Inter-observer Variation Between Pathologists in Diffuse Parenchymal Lung Disease

Overview

Journal Thorax

Date 2004 Jun 1

PMID 15170033

Citations 43

Authors

A G Nicholson

B J Addis

H Bharucha

C A Clelland

B Corrin

A R GIBBS

P S Hasleton

K M Kerr

N B N Ibrahim

S Stewart

W A H Wallace

A U Wells

Affiliations

Soon will be listed here.

Abstract

Background: There have been few inter-observer studies of diffuse parenchymal lung disease (DPLD), but the recent ATS/ERS consensus classification provides a basis for such a study.

Methods: A method for categorising numerically the percentage likelihood of these differential diagnoses was developed, and the diagnostic confidence of pathologists using this classification and the reproducibility of their diagnoses were assessed.

Results: The overall kappa coefficient of agreement for the first choice diagnosis was 0.38 (n = 133 biopsies), increasing to 0.43 for patients (n = 83) with multiple biopsies. Weighted kappa coefficients of agreement, quantifying the level of probability of individual diagnoses, were moderate to good (mean 0.58, range 0.40-0.75). However, in 18% of biopsy specimens the diagnosis was given with low confidence. Over 50% of inter-observer variation related to the diagnosis of non-specific interstitial pneumonia and, in particular, its distinction from usual interstitial pneumonia.

Conclusion: These results show that the ATS/ERS classification can be applied reproducibly by pathologists who evaluate DPLD routinely, and support the practice of taking multiple biopsy specimens.

Citing Articles

Diagnostic alignment to optimize inter-rater reliability among lung transplant pathologists.

Pavlisko E, Neely M, Wikenheiser-Brokamp K, Fishbein G, Litzky L, Farver C J Heart Lung Transplant. 2024; 44(2):173-181.

PMID: 39406318 PMC: 11808823. DOI: 10.1016/j.healun.2024.10.007.

Meta-Analysis of Interobserver Agreement in Assessment of Interstitial Lung Disease Using High-Resolution CT.

Delaney L, Alabed S, Maiter A, Salehi M, Goodlad M, Shah H Radiology. 2024; 313(1):e240016.

PMID: 39404631 PMC: 11535866. DOI: 10.1148/radiol.240016.

Particle analysis of surgical lung biopsies from deployed and non-deployed US service members during the Global War on Terrorism.

Hayden L, Lightner J, Strausborger S, Franks T, Watson N, Lewin-Smith M PLoS One. 2024; 19(4):e0301868.

PMID: 38603724 PMC: 11008878. DOI: 10.1371/journal.pone.0301868.

Speaking the Same Language: The Fleischner Society Glossary for Thoracic Imaging.

Hariri L, Beasley M, Sholl L, Wikenheiser-Brokamp K Radiology. 2024; 310(3):e240414.

PMID: 38530190 PMC: 10982826. DOI: 10.1148/radiol.240414.

The Evolving Concept of the Multidisciplinary Approach in the Diagnosis and Management of Interstitial Lung Diseases.

Sanduzzi Zamparelli S, Sanduzzi Zamparelli A, Bocchino M Diagnostics (Basel). 2023; 13(14).

PMID: 37510180 PMC: 10378270. DOI: 10.3390/diagnostics13142437.

References

Travis W, Matsui K, Moss J, Ferrans V . Idiopathic nonspecific interstitial pneumonia: prognostic significance of cellular and fibrosing patterns: survival comparison with usual interstitial pneumonia and desquamative interstitial pneumonia. Am J Surg Pathol. 2000; 24(1):19-33. DOI: 10.1097/00000478-200001000-00003. View

Nicholson A, Colby T, du Bois R, Hansell D, Wells A . The prognostic significance of the histologic pattern of interstitial pneumonia in patients presenting with the clinical entity of cryptogenic fibrosing alveolitis. Am J Respir Crit Care Med. 2000; 162(6):2213-7. DOI: 10.1164/ajrccm.162.6.2003049. View

Nicholson A, Perry L, Cury P, Jackson P, McCormick C, Corrin B . Reproducibility of the WHO/IASLC grading system for pre-invasive squamous lesions of the bronchus: a study of inter-observer and intra-observer variation. Histopathology. 2001; 38(3):202-8. DOI: 10.1046/j.1365-2559.2001.01078.x. View

Nicholson A, Wells A . Nonspecific interstitial pneumonia-nobody said it's perfect. Am J Respir Crit Care Med. 2001; 164(9):1553-4. DOI: 10.1164/ajrccm.164.9.2108099a. View

Flaherty K, Travis W, Colby T, Toews G, Kazerooni E, Gross B . Histopathologic variability in usual and nonspecific interstitial pneumonias. Am J Respir Crit Care Med. 2001; 164(9):1722-7. DOI: 10.1164/ajrccm.164.9.2103074. View

Flaherty K, Toews G, Travis W, Colby T, Kazerooni E, Gross B . Clinical significance of histological classification of idiopathic interstitial pneumonia. Eur Respir J. 2002; 19(2):275-83. DOI: 10.1183/09031936.02.00182002. View

Bouros D, Wells A, Nicholson A, Colby T, Polychronopoulos V, Pantelidis P . Histopathologic subsets of fibrosing alveolitis in patients with systemic sclerosis and their relationship to outcome. Am J Respir Crit Care Med. 2002; 165(12):1581-6. DOI: 10.1164/rccm.2106012. View

Nicholson A, Fulford L, Colby T, du Bois R, Hansell D, Wells A . The relationship between individual histologic features and disease progression in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2002; 166(2):173-7. DOI: 10.1164/rccm.2109039. View

Yousem S, Dacic S . Idiopathic bronchiolocentric interstitial pneumonia. Mod Pathol. 2002; 15(11):1148-53. DOI: 10.1097/01.MP.0000037309.04985.B4. View

10.

Colby T, Tazelaar H, Travis W, Bergstralh E, Jett J . Pathologic review of the Mayo Lung Project cancers [corrected]. Is there a case for misdiagnosis or overdiagnosis of lung carcinoma in the screened group?. Cancer. 2002; 95(11):2361-5. DOI: 10.1002/cncr.10930. View

11.

Flaherty K, Thwaite E, Kazerooni E, Gross B, Toews G, Colby T . Radiological versus histological diagnosis in UIP and NSIP: survival implications. Thorax. 2003; 58(2):143-8. PMC: 1746568. DOI: 10.1136/thorax.58.2.143. View

12.

Kung I, Lam W, Lam T . Observer variability studies of the WHO classification of lung cancer. Cancer Treat Res. 1989; 45:53-69. DOI: 10.1007/978-1-4613-1593-3_4. View

13.

CAMPOBASSO O, Andrion A, Ribotta M, Ronco G . The value of the 1981 WHO histological classification in inter-observer reproducibility and changing pattern of lung cancer. Int J Cancer. 1993; 53(2):205-8. DOI: 10.1002/ijc.2910530205. View

14.

Collins C, Wells A, Hansell D, Morgan R, MacSweeney J, du Bois R . Observer variation in pattern type and extent of disease in fibrosing alveolitis on thin section computed tomography and chest radiography. Clin Radiol. 1994; 49(4):236-40. DOI: 10.1016/s0009-9260(05)81847-1. View

15.

Skov B, Lauritzen A, Hirsch F, Nielsen H . The histopathological diagnosis of malignant mesothelioma v. pulmonary adenocarcinoma: reproducibility of the histopathological diagnosis. Histopathology. 1994; 24(6):553-7. DOI: 10.1111/j.1365-2559.1994.tb00575.x. View

16.

Skov B, Braendstrup O, Hirsch F, Lauritzen A, Nielsen H, Skov T . Are pathologists biased by clinical information?: A blinded cross-over study of the histopathological diagnosis of mesothelial tumours versus pulmonary adenocarcinoma. Lung Cancer. 1994; 11(5-6):365-72. DOI: 10.1016/0169-5002(94)92165-2. View

17.

Raab S, Thomas P, Lenel J, Bottles K, Fitzsimmons K, Zaleski M . Pathology and probability. Likelihood ratios and receiver operating characteristic curves in the interpretation of bronchial brush specimens. Am J Clin Pathol. 1995; 103(5):588-93. DOI: 10.1093/ajcp/103.5.588. View

18.

Bjoraker J, Ryu J, Edwin M, Myers J, Tazelaar H, Schroeder D . Prognostic significance of histopathologic subsets in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 1998; 157(1):199-203. DOI: 10.1164/ajrccm.157.1.9704130. View

19.

NAGAI S, Kitaichi M, Itoh H, Nishimura K, Izumi T, Colby T . Idiopathic nonspecific interstitial pneumonia/fibrosis: comparison with idiopathic pulmonary fibrosis and BOOP. Eur Respir J. 1998; 12(5):1010-9. DOI: 10.1183/09031936.98.12051010. View

20.

Daniil Z, Gilchrist F, Nicholson A, Hansell D, Harris J, Colby T . A histologic pattern of nonspecific interstitial pneumonia is associated with a better prognosis than usual interstitial pneumonia in patients with cryptogenic fibrosing alveolitis. Am J Respir Crit Care Med. 1999; 160(3):899-905. DOI: 10.1164/ajrccm.160.3.9903021. View