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Original article
Inter-reader agreement in HRCT detection of pleural plaques and asbestosis in participants with previous occupational exposure to asbestos
  1. François Laurent1,2,
  2. Christophe Paris3,4,
  3. Gilbert R Ferretti5,
  4. Catherine Beigelman6,
  5. Michel Montaudon1,2,
  6. Valerie Latrabe1,2,
  7. A Jankowski5,
  8. Yasmina Badachi6,
  9. Bénédicte Clin7,8,
  10. Antoine Gislard9,
  11. Marc Letourneux7,8,
  12. Amandine Luc3,
  13. Evelyne Schorlé10,
  14. Patrick Brochard11,
  15. Jacques Ameille12,13,
  16. Jean-Claude Pairon13,14
  1. 1Centre Cardiothoracique INSERM 1045, France
  2. 2Université de Bordeaux and CHU de Bordeaux, France
  3. 3EA7298 Université de Lorraine, France
  4. 4Faculté de Médecine, and CHU Nancy, France
  5. 5INSERM U823, and Université J Fourrier, and Clinique universitaire de radiologie et imagerie médicale, CHU, Grenoble, France
  6. 6Service de Radiologie Asssistance-Publique Hôpitaux de Paris, 47–83 Boulevard de l'hôpital, Paris, France
  7. 7Cancers et Populations INSERM U1086, France
  8. 8Service de Santé au Travail et Pathologie Professionnelle, Faculté de Médecine and CHU de Caen, France
  9. 9Service des Maladies Professionnelles, CHU Rouen, France
  10. 10ERSM Rhône-Alpes, Lyon, France
  11. 11INSERM 897 and Université de Bordeaux, CHU de Bordeaux, France
  12. 12Unité de Pathologie Professionnelle, Assistance-Publique Hôpitaux de Paris, Hôpital Raymond Poincaré, Garches, France
  13. 13Institut Interuniversitaire de Médecine du Travail de Paris-Ile de France, Paris, France
  14. 14Service de Pneumologie et Pathologie Professionnelle, INSERM, U955 and Université Paris-Est Créteil, and Centre Hospitalier Intercommunal, Créteil, France
  1. Correspondence to Professor François Laurent, Unité d'imagerie thoracique et cardio-vasculaire, CHU de Bordeaux Hôpital Haut-Lévêque, Avenue de Magellan, PESSAC 33604, France; francois.laurent{at}


Objectives To investigate inter-reader agreement for the detection of pleural and parenchymal abnormalities using CT in a large cross-sectional study comprising information on individual cumulative exposure to asbestos.

Methods The project was approved by the hospital ethics committee, and all patients received information on the study and gave their written informed consent. In 5511 CT scans performed in a cohort of retired workers previously exposed to asbestos and volunteering to participate in a multiregional survey programme (Asbestos Related Diseases Cohort, ARDCO), double randomised standardised readings, triple in case of disagreement, were performed by seven trained expert radiologists specialised in thoracic imaging and blind to the initial interpretation. Inter-reader agreement was evaluated by calculating the κ-weighted coefficient between pairs of expert readers and results of routine practice and final diagnosis after expert reading.

Results κ-Weighted coefficients between trained experts ranged from 0.28 to 0.52 (fair to good), 0.59 to 0.86 (good to excellent) and 0.11 to 0.66 (poor to good) for the diagnosis of asbestosis, pleural plaques and fibrosis of the visceral pleura, respectively. κ-Weighted coefficients between results of routine practice and final diagnosis after expert reading were 0.13 (poor), 0.53 (moderate) and 0.11 (poor) for the diagnosis of asbestosis, pleural plaques and fibrosis of the visceral pleura, respectively.

Conclusions Interpretation of benign asbestos-related thoracic abnormalities requires standardisation of the reading and trained readers, particularly for participants asking for compensation, and with a view to the longitudinal survey of asbestos-exposed workers.

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