title: Imaging-histologic discordance at percutaneous biopsy of the lung.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Radiology, David Geffen School of Medicine at UCLA, 924 Westwood Boulevard, Suite 420, Los Angeles, CA 90024. Electronic address: aoh@mednet.ucla.edu.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Oh
authors.affiliation: Department of Radiology, David Geffen School of Medicine at UCLA, 924 Westwood Boulevard, Suite 420, Los Angeles, CA 90024.
authors.forename: Corey W
authors.initials: CW
authors.lastname: Arnold
authors.affiliation: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Sitaram
authors.initials: S
authors.lastname: Vangala
authors.affiliation: Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: W Dean
authors.initials: WD
authors.lastname: Wallace
authors.affiliation: Department of Radiology, David Geffen School of Medicine at UCLA, 924 Westwood Boulevard, Suite 420, Los Angeles, CA 90024.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Genshaft
authors.affiliation: David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Karthik
authors.initials: K
authors.lastname: Sarma
authors.affiliation: Department of Radiology, David Geffen School of Medicine at UCLA, 924 Westwood Boulevard, Suite 420, Los Angeles, CA 90024.
authors.forename: Denise R
authors.initials: DR
authors.lastname: Aberle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Radiologic–pathologic correlation; imaging–histologic discordance; standardized reporting