The Annals of Thoracic Surgery, Vol 58, 158-162, Copyright © 1994 by The Society of Thoracic Surgeons
Interobserver variability and accuracy of computed tomographic assessment of nodal status in lung cancer
EC Bollen, R Goei, BE van 't Hof-Grootenboer, CW Versteege, HA Engelshove and RJ Lamers
Department of Surgery, De Wever Hospital, Heerlen, The Netherlands.
To assess the interobserver variability of computed tomography in
determining nodal status in non-small cell lung carcinoma, four experienced
radiologists reviewed the computed tomographic scans of 147 patients.
Interobserver variability was calculated using the kappa statistic. In
addition, the accuracy of CT assessment of the nodal status by the four
observers was measured by comparing their findings with thorough
mediastinal exploration at both mediastinoscopy (n = 35) and thoracotomy (n
= 112). Interobserver variability was large between the four radiologists
regarding nodal status on a per-patient basis (kappa = 0.38). Sensitivity
of computed tomography for the observers on a per-patient basis ranged from
40% to 69% with a 1.0-cm criterion and from 28% to 56% with a 1.5-cm
criterion. From the large interobserver variability and the low
sensitivities in this study it can be concluded that a negative result of
computed tomography regarding mediastinal lymph nodes does not eliminate
the need for mediastinoscopy or exploration of the mediastinum at the time
of operation in patients with non-small cell lung cancer.
