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Multidisciplinary interobserver agreement in the diagnosis of idiopathic pulmonary fibrosis

M. Thomeer, M. Demedts, J. Behr, R. Buhl, U. Costabel, C. D. R. Flower, J. Verschakelen, F. Laurent, A. G. Nicholson, E. K. Verbeken, F. Capron, M. Sardina, G. Corvasce, I. Lankhorst the Idiopathic Pulmonary Fibrosis International Group Exploring N-Acetylcysteine I Annual (IFIGENIA) study group
European Respiratory Journal 2008 31: 585-591; DOI: 10.1183/09031936.00063706
M. Thomeer
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M. Demedts
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J. Behr
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R. Buhl
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U. Costabel
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C. D. R. Flower
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J. Verschakelen
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F. Laurent
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A. G. Nicholson
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E. K. Verbeken
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F. Capron
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M. Sardina
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G. Corvasce
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I. Lankhorst
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  • Fig. 1—
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    Fig. 1—

    Study profile of the a) radiology panel and b) histology panel. Observer F was only solicited when observers D and E disagreed. HRCT: high-resolution computed tomography; IPF: idiopathic pulmonary fibrosis; OLB: open lung biopsy; TLB: thoracoscopic lung biopsy; UIP: usual interstitial pneumonia.

  • Fig. 2—
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    Fig. 2—

    The proportion of usual interstitial pneumonia (UIP) diagnosis (□: negative; ▓: positive) on open lung biopsy (OLB)/thoracoscopic lung biopsy (TLB) correlated with the degree of confidence of UIP diagnosis on 238 high-resolution computed tomography (HRCT) observations (40 unlikely, 90 probable and 108 very suggestive).

Tables

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  • Table 1—

    Diagnosis of idiopathic pulmonary fibrosis(IPF) in different subgroups

    IPF by HRCTUIP by OLB/TLBDefinite diagnosis#
    AbsentPresentAbsentPresentAbsentPresent
    Subjects n17982179
    Belgium2 (10.0)18 (90.0)1 (8.3)11 (91.7)2 (10.0)18 (90.0)
    France4 (10.0)36 (90.0)4 (26.7)11 (73.3)6 (15.0)34 (85.0)
    Germany3 (4.8)59 (95.2)5 (29.4)12 (70.6)8 (12.9)54 (87.1)
    Italy1 (5.9)16 (94.1)1 (14.3)6 (85.7)1 (5.9)16 (94.1)
    The Netherlands2 (10.5)17 (89.5)0 (0.0)19 (100.0)2 (10.5)17 (89.5)
    Spain2 (9.5)19 (90.5)3 (25.0)9 (75.0)4 (19.0)17 (81.0)
    Total14 (7.3)165 (92.7)14 (16.0)68 (84.0)23 (12.8)156 (87.2)
    • Data are presented as n (%), unless otherwise indicated. HRCT: high-resolution computed tomography; UIP: usual interstitial pneumonia; OLB: open lung biopsy; TLB: thoracoscopic lung biopsy. #: defined as agreement of the histology and radiology committees with the diagnosis of IPF based on OLB/TLB and thoracic HRCT, or of the radiology committee when only HRCT scans were available.

  • Table 2—

    Weighted kappa coefficients(κw) between thoracic high-resolution computed tomography (HRCT) reviewers#

    Mean κwκw (95% CI)
    A versus BA versus CB versus C
    Total0.400.40 (0.29–0.52)0.33 (0.23–0.44)0.46 (0.36–0.56)
    OLB/TLB: UIP
     Absent0.410.47 (0.03–0.92)0.24 (-0.21–0.69)0.52 (0.19–0.86)
     Present0.350.35 (0.16–0.54)0.21 (0.03–0.40)0.49 (0.33–0.66)
     Total reviewed0.400.41 (0.24–0.58)0.27 (0.11–0.43)0.53 (0.38–0.67)
    TBLB/no biopsy0.400.40 (0.24–0.56)0.40 (0.26–0.54)0.39 (0.26–0.53)
    FVC
     <60% pred0.400.36 (0.16–0.56)0.33 (0.15–0.51)0.50 (0.34–0.67)
     >60% pred0.390.42 (0.28–0.56)0.33 (0.20–0.46)0.43 (0.30–0.56)
    • CI: confidence interval; OLB: open lung biopsy; TLB: thoracoscopic lung biopsy; UIP: usual interstitial pneumonia; TBLB: transbronchial lung biopsy; FVC: forced vital capacity; % pred: % predicted. #: each reviewer (A, B and C) scored the HRCT scans as unlikely, probable or very suggestive for the diagnosis of UIP.

  • Table 3—

    Weighted kappa coefficients(κw) between histology reviewers D and E#

    Mean κw (95% CI)
    Total0.30 (0.12–0.48)
    Thoracic HRCT: UIP
     Absent0.84 (0.55–1.14)
     Present0.16 (-0.03–0.36)
    FVC
     <60% pred0.33 (0.05–0.61)
     >60% pred0.28 (0.06–0.50)
    • CI: confidence interval; HRCT: high-resolution computed tomography; UIP: usual interstitial pneumonia; FVC: forced vital capacity; % pred: % predicted. #: each reviewer (D and E) scored the open lung biopsy or thoracoscopic lung biopsy specimens as unlikely, probable or very suggestive for the diagnosis of UIP.

  • Table 4—

    Overview of studies addressing interobserver agreement on thoracic computed tomography(CT) in various forms of pulmonary fibrosis

    First author [Ref.]YearInterobserver agreement κ coefficientStudy populationSubjects nObservers nComments
    Grenier 1019910.64–0.78Sarcoidosis533Definition of IPF unclear
    Pulmonary fibrosis33
    Histiocytosis X17
    Other ILD37
    Wells 1919930.58–0.76Systemic sclerosis352Interobserver agreement for grading CT appearance and change in nature and extent of disease
    IPF21
    Collins 819940.48Systemic sclerosis634Interobserver agreement for CT pattern type
    IPF63
    Kazerooni 2019970.51–0.83UIP; DIP24; 14Interobserver agreement for pattern type in different lobes
    MacDonald 920010.40NSIP214Interobserver agreement for NSIP and UIP
    UIP32
    Hunninghake 720010.54IPF544Interobserver agreement for IPF versus non-IPF; criteria for IPF diagnosis not mentioned
    Non-IPF37
    Flaherty 320030.43NSIP232Interobserver agreement for NSIP and UIP
    UIP73
    Aziz 2120040.50DPLD13111Interobserver agreement for first-choice diagnosis of IPF
    Present study0.40UIP1563Interobserver agreement for IPF versus non-IPF; IPF patients included following ATS/ERS criteria
    Non-UIP23
    • ILD: interstitial lung disease; IPF: idiopathic pulmonary fibrosis; UIP: usual interstitial pneumonia; DIP: desquamative interstitial pneumonia; NSIP: nonspecific interstitial pneumonia; DPLD: diffuse parenchymal lung disease; ATS: American Thoracic Society; ERS: European Respiratory Society.

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Multidisciplinary interobserver agreement in the diagnosis of idiopathic pulmonary fibrosis
M. Thomeer, M. Demedts, J. Behr, R. Buhl, U. Costabel, C. D. R. Flower, J. Verschakelen, F. Laurent, A. G. Nicholson, E. K. Verbeken, F. Capron, M. Sardina, G. Corvasce, I. Lankhorst
European Respiratory Journal Mar 2008, 31 (3) 585-591; DOI: 10.1183/09031936.00063706

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Multidisciplinary interobserver agreement in the diagnosis of idiopathic pulmonary fibrosis
M. Thomeer, M. Demedts, J. Behr, R. Buhl, U. Costabel, C. D. R. Flower, J. Verschakelen, F. Laurent, A. G. Nicholson, E. K. Verbeken, F. Capron, M. Sardina, G. Corvasce, I. Lankhorst
European Respiratory Journal Mar 2008, 31 (3) 585-591; DOI: 10.1183/09031936.00063706
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