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Presentation transcript:

Subjects characteristics Current guidelines and the Inter-observer Variability of Usual Interstitial Pneumonia Diagnosis Among Chest Radiologists Katarina Janic MD1, Rob Dhillon MD2, Justin Flood MD2, Robert Nolan MD2, Roger Chow MD2, Lisa Jong MD2, Muhannad Hawari MD3 , Onofre Moran MD4 Department of Radiology, University of Toronto1; Department of Radiology, Queen's University2; King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia3; Department of Medicine, Queen's University, Kingston, Ontario, Canada4. R E S U L T S Agreement between Chest Radiologists Background UIP Pattern Honeycombing Current ATS/ERS/JRS/ALAT guidelines on Idiopathic Pulmonary Fibrosis have proposed criteria to diagnose Usual Interstitial Pneumonia (UIP) on a High Resolution chest Computed Tomography (HRCT); and state that a definite UIP pattern on HRCT obviates the need of a surgical biopsy. However, these criteria have not been prospectively validated. Two chest Radiologists at a tertiary care academic center in Canada reviewed 117 HRCTs of patients with Interstitial Lung Diseases (ILD) applying current guidelines to determine the diagnosis of UIP. They assessed the presence and distribution of reticulation and honeycombing, as per the guidelines. All HRCTs interpretations were done by the chest radiologists independently and blinded to each other’s diagnosis; they were also blinded to previous radiological interpretations and clinical diagnosis. Methods Subjects characteristics Chest Radiologist 1 (CR 1) Chest Radiologist 2 (CR 2) Total Definite N (%) Not Definite* N (%) 36 (66%) 19 (35%) 55 Not Definite* N (%) 11 (18%) 51 (82%) 62 47 70 117 CR 1 CR 2 Total Absent N (%) Present N (%) 34 (71%) 14 (29%) 48 Present N (%) 6 (9%) 63 (91%) 69 40 77 117 Mean Age (Min-Max) 71 (42-88) Gender M 65% F 35% Diagnosis IPF 66 NSIP 19 CTD-UIP 9 HP 6 Other 17 Total 117 Objective To assess the agreement among chest radiologists in the diagnosis of UIP, when applying current guidelines. Other include: Asbestosis, Drug related ILD , Respiratory Bronchiolitis-ILD, Interstitial Pneumonia with Autoimmune Features, and Unclassifiable ILD. * One radiologist determined that two cases did not have ILD. Percentage Agreement Kappa (κ) UIP Pattern 74% 0.48 Honeycombing 85% 0.70 Reticulation 95% 0.64 Basilar predominance 73% 0.46 Subpleural predominance 82% 0.39 Reticulation Subpleural Predominance CR 1 CR 2 Total Absent N (%) Present N (%) 4 (100%) 0 (0%) 4 Present N (%) 4 (3%) 109 (97%) 113 8 109 117 CR 1 CR 2 Total * Yes N (%) No N (%) 6 (46%) 12 No N (%) 7 (7%) 96 (93%) 103 13 102 115 * One radiologist determined that two cases did not have ILD. Chest radiologists achieved only moderate agreement in the diagnosis of a definite UIP pattern on HRCT when applying guideline recommended criteria. Disagreement in the diagnosis of UIP pattern occurred in one out of every 4 patients. The main disagreement was about the location of abnormalities. Future guidelines should include criteria with high inter-observer agreement. Conclusions Statistics We calculated the percentage agreement between radiologists and the Kappa statistic (κ).