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Acta Radiol. 2015 Oct;56(10):1180-6. doi: 10.1177/0284185114551975. Epub 2014 Oct 7.

Inter-reader variability when applying the 2013 Fleischner guidelines for potential solitary subsolid lung nodules.

Author information

1
Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA alex3005@stanford.edu.
2
Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA.

Abstract

BACKGROUND:

In 2013, the Fleischner Society published recommendations for managing subsolid pulmonary nodules. Inter-reader variability has not yet been defined and has potential implications for the ease and reproducibility of applying the guidelines to clinical practice.

PURPOSE:

To evaluate inter-reader variability when applying the 2013 Fleischner guidelines for potential solitary subsolid lung nodules.

MATERIAL AND METHODS:

Potential nodules were identified through a systematic retrospective review of CT studies that reported a ground-glass lesion. Three radiologists decided whether these lesions fit criteria of a subsolid nodule and thus merit application of the Fleischner Society guidelines, determined if a solid component was present, and measured each component in two dimensions. Final management recommendations were based on these intermediate decisions. Inter-reader variability for management was calculated and Fleiss' kappa was used to determine significance. Logistic regression and Fisher's exact test determined whether management was contingent on each intermediate decision.

RESULTS:

Forty-four nodules with mean diameter of 9.4 mm were evaluated by three radiologists. Final management recommendations were in agreement for 93 out of 132 cases (70.4%, kappa = 0.56). Inter-reader variability in management recommendation was contingent on disagreement over whether a pulmonary lesion fit criteria of a subsolid nodule for 24 cases (P < 0.01), whether there was a solid component for 10 cases (P = 0.01), and whether the measurement met the threshold of 5 mm for five cases (P = 0.12).

CONCLUSION:

There is moderate inter-reader variability when applying the 2013 Fleischner Society management recommendations. Significant contributors of variability include whether the potential lesions fit subsolid nodule criteria and whether a solid component is present. Measurement variability does not significantly affect the final management decisions.

KEYWORDS:

CT – spiral; decision analysis; lung; thorax

PMID:
25293951
DOI:
10.1177/0284185114551975
[Indexed for MEDLINE]

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