http://www.ncbi.nlm.nih.gov/pubmed/23220902

Radiology. 2012 Dec 6. [Epub ahead of print]

Interobserver Variability in the CT Assessment of Honeycombing in the Lungs.

Watadani T, Sakai F, Johkoh T, Noma S, Akira M, Fujimoto K, Bankier AA, Lee KS, Müller NL, Song JW, Park JS, Lynch DA, Hansell DM, Remy-Jardin M,Franquet T, Sugiyama Y.

Source

Dept of Diagnostic Radiology, Saitama International Medical Ctr, Saitama Medical Univ, Hidaka, Saitama 3501298, Japan; Dept of Radiology, Univ of Tokyo, Tokyo, Japan; Dept of Radiology, Kinki Central Hosp of Mutual Aid Association of Public School Teachers, Itami, Japan; Dept of Radiology, Tenri Hosp, Tenri, Japan; Dept of Radiology, National Hosp Organization Kinki-Chuo Chest Medical Ctr, Sakai, Japan; Dept of Radiology and Ctr for Diagnostic Imaging, Kurume Univ School of Medicine, Kurume, Japan; Dept of Radiology, Beth Israel Deaconess Medical Ctr, Boston, Mass; Dept of Radiology, Samsung Medical Ctr, Sungkyunkwan Univ School of Medicine, Seoul, Korea; Dept of Radiology, Univ of British Columbia, Vancouver, British Columbia, Canada; Dept of Radiology, Univ of Ulsan College of Medicine, Asan Medical Ctr, Seoul, Korea; Dept of Radiology, Soonchunhyang Univ Hosp, Seoul, Korea; Dept of Radiology, National Jewish Medical and Research Ctr, Denver, Colo; Dept of Radiology, Royal Brompton Hosp, London, England; Dept of Thoracic Imaging, Hosp Calmette, Univ Center of Lille, Lille, France; Dept of Radiology, Hosp de la Santa Creu i Sant Pau, Barcelona, Spain; Div of Pulmonary Medicine, Dept of Internal Medicine, Jichi Medical Univ, Shimotsuke, Japan; on behalf of the Diffuse Lung Diseases Research Group of the Ministry of Health, Labor and Welfare, Japan, c/o Div of Pulmonary Medicine, Dept of Internal Medicine, Jichi Medical Univ, Shimotsuke, Japan; Japanese Society of Thoracic Radiology, c/o Dept of Diagnostic Radiology, Saitama International Medical Ctr, Saitama Medical Univ, Hidaka, Japan.

Abstract

Purpose:To quantify observer agreement and analyze causes of disagreement in identifying honeycombing at chest computed tomography (CT).Materials and Methods:The institutional review board approved this multiinstitutional HIPAA-compliant retrospective study, and informed patient consent was not required. Five core study members scored 80 CT images with a five-point scale (5 = definitely yes to 1 = definitely no) to establish a reference standard for the identification of honeycombing. Forty-three observers from various subspecialties and geographic regions scored the CT images by using the same scoring system. Weighted κ values of honeycombing scores compared with the reference standard were analyzed to investigate intergroup differences. Images were divided into four groups to allow analysis of imaging features of cases in which there was disagreement: agreement on the presence of honeycombing, agreement on the absence of honeycombing, disagreement on the presence of honeycombing, and other (none of the preceding three groups applied).Results:Agreement of scores of honeycombing presence by 43 observers with the reference standard was moderate (Cohen weighted κ values: 0.40-0.58). There were no significant differences in κ values among groups defined by either subspecialty or geographic region (Tukey-Kramer test, P = .38 to >.99). In 29% of cases, there was disagreement on identification of honeycombing. These cases included honeycombing mixed with traction bronchiectasis, large cysts, and superimposed pulmonary emphysema.Conclusion:Identification of honeycombing at CT is subjective, and disagreement is largely caused by conditions that mimic honeycombing.