Interobserver agreement for the ATS/ERS/JRS/ALAT criteria for a UIP pattern on CT

• Published in: Thorax Vol. 71; no. 1; pp. 45 - 51
• Main Authors: Walsh, Simon L F, Calandriello, Lucio, Sverzellati, Nicola, Wells, Athol U, Hansell, David M
• Format: Journal Article Web Resource
• Language: English
• Published: England BMJ Publishing Group LTD 01.01.2016; BMJ Publishing Group
• Subjects: Agreements; Biopsy; Clinical Competence; Disease Progression; Emphysema; Female; Human health sciences; Humans; Idiopathic Interstitial Pneumonias - diagnostic imaging; Idiopathic Interstitial Pneumonias/radiography; Idiopathic pulmonary fibrosis; Imaging/CT MRI etc; Interstitial Fibrosis; Lung diseases; Male; Management decisions; Medical imaging; Middle Aged; Performance evaluation; Practice Patterns, Physicians; Prognosis; Pulmonary fibrosis; Radiography, Thoracic - standards; Radiologie, médecine & imagerie nucléaire; Radiology, nuclear medicine & imaging; Sarcoidosis; Sciences de la santé humaine; Studies; Tomography, X-Ray Computed - standards; Interstitial Fibrosis; Imaging/CT MRI etc; Idiopathic pulmonary fibrosis
• ISSN: 0040-6376; 1468-3296; 1468-3296
• DOI: 10.1136/thoraxjnl-2015-207252

ObjectivesTo establish the level of observer variation for the current ATS/ERS/JRS/ALAT criteria for a diagnosis of usual interstitial pneumonia (UIP) on CT among a large group of thoracic radiologists of varying levels of experience.Materials and methods112 observers (96 of whom were thoracic radiologists) categorised CTs of 150 consecutive patients with fibrotic lung disease using the ATS/ERS/JRS/ALAT CT criteria for a UIP pattern (3 categories—UIP, possibly UIP and inconsistent with UIP). The presence of honeycombing, traction bronchiectasis and emphysema was also scored using a 3-point scale (definitely present, possibly present, absent). Observer agreement for the UIP categorisation and for the 3 CT patterns in the entire observer group and in subgroups stratified by observer experience, were evaluated.ResultsInterobserver agreement across the diagnosis category scores among the 112 observers was moderate, ranging from 0.48 (IQR 0.18) for general radiologists to 0.52 (IQR 0.20) for thoracic radiologists of 10–20 years’ experience. A binary score for UIP versus possible or inconsistent with UIP was examined. Observer agreement for this binary score was only moderate. No significant differences in agreement levels were identified when the CTs were stratified according to multidisciplinary team (MDT) diagnosis or patient age or when observers were categorised according to experience. Observer agreement for each of honeycombing, traction bronchiectasis and emphysema were 0.59±0.12, 0.42±0.15 and 0.43±0.18, respectively.ConclusionsInterobserver agreement for the current ATS/ERS/JRS/ALAT CT criteria for UIP is only moderate among thoracic radiologists, irrespective of their experience, and did not vary with patient age or the MDT diagnosis.