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Inter-observer variation between pathologists in diffuse parenchymal lung disease
  1. A G Nicholson1,
  2. B J Addis2,
  3. H Bharucha3,
  4. C A Clelland4,
  5. B Corrin1,
  6. A R Gibbs5,
  7. P S Hasleton6,
  8. K M Kerr7,
  9. N B N Ibrahim8,
  10. S Stewart9,
  11. W A H Wallace10,
  12. A U Wells11
  1. 1Department of Histopathology, Royal Brompton Hospital, London, UK
  2. 2Department of Histopathology, Southampton General Hospital, Southampton, UK
  3. 3Department of Histopathology, Royal Victoria Hospital, Belfast, UK
  4. 4Department of Histopathology, John Radcliffe Infirmary, Oxford, UK
  5. 5Department of Histopathology, Llandough Hospital, Penarth, South Glamorgan, UK
  6. 6Department of Histopathology, Wythenshawe Hospital, Manchester, UK
  7. 7Department of Histopathology, Aberdeen Royal Infirmary, Aberdeen, UK
  8. 8Department of Histopathology, Frenchay Hospital, Bristol, UK
  9. 9Department of Histopathology, Papworth Hospital, Cambridge, UK
  10. 10Department of Histopathology, Royal Infirmary of Edinburgh, Edinburgh, UK
  11. 11Department of Medicine, Royal Brompton Hospital, London, UK
  1. Correspondence to:
    Dr A G Nicholson
    Department of Histopathology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK;


Background: There have been few inter-observer studies of diffuse parenchymal lung disease (DPLD), but the recent ATS/ERS consensus classification provides a basis for such a study.

Methods: A method for categorising numerically the percentage likelihood of these differential diagnoses was developed, and the diagnostic confidence of pathologists using this classification and the reproducibility of their diagnoses were assessed.

Results: The overall kappa coefficient of agreement for the first choice diagnosis was 0.38 (n = 133 biopsies), increasing to 0.43 for patients (n = 83) with multiple biopsies. Weighted kappa coefficients of agreement, quantifying the level of probability of individual diagnoses, were moderate to good (mean 0.58, range 0.40–0.75). However, in 18% of biopsy specimens the diagnosis was given with low confidence. Over 50% of inter-observer variation related to the diagnosis of non-specific interstitial pneumonia and, in particular, its distinction from usual interstitial pneumonia.

Conclusion: These results show that the ATS/ERS classification can be applied reproducibly by pathologists who evaluate DPLD routinely, and support the practice of taking multiple biopsy specimens.

  • reproducibility
  • interstitial lung disease
  • histopathology
  • inter-observer variation

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