Differentiating between Subsolid and Solid Pulmonary Nodules at CT: Inter- and Intraobserver Agreement between Experienced Thoracic Radiologists

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Purpose To quantify the reproducibility and accuracy of experienced thoracic radiologists in differentiating between subsolid and solid pulmonary nodules at CT. Materials and Methods The institutional review board of Beth Israel Deaconess Medical Center approved this multicenter study. Six thoracic radiologists, with a mean of 21 years of experience in thoracic radiology (range, 17-22 years), selected images of 10 solid and 10 subsolid nodules to create a database of 120 nodules; this selection served as the reference standard. Each radiologist then interpreted 120 randomly ordered nodules in two different sessions that were separated by a minimum of 3 weeks. The radiologists classified whether or not each nodule was subsolid. Inter- and intraobserver agreement was assessed with a κ statistic. The number of correct classifications was calculated and correlated with nodule size by using Bland-Altman plots. The relationship between disagreement and nodule morphologic characteristics was analyzed by calculating the intraclass correlation coefficient. Results Interobserver agreement (κ) was 0.619 (range, 0.469-0.745; 95\% confidence interval (CI): 0.576, 0.663) and 0.670 (range, 0.440-0.839; 95\% CI: 0.608, 0.733) for interpretation sessions 1 and 2, respectively. Intraobserver agreement (κ) was 0.792 (95\% CI: 0.750, 0.833). Averaged for interpretation sessions, correct classification was achieved by all radiologists for 58\% (70 of 120) of nodules. Radiologists agreed with their initial determination (the reference standard) in 77\% of cases (range, 45\%-100\%). Nodule size weakly correlated with correct classification (long axis: Spearman rank correlation coefficient, rs = 0.161 and P = .049; short axis: rs = 0.128 and P = .163). Conclusion The reproducibility and accuracy of thoracic radiologists in classifying whether or not a nodule is subsolid varied in the retrospective study. This inconsistency may affect surveillance recommendations and prognostic determina