Interobserver variability in the detection of cervical-thoracic Hodgkin's disease by computed tomography

Purpose: Computed tomography (CT) scans of the neck and chest are obtained at diagnosis of Hodgkin's disease to establish disease extent, plan radioth erapy, and serve as baseline studies for subsequent evaluation of response to therapy. However, differences in interpretation may occur even among exp erienced radiologists. This study was designed to test the extent of variat ion among expert radiologists' interpretations and to assess how their inte rpretations differed from that of the primary (institutional) radiologists. Materials and Methods: Five radiologists independently reviewed randomly se lected CT scans of 59 patients enrolled onto two Pediatric Oncology Group H odgkin's disease treatment protocols, For each patient, 31 potential diseas e sites were scored as positive, negative, uncertain, or unassessable. Agre ement among the reviewers and between the reviewers and the primary readers was analyzed. Results: For 58% of the sites, at least four of the five reviewers agreed i n greater than or equal to 80% of the cases. Kappa analysis thawed moderate agreement in approximately two thirds of the rites and poor agreement in t he remainder. There war moderate agreement between a majority of the expert readers and the primary radiologist reports for approximately one third of the sites, and agreement was poor in two thirds. Conclusion: There are disparities among radiologists' interpretations of ce rvical-thoracic CT imaging of patients with Hodgkin's disease. This variabi lity may affect patient core and the performance and results of multi-insti tutional clinical trials. We propose that a standardized method of reportin g might improve the consistency of interpretation of CT scans in these pati ents. (C) 1999 by American Society of Clinical Oncology.