Rationale and Objectives
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.
Materials and Methods
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.
Results
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.
Conclusions
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.
Key Words
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Article info
Publication history
Published online: January 16, 2015
Accepted:
November 25,
2014
Received:
June 12,
2014
Identification
Copyright
Published by Elsevier Inc.
