Observer Agreement in the Evaluation of Interstitial Lung Diseases in Argentina

Abstract

SESSION TITLE: Diffuse Lung Disease 1 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Primary objective: To evaluate the agreement in the diagnosis and treatment of Interstitial Lung Diseases (ILD) between multiple observers in Argentina. Secondary objective: To evaluate the agreement of performing a surgical biopsy to confirm the diagnosis. METHODS: Patients with diagnosis of ILD were analyzed retrospectively. The clinical cases were reviewed by 5 pulmonologists ( 4 of them with 5 to 10 years of experience in the management of patients with ILD, and the last one with more than 20 years of experience in the management of these patients). Relevant clinical and laboratory data, including autoantibodies, bronchoalveolar lavage, transbronchial biopsy, lung function and high resolution computed tomography (HRCT) were evaluated in each case. The interobserver agreement was evaluated analyzing the different HRCT patterns, the final diagnosis of each observer, the therapeutic approach and the need to perform or not a surgical biopsy to confirm the diagnosis. Descriptive analysis was performed. The kappa was calculated for multiple observers. RESULTS: Twenty patients with diagnosis of ILD were evaluated (12 men and 8 women). The mean age of the patients was 63 ± 11.75 years old. Seventy percent (14 patients) were current or former smokers. The mean forced vital capacity (FVC) was 2.86± 0.77 litters in absolute values and 73% ± 11.85 expressed in percentage of the predicted value, and the mean DLCO expressed in percentage of predicted value was 58% ± 18.31. Regarding the HRCT pattern, the agreement was 0.65 (CI 95%: 0.54-0.75), with a greater agreement in the definition of possible usual interstitial pneumonia (UIP) pattern 0.65 (CI 95%: 0.48-0.82), definitive UIP pattern 0.59 (CI 95%: 0.44-0.75) and nonspecific interstitial pneumonia (NISP) pattern 0.57 (CI 95%: 0.46-0.69). In concern to the final the diagnosis, the agreement was 0.78 (CI 95%: 0.66-0.89), with a perfect degree of agreement in the diagnosis of the collagen tissue diseases (CTD)-ILD (kappa=1), moderate in idiopathic pulmonary fibrosis (IPF) 0.60 (CI 95%: 0.47-0.73) and weak in possible UIP 0.24 (CI 95%: 0.015-051). The need for surgical biopsy showed a moderate agreement of 0.45 (CI 95%: 0.31-0.59).The therapeutic approach showed a kappa of 0.49 (CI 95%: 0.40-0.57). The concordance was very good in regard to the indication of antifibrotic treatment 0.85 (CI 95%: 0.76-0.94), oral steroids and good in immunosuppressive drugs 0.68 (CI 95%: 0.56-0.79). There was less agreement in the choice of the immunosuppressive and its route of administration: oral (mycophenolate) or intravenous (cyclophosphamide or pulses with steroids). CONCLUSIONS: The overall agreement in the HRCT patterns and final diagnosis between the different observers was good. There was good agreement in the indication of antifibrotics and immunosuppression. The decision to perform a lung surgical biopsy showed a moderate agreement. CLINICAL IMPLICATIONS: In spite of a significant agreement in the CT pattern and potential diagnosis, the considerable lack of agreement about the need on biopsy and choice of treatment emphasizes the importance of the discussion in the multidisciplinary team. DISCLOSURE: The following authors have nothing to disclose: Brenda Varela, Gabriela Tabaj, Silvia Quadrelli, Juan Ignacio Enghelmayer, Maria Otaola, Carlos Nigro No Product/Research Disclosure Information