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  • Nair, ArjunUniversity College London (author)

Variable radiological lung nodule evaluation leads to divergent management recommendations

  • Article/chapterEnglish2018

Publisher, publication year, extent ...

  • 2018-11-08
  • European Respiratory Society (ERS),2018

Numbers

  • LIBRIS-ID:oai:lup.lub.lu.se:6697e1db-d515-4928-b075-7b080abc0398
  • https://lup.lub.lu.se/record/6697e1db-d515-4928-b075-7b080abc0398URI
  • https://doi.org/10.1183/13993003.01359-2018DOI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:art swepub-publicationtype
  • Subject category:ref swepub-contenttype

Notes

  • 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.

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Added entries (persons, corporate bodies, meetings, titles ...)

  • Bartlett, Emily CKing's College Hospital (author)
  • Walsh, Simon L FKing's College Hospital (author)
  • Wells, Athol UNHS Foundation Trust (author)
  • Navani, NealUniversity College London (author)
  • Hardavella, GeorgiaKing's College Hospital (author)
  • Bhalla, SanjeevWashington University in St. Louis (author)
  • Calandriello, Lucio (author)
  • Devaraj, Anand (author)
  • Goo, Jin MoSeoul National University Hospital (author)
  • Klein, Jeffrey SUniversity of Vermont Medical Center (UVM) (author)
  • MacMahon, Heber (author)
  • Schaefer-Prokop, C M (author)
  • Seo, Joon-Beom (author)
  • Sverzellati, NicolaUniversity of Parma (author)
  • Desai, Sujal R (author)
  • Bozovic, GracijelaLund University,Lunds universitet,Diagnostisk radiologi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Diagnostic Radiology, (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine(Swepub:lu)med-gbz (creator_code:cre_t)
  • University College LondonKing's College Hospital (creator_code:org_t)
  • Lung Nodule Evaluation Group

Related titles

  • In:The European respiratory journal: European Respiratory Society (ERS)52:6, s. 1-121399-30030903-1936

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