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Lung Cancer Screening with Submillisievert Chest CT: Potential Pitfalls of Pulmonary Findings in Different Readers with Various Experience Levels


Martini, Katharina; Ottilinger, Thorsten; Serrallach, Bettina; Markart, Stefan; Glaser-Gallion, Nicola; Blüthgen, Christian; Leschka, Sebastian; Bauer, Ralf W; Wildermuth, Simon; Messerli, Michael (2019). Lung Cancer Screening with Submillisievert Chest CT: Potential Pitfalls of Pulmonary Findings in Different Readers with Various Experience Levels. European Journal of Radiology, 121:108720.

Abstract

Purpose
To assess the interreader variability of submillisievert CT for lung cancer screening in radiologists with various experience levels.
Method
Six radiologists with different degrees of clinical experience in radiology (range, 1-15 years), rated 100 submillisievert CT chest studies as either negative screening finding (no nodules, benign nodules, nodules <5 mm), indeterminate finding (nodules 5-10 mm), positive finding (nodules >10 mm). Each radiologist interpreted scans randomly ordered and reading time was recorded. Interobserver agreement was assessed with ak statistic. Reasons for differences in nodule classification were analysed on a case-by-case basis. Reading time was correlated with reader experience using Pearson correlation (r).
Results
The overall interobserver agreement between all readers was moderate (k = 0.454; p < 0.001). In 57 patients, all radiologists agreed on the differentiation of negative and indeterminate/positive finding. In 64 cases disagreement between readers led to different nodule classification. In 8 cases some readers rated the nodule as benign, whereas others scored the case as positive. Overall, disagreement in nodule classification was mostly due to failure in identification of target lesion (n = 40), different lesion measurement (n = 44) or different classification (n = 26). Mean overall reading time per scan was of 2 min 2 s (range: 7s-7 min 45 s) and correlated with reader-experience (r =-0.824).
Conclusions
Our study showed substantial interobserver variability for the detection and classification of pulmonary nodules in submillisievert CT. This highlights the importance for careful standardisation of screening programs with the objective of harmonizing efforts of involved radiologists across different institutions by defining and assuring quality standards.

Abstract

Purpose
To assess the interreader variability of submillisievert CT for lung cancer screening in radiologists with various experience levels.
Method
Six radiologists with different degrees of clinical experience in radiology (range, 1-15 years), rated 100 submillisievert CT chest studies as either negative screening finding (no nodules, benign nodules, nodules <5 mm), indeterminate finding (nodules 5-10 mm), positive finding (nodules >10 mm). Each radiologist interpreted scans randomly ordered and reading time was recorded. Interobserver agreement was assessed with ak statistic. Reasons for differences in nodule classification were analysed on a case-by-case basis. Reading time was correlated with reader experience using Pearson correlation (r).
Results
The overall interobserver agreement between all readers was moderate (k = 0.454; p < 0.001). In 57 patients, all radiologists agreed on the differentiation of negative and indeterminate/positive finding. In 64 cases disagreement between readers led to different nodule classification. In 8 cases some readers rated the nodule as benign, whereas others scored the case as positive. Overall, disagreement in nodule classification was mostly due to failure in identification of target lesion (n = 40), different lesion measurement (n = 44) or different classification (n = 26). Mean overall reading time per scan was of 2 min 2 s (range: 7s-7 min 45 s) and correlated with reader-experience (r =-0.824).
Conclusions
Our study showed substantial interobserver variability for the detection and classification of pulmonary nodules in submillisievert CT. This highlights the importance for careful standardisation of screening programs with the objective of harmonizing efforts of involved radiologists across different institutions by defining and assuring quality standards.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Radiology, Nuclear Medicine and Imaging
Uncontrolled Keywords:Radiology Nuclear Medicine and imaging, General Medicine
Language:English
Date:1 December 2019
Deposited On:01 Nov 2019 13:26
Last Modified:25 Oct 2020 00:00
Publisher:Elsevier
ISSN:0720-048X
OA Status:Green
Publisher DOI:https://doi.org/10.1016/j.ejrad.2019.108720
PubMed ID:31711024

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