Oh Andrea S, Arnold Corey W, Vangala Sitaram, Wallace W Dean, Genshaft Scott J, Sarma Karthik, Aberle Denise R
Department of Radiology, David Geffen School of Medicine at UCLA, 924 Westwood Boulevard, Suite 420, Los Angeles, CA 90024.
Department of Radiology, David Geffen School of Medicine at UCLA, 924 Westwood Boulevard, Suite 420, Los Angeles, CA 90024.
Acad Radiol. 2015 Apr;22(4):481-7. doi: 10.1016/j.acra.2014.11.009. Epub 2015 Jan 15.
The purpose of this study was to quantify the degree of imaging-histologic discordance in a cohort of patients undergoing computed tomography (CT)-guided lung biopsy for focal lung disease.
A retrospective review was performed of 186 patients who underwent percutaneous lung biopsy of a parenchymal lesion at our institution between January and December 2009. Diagnostic radiology reports of CT or positron emission tomography-CTs performed before biopsy were used to classify the lesion as malignant or benign by five readers. Pathology reports of the biopsied lesions were classified by three readers. Inter-reader agreement and imaging-histologic concordance were quantified using kappa statistics. Discordant benign cases were then revisited to determine downstream effects.
Inter-reader agreement on report content was substantial or almost perfect with kappas >0.783. Kappas for concordance were as follows: malignant (0.448), primary lung cancer (0.517), metastatic disease to lung (0.449), benign (0.510), and overall agreement (0.381). Of the twelve discordant benign cases that were revisited, four were found to be false negatives, resulting in a delay in diagnosis.
Our study of imaging-histologic discordance in percutaneous biopsy of lung lesions supports the need for imaging report standardization and improved integration and communication between the fields of radiology and pathology.
本研究旨在量化一组因局灶性肺部疾病接受计算机断层扫描（CT）引导下肺活检的患者中影像与组织学不一致的程度。
对2009年1月至12月在我院接受实质性病变经皮肺活检的186例患者进行回顾性研究。活检前进行的CT或正电子发射断层扫描-CT的诊断放射学报告由五名阅片者用于将病变分类为恶性或良性。活检病变的病理报告由三名阅片者进行分类。使用kappa统计量对阅片者间的一致性和影像与组织学的一致性进行量化。然后重新审视不一致的良性病例以确定下游影响。
阅片者间对报告内容的一致性较高或几乎完美，kappa值>0.783。一致性的kappa值如下：恶性（0.448）、原发性肺癌（0.517）、肺转移瘤（0.449）、良性（0.510）和总体一致性（0.381）。在重新审视的12例不一致的良性病例中，有4例被发现为假阴性，导致诊断延迟。
我们对肺部病变经皮活检中影像与组织学不一致的研究支持了影像报告标准化以及改善放射学和病理学领域之间整合与沟通的必要性。
