Inter-Observer Variability in the Detection and Interpretation of Chest X-Ray Anomalies in Adults in an Endemic Tuberculosis Area

Boniface Moifo^1,2*, Eric Walter Pefura-Yone^1,3,4, Georges Nguefack-Tsague^1,5, Marie Laure Gharingam¹, Jean Roger Moulion Tapouh², André-Pascal Kengne⁶, Samuel Nko’o Amvene^1,2

¹Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon.
²Department of Radiology and Radiation Oncology, FMBS, Yaoundé, Cameroon.
³Department of Internal Medicine and Specialties’, FMBS, Yaoundé, Cameroon.
⁴Service of Pneumology A, Jamot Hospital of Yaoundé, Yaoundé, Cameroon.
⁵Department of Public Health, FMBS, Yaoundé, Cameroon.
⁶South African Medical Research Council & University of Cape Town, Cape Town, South Africa.

DOI: 10.4236/ojmi.2015.53018                

Abstract

Purpose: To assess the inter-observer agreement in reading adults chest radiographs (CXR) and determine the effectiveness of observers in radiographic diagnosis of pulmonary tuberculosis (PTB) in a tuberculosis endemic area. Methods: A quasi-observational study was conducted in the Pneumology Department of Yaounde Jamot Hospital (Cameroon) from January to March 2014. This included six observers (two chest physicians, two radiologists, two end-training residents in medical imaging) and 47 frontal CXRs (4 of diffuse interstitial lung disease, 6 normal, 7 of lung cancers, 7 of bacterial pneumonia, 23 of PTB). The sample size was calculated on the basis of an expected 0.47 Kappa with a spread of 0.13 (α = 5%, CI = 95%) for six observers and five diagnostic items. The analysis of concordance was focused on the detection of nodules, cavitary lesions, pleural effusion, adenomegaly and diagnosis of PTB and lung cancer. These intervals of kappa coefficient were considered: discordance (<0.0), poor agreement (0.0 - 0.20), fair (0.21 - 0.40), moderate (0.41 - 0.60), good (0.61 - 0.80), excellent (>0.81). Results: The average score for the detection of caverns was the highest (58.3%) followed by that of the correct diagnosis of tuberculosis (49.3%). Pneumologists had the highest proportions of correct diagnosis of tuberculosis (69.6% and 73.9%) and better inter-observer agreement (k = 0.71) for PTB diagnosis. Observers were more in agreement for the detection of nodules (0.32 - 0.74), adenomegalies (0.43 - 0.69), and for the diagnosis of cancer (0.22 - 1) than for the diagnosis of tuberculosis (0.19 - 0.71). Disagreements were more frequent for the detection of pleural effusions (－0.08 - 0.73). Conclusion: The inter-observer agreement varies with the type of lesions and diagnosis. Pneumologists were most effective for the diagnosis of pulmonary tuberculosis. Observers were more in agreement for the detection of nodules and the diagnosis of cancer than for the diagnosis of pulmonary tuberculosis.

Keywords

Inter-Observer Variability, Concordance, Pulmonary Tuberculosis, Nodules, Caverns, Lung Cancer, Chest Radiography, Kappa

Conflicts of Interest

The authors declare no conflicts of interest.

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