title: Interobserver variability in the CT assessment of honeycombing in the lungs.
abstract: OBJECTIVE
  To quantify observer agreement and analyze causes of disagreement in identifying honeycombing at chest computed tomography (CT).
  
  
  METHODS
  The institutional review board approved this multiinstitutional HIPAA-compliant retrospective study, and informed patient consent was not required. Five core study members scored 80 CT images with a five-point scale (5 = definitely yes to 1 = definitely no) to establish a reference standard for the identification of honeycombing. Forty-three observers from various subspecialties and geographic regions scored the CT images by using the same scoring system. Weighted κ values of honeycombing scores compared with the reference standard were analyzed to investigate intergroup differences. Images were divided into four groups to allow analysis of imaging features of cases in which there was disagreement: agreement on the presence of honeycombing, agreement on the absence of honeycombing, disagreement on the presence of honeycombing, and other (none of the preceding three groups applied).
  
  
  RESULTS
  Agreement of scores of honeycombing presence by 43 observers with the reference standard was moderate (Cohen weighted κ values: 0.40-0.58). There were no significant differences in κ values among groups defined by either subspecialty or geographic region (Tukey-Kramer test, P = .38 to >.99). In 29% of cases, there was disagreement on identification of honeycombing. These cases included honeycombing mixed with traction bronchiectasis, large cysts, and superimposed pulmonary emphysema.
  
  
  CONCLUSIONS
  Identification of honeycombing at CT is subjective, and disagreement is largely caused by conditions that mimic honeycombing.
authors.affiliation: Dept of Diagnostic Radiology, Saitama International Medical Ctr, Saitama Medical Univ, Hidaka, Saitama 3501298, Japan.
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Watadani
authors.forename: Fumikazu
authors.initials: F
authors.lastname: Sakai
authors.forename: Takeshi
authors.initials: T
authors.lastname: Johkoh
authors.forename: Satoshi
authors.initials: S
authors.lastname: Noma
authors.forename: Masanori
authors.initials: M
authors.lastname: Akira
authors.forename: Kiminori
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Bankier
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Lee
authors.forename: Nestor L
authors.initials: NL
authors.lastname: Müller
authors.forename: Jae-Woo
authors.initials: JW
authors.lastname: Song
authors.forename: Jai-Soung
authors.initials: JS
authors.lastname: Park
authors.forename: David A
authors.initials: DA
authors.lastname: Lynch
authors.forename: David M
authors.initials: DM
authors.lastname: Hansell
authors.forename: Martine
authors.initials: M
authors.lastname: Remy-Jardin
authors.forename: Tomás
authors.initials: T
authors.lastname: Franquet
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Sugiyama
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015588:Observer Variation; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*