Variable radiological lung nodule evaluation leads to divergent management recommendations
Por:
Nair, A, Bartlett, E, Walsh, S, Wells, A, Navani, N, Hardavella, G, Bhalla, S, Calandriello, L, Devaraj, A, Goo, J, Klein, J, MacMahon, H, Schaefer-Prokop, C, Seo, J, Sverzellati, N, Desai, S, Ahlfors, F, Bastos, A, Behr, J, Benes, J, Bozovic, G, Buzan, M, Castaner, E, Chaves, M, Choi, Y, Dalpiaz, G, David, S, De Jong, P, Dournes, G, Eberhard, M, Escuissato, D, Farchione, A, Flors, L, Franchi, P, Frauenfelder, T, Fujimoto, K, Gatti, M, Gavelli, G, Grgic, A, Haine, L, Haramati, L, Iiartman, T, Hartmann, I, Hering, J, Herpels, V, Herraez, I, Hobbs, S, Hochhegger, B, Hursoy, N, Ip, J, Iyengar, S, Jimenez, J, Johnson, K, Kanne, J, Kapur, S, Karaman, C, Karl, R, Kirova, G, Ko, J, Kramer, G, Kul, M, Larici, A, Lee, Y, Leifels, L, Ley, S, Machnicki, S, Maidas, P, Mak, S, Mariani, F, Meirelles, G, Hoesein, F, Montet, X, Murchison, J, Nath, H, Nenkina, T, Nganga, E, Linh, N, Niemann, T, Nunez, C, Occhipiniti, M, Oikonomou, A, Ozawa, Y, Pandher, T, Parkar, A, Piciucchi, S, Pinheiro, D, Poerio, A, Polverosi, R, Pope, K, Prosch, H, Pulzato, I, Rampinelli, C, Rodrigues, J, Romanos, O, Romei, C, Roos, J, Rossi, S, Ruhtsov, R, Ruggirello, M, Sanchez, M, Santos, M, Schubert, M, Senbanjo, T, Silva, C, Silva, M, Snoeckx, A, Sonavane, S, Sriharan, M, Stefanidis, K, Taydas, O, Tomiyama, N, Tran, S, Villanueva, A, Williams, M and Lung Nodule Evaluation Grp
Publicada:
1 dic 2018
Resumen:
Radiological evaluation of incidentally detected lung nodules on computed tomography (CT) influences management. We assessed international radiological 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: 1) first-choice composition (solid, part-solid or ground-glass, with percentage confidence); 2) morphological features; 3) dimensions; 4) recommended management; and 5) decision-influencing factors. We modelled hypothetical management decisions on the 2005 and updated 2017 Fleischner Society, and both liberal and parsimonious interpretations of the British Thoracic Society 2015 guidelines.
Overall agreement for first-choice nodule composition was good (Fleiss' kappa=0.65), but poorest for part-solid nodules (weighted 0.62, interquartile range 0.50-0.71). Morphological variables, including spiculation (kappa=0.35), showed poor-to-moderate agreement (kappa=0.23-0.53). Variation in diameter was greatest at key thresholds (5 mm and 6 mm).
Agreement for radiologists' recommendations was poor (kappa=0.30); 21% disagreed with the majority. Although agreement within the four guideline-modelled management strategies was good (kappa=0.63-0.73), 5-10% of radiologists would disagree with majority decisions if they applied guidelines strictly. 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.
Filiaciones:
Nair, A:
Univ Coll London Hosp NHS Fdn Trust, Dept Radiol, 235 Euston Rd, London NW1 2BU, England
Bartlett, E:
Kings Coll Hosp NHS Fdn Trust, Dept Radiol, London, England
Walsh, S:
Kings Coll Hosp NHS Fdn Trust, Dept Radiol, London, England
Wells, A:
Royal Brompton Hosp & Harefield NHS Fdn Trust, Dept Resp Med, London, England
Navani, N:
UCLH, Dept Thorac Med, London, England
UCL, UCL Resp, Lungs Living Ctr, London, England
Hardavella, G:
Kings Coll Hosp London, Dept Resp Med, London, England
Bhalla, S:
Mallinckrodt Inst Radiol, St Louis, MO USA
Calandriello, L:
Fdn Policlin Univ A Gemelli IRCCS, Radiol Diagnost & Interventist Gen, Rome, Italy
Devaraj, A:
Royal Brompton Hosp & Harefield NHS Fdn Trust, Dept Radiol, London, England
Goo, J:
Seoul Natl Univ Hosp, Seoul, South Korea
Klein, J:
Univ Vermont, Med Ctr, Burlington, VT USA
MacMahon, H:
Univ Chicago, Dept Radiol, Med Ctr, Chicago, IL 60637 USA
Schaefer-Prokop, C:
Meander Med Ctr, Dept Radiol, Amersfoort, Netherlands
Seo, J:
Univ Ulsan, Asan Med Ctr, Dept Radiol, Coll Med, Seoul, South Korea
Univ Ulsan, Asan Med Ctr, Inst Radiol, Coll Med, Seoul, South Korea
Sverzellati, N:
Univ Parma, Dept Clin Sci, Div Radiol, Parma, Italy
Desai, S:
Kings Coll Hosp NHS Fdn Trust, Dept Radiol, London, England
Royal Brompton Hosp & Harefield NHS Fdn Trust, Dept Radiol, London, England
Imperial Coll London, Natl Heart & Lung Inst, London, England
Ahlfors, F:
European Telemed Clin, Stockholm, Sweden
Bastos, A:
Univ Fed Minas Gerais, Fac Med, Belo Horizonte, MG, Brazil
Behr, J:
Hosp Jean Minioz Besancon, Besancon, France
Benes, J:
Charles Univ Prague, Gen Univ Hosp, Prague, Czech Republic
Bozovic, G:
Univ Hosp Lund, Radiol Dept, Lund, Sweden
Buzan, M:
Papworth Hosp NHS Fdn Trust, Cambridge, England
Castaner, E:
UDIAT Ctr Diagnost, Inst Univ Parc Tauli, Barcelona, Spain
Chaves, M:
DASA, Sao Paulo, SP, Brazil
Choi, Y:
Hanyang Univ, Seoul Hosp, Seoul, South Korea
Dalpiaz, G:
Bellaria Hosp, Bologna, Italy
David, S:
Univ Hosp Lewisham, London, England
De Jong, P:
UMC Utrecht, Utrecht, Netherlands
Dournes, G:
CHU Bordeaux, Bordeaux, France
Eberhard, M:
Univ Hosp Zurich, Zurich, Switzerland
Escuissato, D:
Univ Fed Parana, Curitiba, Parana, Brazil
Farchione, A:
Univ Cattolica Sacro Cuore, A Gemelli Univ Hosp, Milan, Italy
Flors, L:
Univ Virginia, Charlottesville, VA 22903 USA
Franchi, P:
AUSL Teramo, Teramo, Italy
Frauenfelder, T:
Univ Hosp Zurich, Radiol, Zurich, Switzerland
Fujimoto, K:
Kurume Univ, Dept Radiol, Sch Med, Kurume, Fukuoka, Japan
Gatti, M:
Univ Turin, Turin, Italy
Gavelli, G:
Ist Tumori Romagna, Meldola, Italy
Grgic, A:
Univ Hosp, Heidelberg, Germany
Haine, L:
Royal Derby Hosp, Derby, England
Haramati, L:
Albert Einstein Coll Med, Montefiore Med Ctr, Bronx, NY 10467 USA
Iiartman, T:
Mayo Clin, Rochester, MN USA
Hartmann, I:
Maasstad Hosp Rotterdam, Rotterdam, Netherlands
Hering, J:
Univ Munster, inst Clin Radiol, Munster, Germany
Herpels, V:
AZ Groeninge, Kortrijk, Belgium
Herraez, I:
Hosp Univ Leon, Leon, Spain
Hobbs, S:
Univ Rochester, Med Ctr, Rochester, NY 14627 USA
Hochhegger, B:
Pontificial Catholic Univ Rio Grande do Sul, Porto Alegre, RS, Brazil
Hursoy, N:
Ankara Univ, Sch Med, Dept Radiol, Ankara, Turkey
Ip, J:
Fundacao Champalimaud, Lisbon, Portugal
Iyengar, S:
Frimley Hlth NHSFT, Frimley, England
:
Hosp Gen Univ Alicante, Alicante, Spain
Johnson, K:
Salisbury NHS Trust, Salisbury, Wilts, England
Kanne, J:
Univ Wisconsin, Madison, WI USA
Kapur, S:
Univ Cincinnati, Cincinnati, OH 45221 USA
Karaman, C:
Adnan Menderes Univ, Aydin, Turkey
Karl, R:
LSU, Baton Rouge, LA USA
Kirova, G:
Tokuda Hosp Sofia, Sofia, Bulgaria
Ko, J:
NYU, Langone Med Ctr, New York, NY USA
Kramer, G:
CHRU, Lyon, France
Kul, M:
Ankara Univ, Sch Med, Dept Radiol, Ankara, Turkey
Larici, A:
Catholic Univ Sacred Hearth Rome, Rome, Italy
Lee, Y:
Hanyang Univ, Guri Hosp, Seoul, South Korea
Leifels, L:
Univ Leipzig, Leipzig, Germany
Ley, S:
Univ Teaching Hosp, Bonn, Germany
Machnicki, S:
Lenox Hill Hosp, New York, NY 10021 USA
Maidas, P:
Univ Hosp Aalborg, Aalborg, Denmark
Mak, S:
Guys & St Thomas Hosp, London, England
Mariani, F:
St Orsola Hosp, Bologna, Italy
Meirelles, G:
Fleury Grp, Sao Paulo, Brazil
Hoesein, F:
Univ Med Ctr Utrecht, Utrecht, Netherlands
Montet, X:
Geneva Univ Hosp, Geneva, Switzerland
Murchison, J:
Edinburgh Royal Infirm, Edinburgh, Midlothian, Scotland
Nath, H:
UAB, Birmingham, AL USA
Nenkina, T:
Private Hosp, Plovdiv, Bulgaria
Nganga, E:
Aga Khan Univ Hosp, Nairobi, Kenya
Linh, N:
Univ Hosp Zurich, Zurich, Switzerland
Niemann, T:
Kantonsspital Baden, Baden, Switzerland
Nunez, C:
Hosp Univ & Politecn La Fe, Valencia, Spain
Occhipiniti, M:
Univ Florence, Florence, Italy
Oikonomou, A:
Sunny Brook Hlth Sci Ctr, Toronto, ON, Canada
Ozawa, Y:
Nagoya City Univ, Grad Sch Med Sci, Nagoya, Aichi, Japan
Pandher, T:
Plymouth Hosp NHS Trust, Plymouth, Devon, England
Parkar, A:
Deaconess Hosp, Haraldsplass, Bergen, Norway
Piciucchi, S:
GB Morgagni L Pierantoni Hosp, Forli, Italy
Pinheiro, D:
Hosp Vita, Curitiba, Parana, Brazil
Poerio, A:
Univ Bologna, Bologna, Italy
Polverosi, R:
Affidea Padova, Padua, Italy
Pope, K:
Univ Kansas, Med Ctr, Lawrence, KS 66045 USA
Prosch, H:
Med Univ Vienna, Vienna, Austria
Pulzato, I:
Univ Genoa, Genoa, Italy
Rampinelli, C:
European Inst Oncol, Milan, Italy
Rodrigues, J:
Bristol Royal Infirm & Gen Hosp, Bristol, Avon, England
Romei, C:
Pisa Univ Hosp, Pisa, Italy
Roos, J:
Cantonal Hosp Lucerne, Dept Radiol & Nucl Med, Luzern, Switzerland
Rossi, S:
ROSSI, Buenos Aires, DF, Argentina
Ruhtsov, R:
Heidelberg Univ Hosp, Heidelberg, Germany
Ruggirello, M:
Univ Parma, Parma, Italy
Sanchez, M:
Hosp Clin Barcelona, Barcelona, Spain
Santos, M:
Univ Sao Paulo, Sch Med Ribeirao Preto, Sao Paulo, Brazil
Schubert, M:
Univ Hosp, Oslo, Norway
Senbanjo, T:
Epsom & St Helier NHS Trust, Epsom, Surrey, England
Silva, C:
Clin Alemana Santiago, Santiago, Chile
Silva, M:
Univ Parma, Parma, Italy
Snoeckx, A:
Antwerp Univ Hosp, Antwerp, Belgium
Sonavane, S:
Univ Alabama Birmingham, Birmingham, AL USA
Sriharan, M:
Kings Coll Hosp NHS Fdn Trust, London, England
Stefanidis, K:
Kings Coll Hosp NHS Fdn Trust, London, England
Taydas, O:
Hacettepe Univ, Ankara, Turkey
Tomiyama, N:
Osaka Univ, Diagnost & Intervent Radiol, Grad Sch Med, Suita, Osaka, Japan
Tran, S:
Kings Coll Hosp London, London, England
Villanueva, A:
Hinchingbrooke Hosp, Huntingdon, England
Peterborough City Hosp, Peterborough, Cambs, England
Williams, M:
Univ Edinburgh, Edinburgh, Midlothian, Scotland
Green Accepted, Bronze
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