Variable radiological lung nodule evaluation leads to divergent management recommendations. Issue 6 (20th December 2018)

• Record Type: Journal Article
• Authors: Nair, Arjun; Bartlett, Emily C.; Walsh, Simon L.F.; Wells, Athol U.; Navani, Neal; Hardavella, Georgia; Bhalla, Sanjeev; Calandriello, Lucio; Devaraj, Anand; Goo, Jin Mo; Klein, Jeffrey S.; MacMahon, Heber; Schaefer-Prokop, C.M.; Seo, Joon-Beom; Sverzellati, Nicola; Desai, Sujal R.
• Other Names: author non-byline.; Ahlfors Fredrik author non-byline.; Bastos Andréa author non-byline.; Behr Julien author non-byline.; Benes Jiri author non-byline.; Bozovic Gracijela author non-byline.; Teodora Buzan Maria author non-byline.; Castañer Eva author non-byline.; Chaves Marcelo author non-byline.; Won Choi Yo author non-byline.; Dalpiaz Giorgia author non-byline.; David Sarojini author non-byline.; De Jong Pim A. author non-byline.; Dournes Gael author non-byline.; Eberhard Matthias author non-byline.; Escuissato Dante author non-byline.; Farchione Alessandra author non-byline.; Flors Lucia author non-byline.; Franchi Paola author non-byline.; Frauenfelder Thomas author non-byline.; Fujimoto Kiminori author non-byline.; Gatti Marco author non-byline.; Gavelli Giampaolo author non-byline.; Grgic Aleksandar author non-byline.; Haine Louise author non-byline.; Haramati Linda author non-byline.; Hartman Thomas author non-byline.; Hartmann Ieneke author non-byline.; Hering Jan Philipp author non-byline.; Herpels Vincent author non-byline.; Herráez Inmaculada author non-byline.; Hobbs Susan author non-byline.; Hochhegger Bruno author non-byline.; Hursoy Nur author non-byline.; Ip Joana author non-byline.; Iyengar Srikanth author non-byline.; Jiménez Juan Arenas author non-byline.; Johnson Katharine author non-byline.; Kanne Jeffrey author non-byline.; Kapur Sangita author non-byline.; Karaman Can Zafer author non-byline.; Karl Robert author non-byline.; Kirova Galina author non-byline.; Ko Jane author non-byline.; Kramer Gerdien author non-byline.; Kul Melahat author non-byline.; Larici Anna Rita author non-byline.; Lee Youkyung author non-byline.; Leifels Leonard author non-byline.; Ley Sebastian author non-byline.; Machnicki Stephen author non-byline.; Maidas Panagiotis author non-byline.; Mak Sze Mun author non-byline.; Mariani Francesca author non-byline.; Meirelles Gustavo author non-byline.; Mohamed Hoesein Firdaus A. author non-byline.; Montet Xavier author non-byline.; Murchison John author non-byline.; Nath Hrudaya author non-byline.; Nenkina Tatyana author non-byline.; Nganga Edward author non-byline.; Nguyen-Kim Thi Dan Linh author non-byline.; Niemann Tilo author non-byline.; Núñez Carlos Francisco Muñoz author non-byline.; Occhipiniti Mariaelena author non-byline.; Oikonomou Anastasia author non-byline.; Ozawa Yoshiyuki author non-byline.; Pandher Tej author non-byline.; Parkar Anagha P. author non-byline.; Piciucchi Sara author non-byline.; Pinheiro Diogo author non-byline.; Poerio Antonio author non-byline.; Polverosi Roberta author non-byline.; Pope Kristen author non-byline.; Prosch Helmut author non-byline.; Pulzato Ilaria author non-byline.; Rampinelli Cristiano author non-byline.; Rodrigues Jonathan author non-byline.; Romanos Odyssefs author non-byline.; Romei Chiara author non-byline.; Roos Justus author non-byline.; Rossi Santiago author non-byline.; Rubtsov Roman author non-byline.; Ruggirello Margherita author non-byline.; Sánchez Marcelo author non-byline.; Santos Marcel Koenigkam author non-byline.; Schubert Michael author non-byline.; Senbanjo Taiwo author non-byline.; Silva Claudio author non-byline.; Silva Mario author non-byline.; Snoeckx Annemie author non-byline.; Sonavane Sushilkumar author non-byline.; Sriharan Mona author non-byline.; Stefanidis Konstantinos author non-byline.; Taydas Onur author non-byline.; Tomiyama Noriyuki author non-byline.; Tran Sa author non-byline.; Villanueva Alberto author non-byline.; Williams Michelle author non-byline.;
• Is Part Of: European respiratory journal. Volume 52:Issue 6(2018)
• Publication Date: 2018-12-20
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; 616.2
• DOI: 10.1183/13993003.01359-2018
• Languages: English
• ISSNs: 0903-1936

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 part-solid 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. Radiological variations in pulmonary nodule evaluation translate into good overall agreement for guideline-modelled management, but poor agreement for radiologists' actual recommendations: 21% of radiologists can disagree with majority decisions http://ow.ly/bPOu30mcRYA