Thomeer M, Demedts M, Behr J, Buhl R, Costabel U, Flower C D R, Verschakelen J, Laurent F, Nicholson A G, Verbeken E K, Capron F, Sardina M, Corvasce G, Lankhorst I
UZ Leuven, Afdeling Longziekten, Herestraat 49, B - 3000 Leuven, Belgium.
Eur Respir J. 2008 Mar;31(3):585-91. doi: 10.1183/09031936.00063706. Epub 2007 Dec 5.
The purpose of the present study was to evaluate the accuracy of the diagnosis of idiopathic pulmonary fibrosis (IPF) by respiratory physicians in six European countries, and to calculate the interobserver agreement between high-resolution computed tomography reviewers and histology reviewers in IPF diagnosis. The diagnosis of usual interstitial pneumonia (UIP) was assessed by a local investigator, following the American Thoracic Society/European Respiratory Society consensus statement, and confirmed when a minimum of two out of three expert reviewers from each expert panel agreed with the diagnosis. The level of agreement between readers within each expert panel was calculated by weighted kappa. The diagnosis of UIP was confirmed by the expert panels in 87.2% of cases. A total of 179 thoracic high-resolution computed tomography scans were independently reviewed, and an interobserver agreement of 0.40 was found. Open or thoracoscopic lung biopsy was performed in 97 patients, 82 of whom could be reviewed by the expert committee. The weighted kappa between histology readers was 0.30. It is concluded that, although the level of agreement between the readers within each panel was only fair to moderate, the overall accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis in expert centres is good (87.2%).
本研究的目的是评估欧洲六个国家的呼吸内科医生对特发性肺纤维化(IPF)的诊断准确性,并计算高分辨率计算机断层扫描阅片者与IPF诊断组织学阅片者之间的观察者间一致性。由当地研究人员根据美国胸科学会/欧洲呼吸学会共识声明对普通型间质性肺炎(UIP)进行诊断,当每个专家小组的三名专家审阅者中至少有两名同意该诊断时予以确认。通过加权kappa计算每个专家小组内阅片者之间的一致性水平。专家小组在87.2%的病例中确认了UIP的诊断。共对179例胸部高分辨率计算机断层扫描进行了独立审阅,发现观察者间一致性为0.40。97例患者进行了开放性或胸腔镜肺活检,其中82例可由专家委员会进行审阅。组织学阅片者之间的加权kappa为0.30。结论是,虽然每个小组内阅片者之间的一致性水平仅为一般到中等,但专家中心对特发性肺纤维化临床诊断的总体准确性良好(87.2%)。