Interobserver Agreement of Usual Interstitial Pneumonia Diagnosis Correlated With Patient Outcome.
BACKGROUND
- The histopathologic criteria for idiopathic pulmonary fibrosis were revised in the American Thoracic Society/European Respiratory Society/Japan Respiratory Society/Latin American Thoracic Association guidelines in 2011. However, the evidence of diagnosis based on the guidelines needs further investigation.


OBJECTIVE
- To examine whether the revised histopathologic criteria for idiopathic pulmonary fibrosis improved interobserver agreement among pathologists and the predicted prognosis in patients with interstitial pneumonia.


METHODS
- Twenty, consecutive, surgical lung-biopsy specimens from cases of interstitial pneumonia were examined for histologic patterns by 11 pathologists without knowledge of clinical and radiologic data. Diagnosis was based on American Thoracic Society/European Respiratory Society guidelines of 2002 and 2011. Pathologists were grouped by cluster analysis, and interobserver agreement and association to the patient prognosis were compared with the diagnoses for each cluster.


RESULTS
- The generalized κ coefficient of diagnosis for all pathologists was 0.23. If the diagnoses were divided into 2 groups: usual interstitial pneumonia (UIP)/probable UIP (the UIP group) or possible/not UIP (the non-UIP group), according to the 2011 guidelines, the κ improved to 0.37. The pathologists were subdivided into 2 clusters in which 1 showed an association between UIP group diagnosis and patient prognosis (P < .05).


CONCLUSIONS
- Agreement about pathologic diagnosis of interstitial pneumonia is low; however, results after division into UIP and non-UIP groups provided favorable agreement. The cluster analysis revealed 1 of the 2 clusters providing high interobserver agreement and prediction of patient prognosis.
From the Department of Pathology, Nagasaki University Hospital, Sakamoto, Nagasaki, Japan (Drs Hashisako, Tanaka, and Fukuoka); the Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan (Dr Terasaki); the Department of Pathology, Japan Labour Health and Welfare Organization, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan (Dr Uekusa); the Division of Pathology, National Jewish Health, Denver, Colorado (Dr Achcar); the Department of Pathology, Rhode Island Hospital, Providence (Dr Aswad); the Department of Pathology and Laboratory Medicine, King Abdullah Medical City, Riyadh, Saudi Arabia (Dr Bamefleh); the Faculty of Medicine, University of São Paulo, São Paulo, Brazil (Drs Capelozzi and Fabro); the Department of Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada (Dr English); the Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan (Drs Kataoka, Kondoh, and Taniguchi); and the Department of Pathology, Nagasaki Prefecture Shimabara Hospital, Shimabara, Nagasaki, Japan (Dr Hayashi). Dr Hashisako is now with the Research Institute for Diseases of the Chest, Kyushu University, Fukuoka, Japan.
Mikiko
M
Hashisako
Tomonori
T
Tanaka
Yasuhiro
Y
Terasaki
Toshimasa
T
Uekusa
Rosane D
RD
Achcar
Bassam I
BI
Aswad
Hanaa S
HS
Bamefleh
Vera L
VL
Capelozzi
John C
JC
English
Alexandre T
AT
Fabro
Kensuke
K
Kataoka
Tomayoshi
T
Hayashi
Yasuhiro
Y
Kondoh
Hiroyuki
H
Taniguchi
Junya
J
Fukuoka
D000328:Adult; D000368:Aged; D001706:Biopsy; D016000:Cluster Analysis; D003131:Combined Modality Therapy; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D007564:Japan; D008168:Lung / Q000473:pathology* / Q000503:physiopathology; D017563:Lung Diseases, Interstitial / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012955:Societies, Medical; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome; D014481:United States