Pulmonary Nodule Detection with Low-Dose CT of the Lung: Agreement Among Radiologists

Leader, Joseph K.; Warfel, Thomas; Fuhrman, Carl R.; Golla, Sara; Weissfeld, Joel L.; Avila, Ricardo S.; Turner, Wesly D.; Zheng, Bin

doi:10.2214/ajr.04.1225

Cited by 78 publications

(59 citation statements)

References 34 publications

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“…We found that PET had superior interobserver and intraobserver reliability, compared with CT. In addition to the superior performance in characterizing indeterminate lesions, this reliability contributes to the superior accuracy of PET over CT. For characterization of solitary nodules, the interobserver reliability reported here for PET is similar to that previously reported in a smaller series (29), whereas for CT it is better than previously reported (30).…”

Section: Discussionsupporting

confidence: 89%

A Comparison of the Diagnostic Accuracy of¹⁸F-FDG PET and CT in the Characterization of Solitary Pulmonary Nodules

et al. 2008

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CT and PET are widely used to characterize solitary pulmonary nodules (SPNs). However, most CT accuracy studies have been performed with outdated technology and methods, and previous PET studies have been limited by small sample sizes and incomplete masking. Our objective was to compare CT and PET accuracy in veterans with SPN. Methods: Between January 1999 and June 2001, we recruited 532 participants with SPNs newly diagnosed on radiography and untreated. The SPNs were 7-30 mm. All patients underwent 18 F-FDG PET and CT. A masked panel of 3 PET and 3 CT experts rated the studies on a 5-point scale. SPN tissue diagnosis or 2-y follow-up established the final diagnosis. Results: A definitive diagnosis was established for 344 participants. The prevalence of malignancy was 53%. The average size was 16 mm. Likelihood ratios (LRs) for PET and CT results for combined ratings of either definitely benign (33% and 9% of patients, respectively) or probably benign (27% and 12%) were 0.10 and 0.11, respectively. LRs for PET and CT results for combined ratings of indeterminate (1% and 25%), probably malignant (21% and 39%), or definitely malignant (35% and 15%) were 5.18 and 1.61, respectively. Area under the receiver operating characteristic curve was 0.93 (95% confidence interval, 0.90-0.95) for PET and 0.82 (95% confidence interval, 0.77-0.86) for CT (P , 0.0001 for the difference). PET inter-and intraobserver reliability was superior to CT. Conclusion: Definitely and probably benign results on PET and CT strongly predict benign SPN. However, such results were 3 times more common with PET. Definitely malignant results on PET were much more predictive of malignancy than were these results on CT. A malignant final diagnosis was approximately 10 times more likely than a benign final diagnosis in participants with PET results rated definitely malignant.

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Section: Discussionsupporting

confidence: 89%

A Comparison of the Diagnostic Accuracy of¹⁸F-FDG PET and CT in the Characterization of Solitary Pulmonary Nodules

et al. 2008

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“…Interobserver variability in reader performance for the detection and characterization of pulmonary nodules has been found to be relatively high with chest computed tomographic (CT) imaging both in the clinical setting and in lung cancer screening (18)(19)(20)(21). So far, the effect of double reading on the cancer detection in lung cancer CT screening has, to our knowledge, not been…”

Section: Study Groupmentioning

confidence: 99%

No Benefit for Consensus Double Reading at Baseline Screening for Lung Cancer with the Use of Semiautomated Volumetry Software

Wang¹,

Klaveren²,

Bock³

et al. 2012

Radiology

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Purpose:To retrospectively evaluate the performance of consensus double reading compared with single reading at baseline screening of a lung cancer computed tomography (CT) screening trial. Materials and Methods:The study was approved by the Dutch Minister of Health and ethical committees. Written informed consent was obtained from all participants. The benefi t of consensus double reading was expressed by the percentage change in cancer detection rate, recall rate, number of additional nodules detected, and change in sensitivity and specifi city in 7557 participants. The reference standard was a retrospective analysis of the serial CT scans performed in participants diagnosed with lung cancer during a 2-year period after baseline. Semiautomated volumetric software was used for nodule evaluation. McNemar tests were performed to test statistical signifi cance. In addition, sensitivity, specifi city, positive predictive value (PPV), and negative predictive value (NPV) were calculated and 95% confi dence intervals (CIs) constructed. Results:Seventy-four cases of lung cancer were qualifi ed as detectable at baseline. Compared with single reading, consensus double reading did not increase the cancer detection rate (2.7%; 95% CI: 2 1.0%, 6.4%; P = .50) or change the recall rate (20.6% vs 20.8%, P = . Conclusion:There is no statistically signifi cant benefi t for consensus double reading at baseline screening for lung cancer with the use of a nodule management strategy based solely on semiautomated volumetry.

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“…This shows that variability estimates from controlled reader studies may be similar to such estimates from clinical studies, where readers' calls do affect patient outcome. Leader et al (13) examined agreement between readers in nodule detection at CT and showed poor nodule-based interobserver agreement (k = 0.120) but relatively good examination-based interobserver agreement (k = 0.458). A number of other studies (14,15) examined variability across readers in the estimation of lung nodule volume at CT in a controlled setting; NLST radiologists did not assess nodule volume.…”

Section: Disclosures Of Conflicts Of Interest: Pfpmentioning

confidence: 99%

National Lung Screening Trial: Variability in Nodule Detection Rates in Chest CT Studies

Pinsky¹,

Gierada²,

Nath³

et al. 2013

Radiology

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Purpose:To characterize the variability in radiologists' interpretations of computed tomography (CT) studies in the National Lung Screening Trial (NLST) (including assessment of false-positive rates [FPRs] and sensitivity), to examine factors that contribute to variability, and to evaluate trade-offs between FPRs and sensitivity among different groups of radiologists. Materials and Methods:The HIPAA-compliant NLST was approved by the institutional review board at each screening center; all participants provided informed consent. NLST radiologists reported overall screening results, nodule-specific findings, and recommendations for diagnostic follow-up. A noncalcified nodule of 4 mm or larger constituted a positive screening result. The FPR was defined as the rate of positive screening examinations in participants without a cancer diagnosis within 1 year. Descriptive analyses and mixed-effects models were utilized. The average odds ratio (OR) for a false-positive result across all pairs of radiologists was used as a measure of variability. Results:One hundred twelve radiologists at 32 screening centers each interpreted 100 or more NLST CT studies, interpreting 72 160 of 75 126 total NLST CT studies in aggregate. The mean FPR for radiologists was 28.7% 6 13.7 (standard deviation), with a range of 3.8%-69.0%. The model yielded an average OR of 2.49 across all pairs of radiologists and an OR of 1.83 for pairs within the same screening center. Mean FPRs were similar for academic versus nonacademic centers (27.9% and 26.7%, respectively) and for centers inside (25.0%) versus outside (28.7%) the U.S. "histoplasmosis belt." Aggregate sensitivity was 96.5% for radiologists with FPRs higher than the median (27.1%), compared with 91.9% for those with FPRs lower than the median (P = .02). Conclusion:There was substantial variability in radiologists' FPRs. Higher FPRs were associated with modestly higher sensitivity.q RSNA, 2013

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Pulmonary Nodule Detection with Low-Dose CT of the Lung: Agreement Among Radiologists

Abstract: Unaided intra- and interobserver agreement in detecting pulmonary nodules in low-dose CT of the lung is relatively low. Computer-assisted detection may provide the consistency that is needed for this purpose.

Cited by 78 publications

References 34 publications

A Comparison of the Diagnostic Accuracy of¹⁸F-FDG PET and CT in the Characterization of Solitary Pulmonary Nodules

A Comparison of the Diagnostic Accuracy of¹⁸F-FDG PET and CT in the Characterization of Solitary Pulmonary Nodules

No Benefit for Consensus Double Reading at Baseline Screening for Lung Cancer with the Use of Semiautomated Volumetry Software

National Lung Screening Trial: Variability in Nodule Detection Rates in Chest CT Studies

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Pulmonary Nodule Detection with Low-Dose CT of the Lung: Agreement Among Radiologists

Abstract: Unaided intra- and interobserver agreement in detecting pulmonary nodules in low-dose CT of the lung is relatively low. Computer-assisted detection may provide the consistency that is needed for this purpose.

Cited by 78 publications

References 34 publications

A Comparison of the Diagnostic Accuracy of18F-FDG PET and CT in the Characterization of Solitary Pulmonary Nodules

A Comparison of the Diagnostic Accuracy of18F-FDG PET and CT in the Characterization of Solitary Pulmonary Nodules

No Benefit for Consensus Double Reading at Baseline Screening for Lung Cancer with the Use of Semiautomated Volumetry Software

National Lung Screening Trial: Variability in Nodule Detection Rates in Chest CT Studies

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A Comparison of the Diagnostic Accuracy of¹⁸F-FDG PET and CT in the Characterization of Solitary Pulmonary Nodules

A Comparison of the Diagnostic Accuracy of¹⁸F-FDG PET and CT in the Characterization of Solitary Pulmonary Nodules