Evaluation of Reader Variability in the Interpretation of Follow-up CT Scans at Lung Cancer Screening
Evaluation of Reader Variability in the Interpretation of Follow-up CT Scans at Lung Cancer Screening
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DOI：
10.1148/radiol.10101254
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发表时间：
2011-04-01
期刊：
影响因子：
19.7
通讯作者：
Nath, P. Hrudaya
中科院分区：
文献类型：
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作者：
Singh, Satinder;Pinsky, Paul;Nath, P. Hrudaya
目的：衡量读者在确定基线筛查计算机断层扫描 (CT) 检测到的肺结节在后续筛查检查中是否发生变化的一致性，并评估进一步随访建议的变异性。材料和方法：所有受试者均参加国家肺部筛查试验 (NLST)，每个参与者都同意将其去识别化图像用于研究目的。作者随机选择了 100 例在 1 年筛查 CT 中测量至少 4.0 毫米的结节，这些结节被最初的筛查 CT 阅读器认为存在于基线 CT 扫描中；原始读者认为已发生变化的结节被过采样。从每个病例中选择的在两次检查中显示整个结节的图像被预加载到图片存档和通信系统工作站上。 9位放射科医生作为阅片员，评估基线时是否存在结节，并记录每次检查时的二维测量和结节特征、是否存在变化、CT筛查结果以及随访建议（高水平随访、低水平随访、不随访）。 结果：根据病例选择过程中的回顾，判断随访时发现的5个结节在基线时不存在；对于其余 95 个病例中的 19 个，至少一名读者判断基线时不存在结节。对于一致认为在基线时存在的 76 个结节，21%-47%（平均 6 个标准差，30% +/- 9）被判断为已生长。生长 (kappa = 0.55) 和阳性筛选结果 (kappa = 0.51) 的 kappa 值相似，而边缘和衰减变化 (kappa = 0.27-0.31) 的 kappa 值较低。高水平随访与低水平随访推荐中的 kappa 值较高（kappa = 0.66）。结论：读者对结节生长和筛查结果的同意程度为中等至显着。对后续建议的同意程度较低。 (C) 北美放射学会，2011
Purpose: To measure reader agreement in determining whether lung nodules detected at baseline screening computed tomography (CT) had changed at subsequent screening examinations and to evaluate the variability in recommendations for further follow-up.Materials and Methods: All subjects were enrolled in the National Lung Screening Trial (NLST), and each participant consented to the use of their de-identified images for research purposes. The authors randomly selected 100 cases of nodules measuring at least 4.0 mm at 1-year screening CT that were considered by the original screening CT reader to be present on baseline CT scans; nodules considered by the original reader to have changed were oversampled. Selected images from each case showing the entire nodule at both examinations were preloaded on a picture archiving and communication system workstation. Nine radiologists served as readers, and they evaluated whether the nodule was present at baseline and recorded the bidimensional measurements and nodule characteristics at each examination, presence or absence of change, results of screening CT, and follow-up recommendations (high-level follow-up, low-level follow-up, no follow-up).Results: On the basis of reviews during case selection, five nodules seen at follow-up were judged not to have been present at baseline; for 19 of the remaining 95 cases, at least one reader judged the nodule not to have been present at baseline. For the 76 nodules that were unanimously considered to have been present at baseline, 21%-47% (mean 6 standard deviation, 30% +/- 9) were judged to have grown. The kappa values were similar for growth (kappa = 0.55) and a positive screening result (kappa = 0.51) and were lower for a change in margins and attenuation (kappa = 0.27-0.31). The kappa value in the recommendation of high-versus low-level follow-up was high (kappa = 0.66).Conclusion: Reader agreement on nodule growth and screening result was moderate to substantial. Agreement on follow-up recommendations was lower. (C) RSNA, 2011