidelines strictly. Agreement was lowest for part-solid nodules, while significant measurement variation exists at important size thresholds. These variations resulted in generally good agreement for guideline-modelled management, but poor agreement for radiologists' actual recommendations.
AB - Radiological evaluation of incidentally detected lung nodules on computed tomography (CT) influences management. We assessed international radiological variation in 1) pulmonary nodule characterisation; 2) hypothetical guideline-derived management; and 3) radiologists' management recommendations. 107 radiologists from 25 countries evaluated 69 CT-detected nodules, recording: 1) first-choice composition (solid, part-solid or ground-glass, with percentage confidence); 2) morphological features; 3) dimensions; 4) recommended management; and 5) decision-influencing factors. We modelled hypothetical management decisions on the 2005 and updated 2017 Fleischner Society, and both liberal and parsimonious interpretations of the British Thoracic Society 2015 guidelines. Overall agreement for first-choice nodule composition was good (Fleiss' κ=0.65), but poorest for partsolid nodules (weighted κ 0.62, interquartile range 0.50-0.71). Morphological variables, including spiculation (κ=0.35), showed poor-to-moderate agreement (κ=0.23-0.53). Variation in diameter was greatest at key thresholds (5 mm and 6 mm). Agreement for radiologists' recommendations was poor (κ=0.30); 21% disagreed with the majority. Although agreement within the four guideline-modelled management strategies was good (κ=0.63-0.73), 5-10% of radiologists would disagree with majority decisions if they applied guidelines strictly. Agreement was lowest for part-solid nodules, while significant measurement variation exists at important size thresholds. These variations resulted in generally good agreement for guideline-modelled management, but poor agreement for radiologists' actual recommendations.
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U2 - 10.1183/13993003.01359-2018
DO - 10.1183/13993003.01359-2018
M3 - Article
C2 - 30409817
AN - SCOPUS:85058870567
SN - 0903-1936
VL - 52
SP - 1
EP - 12
JO - European Respiratory Journal
JF - European Respiratory Journal
IS - 6
ER -