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Related Experiment Videos

Inter-observer variation between pathologists in diffuse parenchymal lung disease.

A G Nicholson1, B J Addis, H Bharucha

  • 1Department of Histopathology, Royal Brompton Hospital, London, UK. a.nicholson@rbh.nthames.nhs.uk

Thorax
|June 1, 2004
PubMed
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The ATS/ERS classification for diffuse parenchymal lung disease (DPLD) shows moderate reproducibility among pathologists. Multiple biopsies improve diagnostic agreement for DPLD, supporting their routine use.

Area of Science:

  • Pulmonology
  • Pathology
  • Medical Diagnostics

Background:

  • Limited inter-observer studies exist for diffuse parenchymal lung disease (DPLD).
  • The recent American Thoracic Society/European Respiratory Society (ATS/ERS) consensus classification offers a framework for DPLD assessment.
  • Evaluating DPLD requires consistent diagnostic criteria.

Purpose of the Study:

  • To assess the reproducibility of DPLD diagnoses using the ATS/ERS classification.
  • To evaluate pathologist diagnostic confidence and agreement on DPLD classifications.
  • To determine the impact of multiple biopsies on diagnostic reproducibility.

Main Methods:

  • A numerical categorization method for differential diagnoses of DPLD was developed.
  • Pathologists' diagnostic confidence and reproducibility were assessed using the ATS/ERS classification.

Related Experiment Videos

  • Kappa coefficients (overall and weighted) were calculated to quantify inter-observer agreement.

    • Main Results:

    • Overall kappa coefficient for first-choice DPLD diagnosis was 0.38, improving to 0.43 with multiple biopsies.
    • Weighted kappa coefficients indicated moderate to good agreement (mean 0.58).
    • Low diagnostic confidence was reported in 18% of biopsies, with significant variation in distinguishing non-specific interstitial pneumonia from usual interstitial pneumonia.

    Conclusions:

    • The ATS/ERS classification is reproducibly applicable by pathologists routinely evaluating DPLD.
    • The findings support the practice of obtaining multiple biopsy specimens for improved DPLD diagnosis.
    • Further refinement may be needed for specific DPLD subtypes like interstitial pneumonia.