• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of thoraxThoraxVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Thorax. Jun 2004; 59(6): 500–505.
PMCID: PMC1747021

Inter-observer variation between pathologists in diffuse parenchymal lung disease

Abstract

Background: There have been few inter-observer studies of diffuse parenchymal lung disease (DPLD), but the recent ATS/ERS consensus classification provides a basis for such a study.

Methods: A method for categorising numerically the percentage likelihood of these differential diagnoses was developed, and the diagnostic confidence of pathologists using this classification and the reproducibility of their diagnoses were assessed.

Results: The overall kappa coefficient of agreement for the first choice diagnosis was 0.38 (n = 133 biopsies), increasing to 0.43 for patients (n = 83) with multiple biopsies. Weighted kappa coefficients of agreement, quantifying the level of probability of individual diagnoses, were moderate to good (mean 0.58, range 0.40–0.75). However, in 18% of biopsy specimens the diagnosis was given with low confidence. Over 50% of inter-observer variation related to the diagnosis of non-specific interstitial pneumonia and, in particular, its distinction from usual interstitial pneumonia.

Conclusion: These results show that the ATS/ERS classification can be applied reproducibly by pathologists who evaluate DPLD routinely, and support the practice of taking multiple biopsy specimens.

Full Text

The Full Text of this article is available as a PDF (103K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Nicholson AG, Perry LJ, Cury PM, Jackson P, McCormick CM, Corrin B, Wells AU. Reproducibility of the WHO/IASLC grading system for pre-invasive squamous lesions of the bronchus: a study of inter-observer and intra-observer variation. Histopathology. 2001 Mar;38(3):202–208. [PubMed]
  • Kung IT, Lam WK, Lam TH. Observer variability studies of the WHO classification of lung cancer. Cancer Treat Res. 1989;45:53–69. [PubMed]
  • Campobasso O, Andrion A, Ribotta M, Ronco G. The value of the 1981 WHO histological classification in inter-observer reproducibility and changing pattern of lung cancer. Int J Cancer. 1993 Jan 21;53(2):205–208. [PubMed]
  • Skov BG, Lauritzen AF, Hirsch F, Nielsen HW. The histopathological diagnosis of malignant mesothelioma v. pulmonary adenocarcinoma: reproducibility of the histopathological diagnosis. Histopathology. 1994 Jun;24(6):553–557. [PubMed]
  • Skov BG, Braendstrup O, Hirsch FR, Lauritzen AF, Nielsen HW, Skov T. Are pathologists biased by clinical information?: A blinded cross-over study of the histopathological diagnosis of mesothelial tumours versus pulmonary adenocarcinoma. Lung Cancer. 1994 Dec;11(5-6):365–372. [PubMed]
  • Raab SS, Thomas PA, Lenel JC, Bottles K, Fitzsimmons KM, Zaleski MS, Wittchow RJ, McPhaul LW, Slagel DD, Cohen MB. Pathology and probability. Likelihood ratios and receiver operating characteristic curves in the interpretation of bronchial brush specimens. Am J Clin Pathol. 1995 May;103(5):588–593. [PubMed]
  • Colby Thomas V, Tazelaar Henry D, Travis William D, Bergstralh Erik J, Jett James R. Pathologic review of the Mayo Lung Project cancers [corrected]. Is there a case for misdiagnosis or overdiagnosis of lung carcinoma in the screened group? Cancer. 2002 Dec 1;95(11):2361–2365. [PubMed]
  • Nicholson AG, Colby TV, du Bois RM, Hansell DM, Wells AU. The prognostic significance of the histologic pattern of interstitial pneumonia in patients presenting with the clinical entity of cryptogenic fibrosing alveolitis. Am J Respir Crit Care Med. 2000 Dec;162(6):2213–2217. [PubMed]
  • Bouros Demosthenes, Wells Athol U, Nicholson Andrew G, Colby Thomas V, Polychronopoulos Vlasis, Pantelidis Panos, Haslam Patricia L, Vassilakis Dimitris A, Black Carol M, du Bois Roland M. Histopathologic subsets of fibrosing alveolitis in patients with systemic sclerosis and their relationship to outcome. Am J Respir Crit Care Med. 2002 Jun 15;165(12):1581–1586. [PubMed]
  • Nicholson Andrew G, Fulford Laura G, Colby Thomas V, du Bois Roland M, Hansell David M, Wells Athol U. The relationship between individual histologic features and disease progression in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2002 Jul 15;166(2):173–177. [PubMed]
  • Bjoraker JA, Ryu JH, Edwin MK, Myers JL, Tazelaar HD, Schroeder DR, Offord KP. Prognostic significance of histopathologic subsets in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 1998 Jan;157(1):199–203. [PubMed]
  • Daniil ZD, Gilchrist FC, Nicholson AG, Hansell DM, Harris J, Colby TV, du Bois RM. A histologic pattern of nonspecific interstitial pneumonia is associated with a better prognosis than usual interstitial pneumonia in patients with cryptogenic fibrosing alveolitis. Am J Respir Crit Care Med. 1999 Sep;160(3):899–905. [PubMed]
  • Nagai S, Kitaichi M, Itoh H, Nishimura K, Izumi T, Colby TV. Idiopathic nonspecific interstitial pneumonia/fibrosis: comparison with idiopathic pulmonary fibrosis and BOOP. Eur Respir J. 1998 Nov;12(5):1010–1019. [PubMed]
  • Travis WD, Matsui K, Moss J, Ferrans VJ. Idiopathic nonspecific interstitial pneumonia: prognostic significance of cellular and fibrosing patterns: survival comparison with usual interstitial pneumonia and desquamative interstitial pneumonia. Am J Surg Pathol. 2000 Jan;24(1):19–33. [PubMed]
  • Flaherty KR, Travis WD, Colby TV, Toews GB, Kazerooni EA, Gross BH, Jain A, Strawderman RL, Flint A, Lynch JP, et al. Histopathologic variability in usual and nonspecific interstitial pneumonias. Am J Respir Crit Care Med. 2001 Nov 1;164(9):1722–1727. [PubMed]
  • Flaherty KR, Toews GB, Travis WD, Colby TV, Kazerooni EA, Gross BH, Jain A, Strawderman RL, 3rd, Paine R, Flint A, et al. Clinical significance of histological classification of idiopathic interstitial pneumonia. Eur Respir J. 2002 Feb;19(2):275–283. [PubMed]
  • Collins CD, Wells AU, Hansell DM, Morgan RA, MacSweeney JE, du Bois RM, Rubens MB. Observer variation in pattern type and extent of disease in fibrosing alveolitis on thin section computed tomography and chest radiography. Clin Radiol. 1994 Apr;49(4):236–240. [PubMed]
  • Nicholson AG, Wells AU. Nonspecific interstitial pneumonia-nobody said it's perfect. Am J Respir Crit Care Med. 2001 Nov 1;164(9):1553–1554. [PubMed]
  • Yousem Samuel A, Dacic Sanja. Idiopathic bronchiolocentric interstitial pneumonia. Mod Pathol. 2002 Nov;15(11):1148–1153. [PubMed]
  • Flaherty KR, Thwaite EL, Kazerooni EA, Gross BH, Toews GB, Colby TV, Travis WD, Mumford JA, Murray S, Flint A, et al. Radiological versus histological diagnosis in UIP and NSIP: survival implications. Thorax. 2003 Feb;58(2):143–148. [PMC free article] [PubMed]

Articles from Thorax are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...