Variable radiological lung nodule evaluation leads to divergent management recommendations

Anna Rita Larici, Lucio Calandriello, Alessandra Farchione, Arjun Nair, Emily C. Bartlett, Simon L.F. Walsh, Athol U. Wells, Neal Navani, Georgia Hardavella, Sanjeev Bhalla, Anand Devaraj, Jin Mo Goo, Jeffrey S. Klein, Heber Macmahon, C. M. Schaefer-Prokop, Joon-Beom Seo, Nicola Sverzellati, Sujal R. Desai, Fredrik Ahlfors, Andréa BastosJulien Behr, Jiri Benes, Gracijela Bozovic, Maria Teodora Buzan, Eva Castañer, Marcelo Chaves, Yo Won Choi, Giorgia Dalpiaz, Sarojini David, Pim A. De Jong, Gael Dournes, Matthias Eberhard, Dante Escuissato, Lucia Flors, Paola Franchi, Thomas Frauenfelder, Kiminori Fujimoto, Marco Gatti, Giampaolo Gavelli, Aleksandar Grgic, Louise Haine, Linda Haramati, Thomas Hartman, Ieneke Hartmann, Jan Philipp Hering, Vincent Herpels, Inmaculada Herráez, Susan Hobbs, Bruno Hochhegger, Nur Hursoy, Joana Ip, Srikanth Iyengar, Juan Arenas Jiménez, Katharine Johnson, Jeffrey Kanne, Sangita Kapur, Can Zafer Karaman, Robert Karl, Galina Kirova, Jane Ko, Gerdien Kramer, Melahat Kul, Youkyung Lee, Leonard Leifels, Sebastian Ley, Stephen Machnicki, Panagiotis Maidas, Sze Mun Mak, Francesca Mariani, Gustavo Meirelles, Firdaus A. Mohamed Hoesein, Xavier Montet, John Murchison, Hrudaya Nath, Tatyana Nenkina, Edward Nganga, Thi Dan Linh Nguyen-Kim, Tilo Niemann, Carlos Francisco Muñoz Núñez, Mariaelena Occhipinti, Anastasia Oikonomou, Yoshiyuki Ozawa, Tej Pandher, Anagha P. Parkar, Sara Piciucchi, Diogo Pinheiro, Antonio Poerio, Roberta Polverosi, Kristen Pope, Helmut Prosch, Ilaria Pulzato, Cristiano Rampinelli, Jonathan Rodrigues, Odyssefs Romanos, Chiara Romei, Justus Roos, Santiago Rossi, Roman Rubtsov, Margherita Ruggirello, Marcelo Sánchez, Marcel Koenigkam Santos, Michael Schubert, Taiwo Senbanjo, Claudio Silva, Mario Silva, Annemie Snoeckx, Sushilkumar Sonavane, Mona Sriharan, Konstantinos Stefanidis, Onur Taydas, Noriyuki Tomiyama, Sa Tran, Alberto Villanueva, Michelle Williams

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

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.
Original languageEnglish
Pages (from-to)1-12
Number of pages12
JournalEuropean Respiratory Journal
Volume52
DOIs
Publication statusPublished - 2018

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Lung Neoplasms
  • Male
  • Middle Aged
  • Multiple Pulmonary Nodules
  • Observer Variation
  • Practice Guidelines as Topic
  • Radiologists
  • Reproducibility of Results
  • Solitary Pulmonary Nodule
  • Tomography, X-Ray Computed

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