Van Woensel Julie, Krdzalic Jasenko, de Jaegere Tom, Janssen Marlou T H F, Ramiro Sofia, Magro Checa César, Landewé Robert B M, Mostard Rémy L M
Department of Respiratory Medicine, Zuyderland Medical Centre, Heerlen, Limburg, 6419PC, The Netherlands.
Department of Radiology, Zuyderland Medical Centre, Heerlen, Limburg, 6419PC, The Netherlands.
BJR Open. 2025 Jun 25;7(1):tzaf017. doi: 10.1093/bjro/tzaf017. eCollection 2025 Jan.
An accurate morphological classification of distinct pulmonary phenotypes in sarcoidosis is lacking. Recently, a multinational Delphi study was conducted to reach a consensus on recognizable high-resolution computer tomography (HRCT) phenotypes in pulmonary sarcoidosis as a basis for a more distinctive classification. The reliability of these phenotypes has not yet been evaluated.
HRCT scans of adult sarcoidosis patients from the pulmonology department of a single sarcoidosis referral center were scored by three blinded independent readers. Seven phenotypes were distinguished as described in the Delphi study. They were divided into two subgroups: "non-fibrotic" and "likely-to-be fibrotic". Intra- and inter-reader reliability for scoring the predominant phenotype and the subgroup was assessed using weighted Kappa (K) statistics.
Forty-five patients (mean age, 47 years ± 12, 28 men) were included. For the scoring of the predominant phenotype, inter-reader reliability between all readers was substantial with an overall Fleiss' kappa of 0.69 (CI 0.622-0.765, < .001). We observed a substantial inter-reader reliability between readers A and B ( of 0.76), between readers B and C (K of 0.66) and between readers A and C ( of 0.66). For the scoring of the subgroups "non-fibrotic" vs. "likely-to-be fibrotic," overall Fleiss' Kappa was substantial ( = 0.78, CI 0.607-0.944, < .001). We observed a score of 0.76 between readers A and B; 0.81 between readers A and C; 0.76 between readers B and C. Intra-reader reliability was substantial between the scores of A in scoring the predominant phenotypes ( of 0.71) and it was almost perfect in scoring the subgroups ( of 0.95). Intra-reader reliability was substantial between the scores of B in scoring the predominant phenotype ( of 0.66) and subgroups ( of 0.72).
The inter- and intra-reader reliability of the newly proposed HRCT phenotypes obtained from the Delphi study is very acceptable.
This study is the first to assess the reliability of these HRCT phenotypes and supports the use of them for classification purposes in future clinical and pathogenetic studies.
结节病中不同肺表型缺乏准确的形态学分类。最近，开展了一项多国德尔菲研究，以就肺结节病中可识别的高分辨率计算机断层扫描（HRCT）表型达成共识，作为更具特色分类的基础。这些表型的可靠性尚未得到评估。
来自单个结节病转诊中心呼吸内科的成年结节病患者的HRCT扫描由三名不知情的独立阅片者进行评分。如德尔菲研究所描述的那样，区分出七种表型。它们被分为两个亚组：“非纤维化”和“可能纤维化”。使用加权卡帕（K）统计量评估阅片者内和阅片者间对主要表型和亚组评分的可靠性。
纳入45例患者（平均年龄47岁±12岁，男性28例）。对于主要表型的评分，所有阅片者之间的阅片者间可靠性较高，总体Fleiss卡帕值为0.69（CI 0.622 - 0.765，P <.001）。我们观察到阅片者A和B之间的阅片者间可靠性较高（K值为0.76），阅片者B和C之间（K值为0.66）以及阅片者A和C之间（K值为0.66）。对于“非纤维化”与“可能纤维化”亚组的评分，总体Fleiss卡帕值较高（K = 0.78，CI 0.607 - 0.944，P <.001）。我们观察到阅片者A和B之间的K值为0.76；阅片者A和C之间为0.81；阅片者B和C之间为0.76。阅片者A在对主要表型评分时阅片者内可靠性较高（K值为0.71），在对亚组评分时几乎完美（K值为0.95）。阅片者B在对主要表型评分时阅片者内可靠性较高（K值为0.66），对亚组评分时（K值为0.72）。
从德尔菲研究中获得的新提出的HRCT表型的阅片者间和阅片者内可靠性非常可接受。
本研究首次评估了这些HRCT表型的可靠性，并支持在未来临床和发病机制研究中使用它们进行分类。
