Variable radiological lung nodule evaluation leads to divergent management recommendations

and the Lung Nodule Evaluation Group, Lung Nodule Evaluation Group

Research output: Contribution to journalArticle

3 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 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.

Original languageEnglish
JournalThe European respiratory journal
Volume52
Issue number6
DOIs
Publication statusPublished - Dec 1 2018

Fingerprint

Guidelines
Lung
Tomography
Glass
Radiologists

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Variable radiological lung nodule evaluation leads to divergent management recommendations. / and the Lung Nodule Evaluation Group; Lung Nodule Evaluation Group.

In: The European respiratory journal, Vol. 52, No. 6, 01.12.2018.

Research output: Contribution to journalArticle

and the Lung Nodule Evaluation Group ; Lung Nodule Evaluation Group. / Variable radiological lung nodule evaluation leads to divergent management recommendations. In: The European respiratory journal. 2018 ; Vol. 52, No. 6.
@article{b69e197f6b2240d2a12e541c8958f2e7,
title = "Variable radiological lung nodule evaluation leads to divergent management recommendations",
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.",
author = "{and the Lung Nodule Evaluation Group} and {Lung Nodule Evaluation Group} and Arjun Nair and Bartlett, {Emily C.} and Walsh, {Simon L.F.} and Wells, {Athol U.} and Neal Navani and Georgia Hardavella and Sanjeev Bhalla and Lucio Calandriello and Anand Devaraj and Goo, {Jin Mo} and Klein, {Jeffrey S.} and Heber MacMahon and Schaefer-Prokop, {C. M.} and Seo, {Joon Beom} and Nicola Sverzellati and Desai, {Sujal R.}",
year = "2018",
month = "12",
day = "1",
doi = "10.1183/13993003.01359-2018",
language = "English",
volume = "52",
journal = "European Journal of Respiratory Diseases",
issn = "0903-1936",
publisher = "European Respiratory Society",
number = "6",

}

TY - JOUR

T1 - Variable radiological lung nodule evaluation leads to divergent management recommendations

AU - and the Lung Nodule Evaluation Group

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.

PY - 2018/12/1

Y1 - 2018/12/1

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 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.

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 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.

UR - http://www.scopus.com/inward/record.url?scp=85058870567&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058870567&partnerID=8YFLogxK

U2 - 10.1183/13993003.01359-2018

DO - 10.1183/13993003.01359-2018

M3 - Article

VL - 52

JO - European Journal of Respiratory Diseases

JF - European Journal of Respiratory Diseases

SN - 0903-1936

IS - 6

ER -