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Variable radiologic...
Variable radiological lung nodule evaluation leads to divergent management recommendations
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- Nair, Arjun (author)
- University College London
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- Bartlett, Emily C (author)
- King's College Hospital
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- Walsh, Simon L F (author)
- King's College Hospital
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- Wells, Athol U (author)
- NHS Foundation Trust
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- Navani, Neal (author)
- University College London
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- Hardavella, Georgia (author)
- King's College Hospital
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- Bhalla, Sanjeev (author)
- Washington University in St. Louis
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Calandriello, Lucio (author)
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Devaraj, Anand (author)
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- Goo, Jin Mo (author)
- Seoul National University Hospital
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- Klein, Jeffrey S (author)
- University of Vermont Medical Center (UVM)
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MacMahon, Heber (author)
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Schaefer-Prokop, C M (author)
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Seo, Joon-Beom (author)
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- Sverzellati, Nicola (author)
- University of Parma
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Desai, Sujal R (author)
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- Bozovic, Gracijela (creator_code:cre_t)
- Lund 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
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(creator_code:org_t)
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- 2018-11-08
- 2018
- English.
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In: The European respiratory journal. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 52:6, s. 1-12
- Related links:
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http://dx.doi.org/10...
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https://erj.ersjourn...
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https://lup.lub.lu.s...
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https://doi.org/10.1...
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Abstract
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Lungmedicin och allergi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Respiratory Medicine and Allergy (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Radiologi och bildbehandling (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Radiology, Nuclear Medicine and Medical Imaging (hsv//eng)
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- art (subject category)
- ref (subject category)
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- By the author/editor
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Nair, Arjun
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Bartlett, Emily ...
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Walsh, Simon L F
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Wells, Athol U
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Navani, Neal
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Hardavella, Geor ...
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show more...
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Bhalla, Sanjeev
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Calandriello, Lu ...
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Devaraj, Anand
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Goo, Jin Mo
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Klein, Jeffrey S
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MacMahon, Heber
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Schaefer-Prokop, ...
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Seo, Joon-Beom
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Sverzellati, Nic ...
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Desai, Sujal R
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Bozovic, Gracije ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Respiratory Medi ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Radiology Nuclea ...
- Articles in the publication
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The European res ...
- By the university
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Lund University