RT Journal Article SR Electronic T1 Variable radiologic lung nodule evaluation leads to divergent management recommendations JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP 1801359 DO 10.1183/13993003.01359-2018 A1 A. Nair A1 E.C. Bartlett A1 S.L.F. Walsh A1 A.U. Wells A1 N. Navani A1 G. Hardavella A1 S. Bhalla A1 L. Calandriello A1 A. Devaraj A1 J.M. Goo A1 J.S. Klein A1 H. MacMahon A1 C. Schaefer-Prokop A1 J.B. Seo A1 N. Sverzellati A1 S.R. Desai A1 The Lung Nodule Evaluation Group (Collaborators) YR 2018 UL http://erj.ersjournals.com/content/early/2018/10/11/13993003.01359-2018.abstract AB Radiologic evaluation of incidentally-detected lung nodules on computed tomography (CT) influences management. We assessed international radiologic variation in (1) pulmonary nodule characterisation; (2) hypothetical guideline-derived management, and (3) radiologists' management recommendations.107 radiologists from 25 countries evaluated 69 CT-detected nodules, recording: i) first-choice composition (solid, part-solid [PSN] or ground-glass [GGN], with percentage confidence), ii) morphologic features, iii) dimensions, iv) recommended management and (v) decision-influencing factors. We modelled hypothetical management decisions on: (1) the 2005 and (2) updated 2017 Fleischner Society, and (3) liberal and (4) parsimonious interpretations of the British Thoracic Society 2015 guidelines.Overall agreement for first-choice nodule composition was good (Fleiss' k=0.65), but poorest for PSNs (weighted Kappa, Kw=0.62; IQR=0.50–0.71). Morphologic variables, including spiculation (k=0.35), showed poor-to-moderate agreement (k=0.23–0.53). Diameter variation was greatest at key thresholds (5 mm and 6 mm). Agreement for radiologists' recommendations was poor (k=0.30); 21% disagreed with the majority. Although agreement within the four guideline-modelled management strategies was good (k=0.63–0.73), 5–10% of radiologists would disagree with majority decisions if they strictly applied guidelines.Agreement was lowest for part-solid nodules, while significant measurement variation exists at important size thresholds. These variations resulted in generally good agreement for guideline-modelled management, but poor agreement for radiologists' actual recommendations.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Nair reports grants from Department of Health NIHR Biomedical Research Centres Funding Scheme, during the conduct of the study; personal fees from Aidence AI, outside the submitted work.Conflict of interest: Dr. Bartlett has nothing to disclose.Conflict of interest: Dr. Walsh has nothing to disclose.Conflict of interest: Dr. Wells has nothing to disclose.Conflict of interest: Dr. Navani has nothing to disclose.Conflict of interest: Dr. Hardavella has nothing to disclose.Conflict of interest: Dr. Bhalla has nothing to disclose.Conflict of interest: Dr. Calandriello has nothing to disclose.Conflict of interest: Dr. Devaraj has nothing to disclose.Conflict of interest: Dr. Goo reports grants from Lunit Inc., outside the submitted work.Conflict of interest: Dr. Klein has nothing to disclose.Conflict of interest: Dr. MacMahon reports personal fees from Riverain Technologies, personal fees from GE Healthcare, grants from Philips Healthcare, other from Konica-Minolta, other from Hologic, other from University of Chicago, outside the submitted work.Conflict of interest: Dr. Schaefer-Prokop has nothing to disclose.Conflict of interest: Dr. Seo has nothing to disclose.Conflict of interest: Dr. SVERZELLATI reports personal fees from ROCHE, personal fees from BOEHRINGER INGELHEIM, outside the submitted work.Conflict of interest: Dr. Desai has nothing to disclose.