TY - JOUR
T1 - Observer variability for Lung-RADS categorisation of lung cancer screening CTs
T2 - impact on patient management
AU - van Riel, Sarah J
AU - Jacobs, Colin
AU - Scholten, Ernst Th
AU - Wittenberg, Rianne
AU - Winkler Wille, Mathilde M
AU - de Hoop, Bartjan
AU - Sprengers, Ralf
AU - Mets, Onno M
AU - Geurts, Bram
AU - Prokop, Mathias
AU - Schaefer-Prokop, Cornelia
AU - van Ginneken, Bram
PY - 2019/2
Y1 - 2019/2
N2 - OBJECTIVES: Lung-RADS represents a categorical system published by the American College of Radiology to standardise management in lung cancer screening. The purpose of the study was to quantify how well readers agree in assigning Lung-RADS categories to screening CTs; secondary goals were to assess causes of disagreement and evaluate its impact on patient management.METHODS: For the observer study, 80 baseline and 80 follow-up scans were randomly selected from the NLST trial covering all Lung-RADS categories in an equal distribution. Agreement of seven observers was analysed using Cohen's kappa statistics. Discrepancies were correlated with patient management, test performance and diagnosis of malignancy within the scan year.RESULTS: Pairwise interobserver agreement was substantial (mean kappa 0.67, 95% CI 0.58-0.77). Lung-RADS category disagreement was seen in approximately one-third (29%, 971) of 3360 reading pairs, resulting in different patient management in 8% (278/3360). Out of the 91 reading pairs that referred to scans with a tumour diagnosis within 1 year, discrepancies in only two would have resulted in a substantial management change.CONCLUSIONS: Assignment of lung cancer screening CT scans to Lung-RADS categories achieves substantial interobserver agreement. Impact of disagreement on categorisation of malignant nodules was low.KEY POINTS: • Lung-RADS categorisation of low-dose lung screening CTs achieved substantial interobserver agreement. • Major cause for disagreement was assigning a different nodule as risk-dominant. • Disagreement led to a different follow-up time in 8% of reading pairs.
AB - OBJECTIVES: Lung-RADS represents a categorical system published by the American College of Radiology to standardise management in lung cancer screening. The purpose of the study was to quantify how well readers agree in assigning Lung-RADS categories to screening CTs; secondary goals were to assess causes of disagreement and evaluate its impact on patient management.METHODS: For the observer study, 80 baseline and 80 follow-up scans were randomly selected from the NLST trial covering all Lung-RADS categories in an equal distribution. Agreement of seven observers was analysed using Cohen's kappa statistics. Discrepancies were correlated with patient management, test performance and diagnosis of malignancy within the scan year.RESULTS: Pairwise interobserver agreement was substantial (mean kappa 0.67, 95% CI 0.58-0.77). Lung-RADS category disagreement was seen in approximately one-third (29%, 971) of 3360 reading pairs, resulting in different patient management in 8% (278/3360). Out of the 91 reading pairs that referred to scans with a tumour diagnosis within 1 year, discrepancies in only two would have resulted in a substantial management change.CONCLUSIONS: Assignment of lung cancer screening CT scans to Lung-RADS categories achieves substantial interobserver agreement. Impact of disagreement on categorisation of malignant nodules was low.KEY POINTS: • Lung-RADS categorisation of low-dose lung screening CTs achieved substantial interobserver agreement. • Major cause for disagreement was assigning a different nodule as risk-dominant. • Disagreement led to a different follow-up time in 8% of reading pairs.
KW - Cancer screening
KW - Lung cancer
KW - Observer variation
KW - Solitary pulmonary nodule
KW - X-ray computed tomography
KW - Tomography, X-Ray Computed/methods
KW - Humans
KW - Risk Factors
KW - Solitary Pulmonary Nodule/diagnostic imaging
KW - Early Detection of Cancer/methods
KW - Lung Neoplasms/diagnostic imaging
KW - Mass Screening/methods
KW - Observer Variation
UR - http://www.scopus.com/inward/record.url?scp=85052136644&partnerID=8YFLogxK
U2 - 10.1007/s00330-018-5599-4
DO - 10.1007/s00330-018-5599-4
M3 - Journal article
C2 - 30066248
SN - 0938-7994
VL - 29
SP - 924
EP - 931
JO - European Radiology
JF - European Radiology
IS - 2
ER -