Defining CT subtypes in chronic obstructive pulmonary disease: real world daily practice does not meet guidelines

Area of Science:

• Pulmonary Medicine
• Radiology
• Medical Imaging Analysis

Background:

• Chronic obstructive pulmonary disease (COPD) diagnosis and management increasingly rely on computed tomography (CT) imaging.
• Standardized reporting of CT findings is crucial for consistent patient care.
• Existing CT chest reports may lack comprehensive details regarding COPD subtypes and associated findings.

Purpose of the Study:

• To assess the quality and inter-rater reliability of CT-definable COPD subtype reporting in real-world clinical practice.
• To evaluate the concordance of CT reports with Fleischner Society guidelines.
• To identify areas for improvement in CT reporting standards for COPD.

Main Methods:

• Retrospective review of 100 CT chest scans mentioning 'emphysema' or 'COPD'.
• Evaluation of existing reports for emphysema phenotype, severity, and location, benchmarked against Fleischner Society guidelines.
• Independent readings by two consultant thoracic radiologists and two radiology residents to assess inter-rater variability using Kappa and ICC statistics.

Main Results:

• Emphysema phenotype was reported in 51% of reports; centrilobular emphysema was most common.
• Only 26% of reports included phenotype, severity, and location.
• Fair inter-rater agreement for emphysema phenotype (κ = 0.371) and moderate for paraseptal emphysema (ICC = 0.733).
• Variable agreement for associated findings like large airways disease (κ = 0.0646) and bronchiectasis (κ = 0.0996).

Conclusions:

• Significant variability exists in the quality of CT reporting for COPD in clinical practice.
• Frequent omissions of essential descriptors and substantial inter-rater variability were observed.
• Standardization of CT reporting is necessary due to the increasing reliance on imaging for COPD diagnosis and management.