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Original Research

Interobserver Variability in the CT Assessment of Honeycombing in the Lungs

Published Online:Mar 1 2013https://doi.org/10.1148/radiol.12112516

Abstract

Even experienced radiologists may disagree on the identification of the presence of honeycombing, and this disagreement is caused mainly by the misinterpretation of conditions that may mimic honeycombing, such as traction bronchiectasis and emphysema.

Purpose

To quantify observer agreement and analyze causes of disagreement in identifying honeycombing at chest computed tomography (CT).

Materials and 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.

Conclusion

Identification of honeycombing at CT is subjective, and disagreement is largely caused by conditions that mimic honeycombing.

© RSNA, 2012

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Article History

Received December 15, 2011; revision requested February 10, 2012; revision received July 16; accepted August 15; final version accepted September 5.
Published online: Mar 2013
Published in print: Mar 2013