Evidence map›Paper›PMID 34074264›Full record

ArticleBMC pulmonary medicine2021

Reliability of histopathologic diagnosis of fibrotic interstitial lung disease: an international collaborative standardization project.

Robert Camp, Maxwell L Smith, Brandon T Larsen, Anja C Roden, Carol Farver, Andre L Moreira, Richard Attanoos, Raghavendra Pillappa, Irene Sansano, Alexandre Todorovic Fabro and 1 more

Abstract read
In one paragraph

Article in BMC pulmonary medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Robert CampDepartment of Pathology, Yale University School of Medicine, New Haven, CT, 06510, USA.
Maxwell L SmithDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, 85259, USA.
Brandon T LarsenDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, 85259, USA.
Anja C RodenDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55902, USA.
Carol FarverDepartment of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA.
Andre L MoreiraDepartment of Pathology, New York University School of Medicine, New York, NY, 10016, USA.
Richard AttanoosDepartment of Cellular Pathology, School of Medicine, University Hospital of Wales, Cardiff University, Cardiff, CF14 4XW, UK.
Raghavendra PillappaDepartment of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA, 23298, USA.
Irene SansanoDepartment of Pathology, Vall d'Hebron Hospital, Barcelona, 08035, Spain.
Alexandre Todorovic FabroDepartment of Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, 14049-900, Brazil.
Robert J HomerDepartment of Pathology, Yale University School of Medicine, New Haven, CT, 06510, USA. robert.homer@yale.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCurrent interstitial lung disease (ILD) diagnostic guidelines assess criteria across clinical, radiologic and pathologic domains. Significant interobserver variation in histopathologic evaluation has previously been shown but the specific source of these discrepancies is poorly documented. We sought to document specific areas of difficulty and develop improved criteria that would reduce overall interobserver variation.

methodsUsing an internet-based approach, we reviewed selected images of specific diagnostic features of ILD histopathology and whole slide images of fibrotic ILD. After an initial round of review, we confirmed the presence of interobserver variation among our group. We then developed refined criteria and reviewed a second set of cases.

resultsThe initial round reproduced the existing literature on interobserver variation in diagnosis of ILD. Cases which were pre-selected as inconsistent with usual interstitial pneumonia/idiopathic pulmonary fibrosis (UIP/IPF) were confirmed as such by multi-observer review. Cases which were thought to be in the spectrum of chronic fibrotic ILD for which UIP/IPF were in the differential showed marked variation in nearly all aspects of ILD evaluation including extent of inflammation and extent and pattern of fibrosis. A proposed set of more explicit criteria had only modest effects on this outcome. While we were only modestly successful in reducing interobserver variation, we did identify specific reasons that current histopathologic criteria of fibrotic ILD are not well defined in practice.

conclusionsAny additional classification scheme must address interobserver variation in histopathologic diagnosis of fibrotic ILD order to remain clinically relevant. Improvements to tissue-based diagnostics may require substantial resources such as larger datasets or novel technologies to improve reproducibility. Benchmarks should be established for expected outcomes among clinically defined subgroups as a quality metric.

Indexed as

Observer VariationReference StandardsHumansIdiopathic Pulmonary FibrosisInternationalityLung Diseases, InterstitialReproducibility of ResultsInterstitial lung diseasePulmonary fibrosisUsual interstitial pneumonia

Identifiers

PMID34074264
PMCPMC8170950

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.