Michele S Sarin - Profile on Academia.edu (original) (raw)
Papers by Michele S Sarin
Frailty stratification using the Modified 5-item frailty index: Significant variation within frailty patients in spine surgery
World Neurosurgery, Jun 1, 2023
Up to 10-year surveillance comparison of survivability in single-level cervical disc replacement versus anterior cervical discectomy and fusion in New York
Journal of neurosurgery, Apr 1, 2023
OBJECTIVE Cervical disc replacement (CDR) is an alternative treatment to anterior cervical discec... more OBJECTIVE Cervical disc replacement (CDR) is an alternative treatment to anterior cervical discectomy and fusion (ACDF), which is the current gold standard, for degenerative cervical diseases such as cervical spondylotic myelopathy and cervical radiculopathy. CDR has several theoretical benefits over ACDF, including preservation of motion, earlier return to unrestricted activity, and potentially a lower risk of adjacent-segment disease. Recent literature has reported positive clinical results for CDR, but few studies have investigated the long-term risk of revision surgery of CDR versus ACDF. The purpose of this study was to identify and analyze the epidemiological, clinical, and operative risk factors that affect revision rates following single-level CDR and ACDF procedures. METHODS A retrospective cohort was extracted from the Statewide Planning and Research Cooperative System using ICD-9 and CPT codes. Inclusion criteria were adult patients undergoing primary, subaxial (C3–7), single-level ACDF or CDR for cervical radiculopathy and/or cervical spondylotic myelopathy between 2005 and 2013. Survivability was defined as the time between the index procedure and the presence of a subsequent discharge record for cervical spinal fusion or disc replacement. Statistical analyses were performed using chi-square tests, t-tests, Cox proportional hazards models, and a Kaplan-Meier plot. RESULTS A total of 7450 patients were included in this study (6615 ACDF and 835 CDR). When adjusted for patient demographics, the hazard ratios showed no significant differences in the incidence of revision risk between the two cohorts. The CDR cohort had a higher incidence of postoperative dysphagia (p < 0.05). Patients undergoing ACDF had a longer average hospital stay (2.8 vs 1.9 days, p < 0.001). There was no significant difference in time to revision surgery (p = 0.486). CONCLUSIONS CDR and ACDF have both been shown to be effective treatments for cervical spine disease. CDR patients had a shorter average inpatient hospital stay compared with ACDF patients but tended to experience dysphagia more frequently. There was a tendency toward increased survivability of CDR; however, this was not found to be statistically significant at any time point. The large size and heterogeneity of each cohort and the availability of > 10 years of surveillance data differentiate this study from other published literature. This investigation has limitations inherent to large data analysis studies, including the implementation and inaccuracy of diagnosis and procedural coding; however, this reflects real-world use of coding by practitioners.
Utilization Trends of Intraoperative Neuromonitoring for Anterior Cervical Discectomy and Fusion in New York State
Spine, Dec 28, 2022
The Utilization of Intraoperative Neurophysiological Monitoring for Lumbar Decompression and Fusion Surgery in New York State
Spine
Study Design. Retrospective database analysis. Objective. To elucidate trends in the utilization ... more Study Design. Retrospective database analysis. Objective. To elucidate trends in the utilization of intraoperative neurophysiological monitoring (IONM) during elective lumbar surgery procedures and to investigate the association between the use of IONM and surgical outcomes. Background. The routine use of IONM in elective lumbar spine procedures has recently been called into question due to longer operative time, higher cost, and other substitute advanced technologies. Methods. The Statewide Planning and Research Cooperative System database was accessed to perform this retrospective study. The trends of IONM use for lumbar decompression and fusion procedures were investigated from 2007 to 2018. The association between IONM use and surgical outcomes was investigated from 2017 to 2018. Multivariable logistic regression analyses, as well as propensity score matching (PS-matching), were conducted to assess IONM association in neurological deficits reduction. Results. The utilization of ...
Comparative effectiveness of anesthetic technique on outcomes after lumbar spine surgery: a retrospective propensity score-matched analysis of the National Surgical Quality Improvement Program, 2009–2019
Regional Anesthesia & Pain Medicine
BackgroundThe impact of anesthetic technique on spine surgery outcomes is controversial. Using a ... more BackgroundThe impact of anesthetic technique on spine surgery outcomes is controversial. Using a large national sample of patients, we compared outcomes after lumbar decompression under regional anesthesia (RA: spinal or epidural) or general anesthesia (GA).MethodsA retrospective population-based study of American College of Surgeons National Surgical Quality Improvement Program data (2009–2019). Patients were propensity score (PS) matched 3:1 (GA:RA) on demographic and surgical variables. The primary outcome was the association between anesthetic type and any complication (cardiac, pulmonary, renal, transfusion, stroke, infectious, deep vein thrombosis/pulmonary embolus). Secondary outcomes included the association between anesthetic type and individual complications, readmission and length of stay (LOS). Unadjusted comparisons (OR, 95% CI), logistic regression and adjusted generalized linear modeling (parameter estimate, PE, 95% CI) were performed before and after PS matching.Resu...
Abstract 21201: Stent Length Remains an Important Risk for Recurrent Events in Women With or Without Diabetes Mellitus After New Generation DES PCI: From the WIN DES Collaboration
Circulation, 2017
Introduction: New Generation drug eluting stents (DES) have overcome the limitations of bare meta... more Introduction: New Generation drug eluting stents (DES) have overcome the limitations of bare metal stents and first generation DES resulting in lower risk of ischemic events in women. Hypothesis: We sought to compare increasing total stent length per patient for 3-yr outcomes in DM and non-DM women after percutaneous coronary intervention (PCI) with new generation DES. Methods: The WIN-DES collaboration is a pooled database of women undergoing PCI with coronary stents in 26 randomized trials. We compared total stent length per patient treated with new generation DES in quartiles (Among DM - Q1: 8-18mm, Q2: 18-24mm, Q3: 24-38mm and Q4: 38+mm; among non-DM Q1: 8-18mm, Q2: 18-24mm, Q3: 24-36mm and Q4: 36+mm). 3-yr outcomes were analyzed in a time to event manner and adjusted using multivariable methods. Major adverse cardiovascular events (MACE) were defined as a composite of death, myocardial infarction (MI) or target lesion revascularization (TLR). Results: The study sample comprised...
Association of Frailty and Preoperative Hypoalbuminemia with the Risk of Complications, Readmission, and Mortality After Spine Surgery
World Neurosurgery, Jun 1, 2023
Longitudinal Trends of Patient Demographics and Morbidity of Different Approaches in Lumbar Interbody Fusion: An Analysis Using the American College of Surgeons National Surgical Quality Improvement Program Database
World Neurosurgery
STUDY DESIGN Retrospective observational population-based study OBJECTIVES: Aims of this study we... more STUDY DESIGN Retrospective observational population-based study OBJECTIVES: Aims of this study were to determine the time trend of demographics, complications, and outcomes for patients undergoing posterior/transforaminal (PLIF/TLIF) or anterior/lateral lumbar interbody fusion (ALIF/LLIF) and to compare the differences in the time trends between both procedures. METHODS The ACS-NSQIP database was queried for patients undergoing PLIF/TLIF and ALIF/LLIF procedures. Outcomes were analyzed for differences between two time periods in the PLIF/TLIF and ALIF/LLIF cohorts separately (2009-2013 and 2015-2019). Longitudinal time trends of the two procedures were determined by difference-in-differences (DID) analysis. Statistical significance was defined as p<0.05. RESULTS For both approaches, there was an increase in age and ASA class over time, accompanied by a significant decrease in blood transfusions and morbidity. The DID analysis showed a greater change in age (DID:-1.8%; p<0.001) and more patients rated ASA class 3 (DID: -2.4%; p=0.033) in the ALIF/LLIF patients compared to PLIF/TLIF. Length of stay (LOS) declined significantly over time in both cohorts, with a greater reduction observed for patients who underwent ALIF/LLIF compared to PLIF/TLIF (DID: 0.2%; p=0.014). There were no changes in readmission rates over time in either cohort (PLIF/TLIF DID: 0.6%; p=0.080; ALIF/LLIF DID: -0.2%; p=0.696). CONCLUSIONS Time trends for PLIF/TLIF and ALIF/LIIF showed a significant increase in the number of older patients with complex medical status undergoing surgery. Despite these trends, there were decreases in overall postoperative morbidity, incidence of blood transfusion, and LOS, without increasing readmission. These results suggest general improvement in surgical and perioperative management of lumbar fusion over time with greater gains found in ALIF/LLIF specific care compared to PLIF/TLIF.
Effect of Increasing Stent Length on 3-Year Clinical Outcomes in Women Undergoing Percutaneous Coronary Intervention With New-Generation Drug-Eluting Stents: Patient-Level Pooled Analysis of Randomized Trials From the WIN-DES Initiative
JACC. Cardiovascular interventions, Jan 8, 2018
The aim of this study was to examine whether stent length per patient and stent length per lesion... more The aim of this study was to examine whether stent length per patient and stent length per lesion are negative markers for 3-year outcomes in women following percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES). In the era of advanced stent technologies, whether stent length remains a correlate of adverse outcomes is unclear. Women treated with new-generation DES in 14 randomized trials from the WIN-DES (Women in Innovation and Drug-Eluting Stents) pooled database were evaluated. Total stent length per patient, which was available in 5,403 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 24 mm; quartile 3, 24 to 36 mm; quartile 4, ≥36 mm), and stent length per lesion, which was available in 5,232 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 20 mm; quartile 3, 20 to 27 mm; quartile 4, ≥27 mm) were analyzed in quartiles. The primary endpoint was 3-year major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardia...
Interobserver Variability in CT and MR Staging of Lung Cancer
Journal of Computer Assisted Tomography, 1993
Our goal was to assess the interobserver variability in staging non-small cell lung cancer using ... more Our goal was to assess the interobserver variability in staging non-small cell lung cancer using CT and MRI. As part of the Radiologic Diagnostic Oncology Group (RDOG) study of lung cancer staging, the CT and MR examinations of 40 patients suspected of having non-small cell bronchogenic carcinoma were blindly interpreted by four expert observers. The primary tumor and lymph node stages in the 40 study subjects were similar to the final proportions reported in the RDOG study. Assessed abnormalities included the presence of a lung nodule, chest wall invasion, mediastinal invasion, bronchial involvement, lymph node metastasis in specific node stations, and T and N classifications. Percent agreement and kappa-values were calculated for each of these determinations. Depending on the finding assessed and the method of analysis, average agreement rates ranged from 58 to 90% for CT and from 61 to 96% for MRI. Average kappa-values were largely between 0.40 and 0.60 when dichotomous analysis was used; weighted kappa-values were similar. With a single exception, no significant differences were found for kappa-values calculated for CT and MRI. Although interobserver agreement rates are good for determining T and N classification in patients with lung cancer, variability in image interpretation is frequent, even among experienced observers.
OBJECTIVE. The purpose of this study was to correlate findings at MR imaging and transrectal sono... more OBJECTIVE. The purpose of this study was to correlate findings at MR imaging and transrectal sonography with histopathologic findings after surgery in patients with prostatic cancer, to identify the pathologic characteristics of prostatic cancer that improved detection with MR imaging and transrectal sonography, and to identify the imaging characteristics that correlated with detection of true cancers. MATERIALS AND METHODS. Data
American Journal of Roentgenology, 1994
Interobserver Variability in CT and MR Staging of Lung Cancer
Journal of Computer Assisted Tomography, 1993
Our goal was to assess the interobserver variability in staging non-small cell lung cancer using ... more Our goal was to assess the interobserver variability in staging non-small cell lung cancer using CT and MRI. As part of the Radiologic Diagnostic Oncology Group (RDOG) study of lung cancer staging, the CT and MR examinations of 40 patients suspected of having non-small cell bronchogenic carcinoma were blindly interpreted by four expert observers. The primary tumor and lymph node stages in the 40 study subjects were similar to the final proportions reported in the RDOG study. Assessed abnormalities included the presence of a lung nodule, chest wall invasion, mediastinal invasion, bronchial involvement, lymph node metastasis in specific node stations, and T and N classifications. Percent agreement and kappa-values were calculated for each of these determinations. Depending on the finding assessed and the method of analysis, average agreement rates ranged from 58 to 90% for CT and from 61 to 96% for MRI. Average kappa-values were largely between 0.40 and 0.60 when dichotomous analysis was used; weighted kappa-values were similar. With a single exception, no significant differences were found for kappa-values calculated for CT and MRI. Although interobserver agreement rates are good for determining T and N classification in patients with lung cancer, variability in image interpretation is frequent, even among experienced observers.
Frailty stratification using the Modified 5-item frailty index: Significant variation within frailty patients in spine surgery
World Neurosurgery, Jun 1, 2023
Up to 10-year surveillance comparison of survivability in single-level cervical disc replacement versus anterior cervical discectomy and fusion in New York
Journal of neurosurgery, Apr 1, 2023
OBJECTIVE Cervical disc replacement (CDR) is an alternative treatment to anterior cervical discec... more OBJECTIVE Cervical disc replacement (CDR) is an alternative treatment to anterior cervical discectomy and fusion (ACDF), which is the current gold standard, for degenerative cervical diseases such as cervical spondylotic myelopathy and cervical radiculopathy. CDR has several theoretical benefits over ACDF, including preservation of motion, earlier return to unrestricted activity, and potentially a lower risk of adjacent-segment disease. Recent literature has reported positive clinical results for CDR, but few studies have investigated the long-term risk of revision surgery of CDR versus ACDF. The purpose of this study was to identify and analyze the epidemiological, clinical, and operative risk factors that affect revision rates following single-level CDR and ACDF procedures. METHODS A retrospective cohort was extracted from the Statewide Planning and Research Cooperative System using ICD-9 and CPT codes. Inclusion criteria were adult patients undergoing primary, subaxial (C3–7), single-level ACDF or CDR for cervical radiculopathy and/or cervical spondylotic myelopathy between 2005 and 2013. Survivability was defined as the time between the index procedure and the presence of a subsequent discharge record for cervical spinal fusion or disc replacement. Statistical analyses were performed using chi-square tests, t-tests, Cox proportional hazards models, and a Kaplan-Meier plot. RESULTS A total of 7450 patients were included in this study (6615 ACDF and 835 CDR). When adjusted for patient demographics, the hazard ratios showed no significant differences in the incidence of revision risk between the two cohorts. The CDR cohort had a higher incidence of postoperative dysphagia (p < 0.05). Patients undergoing ACDF had a longer average hospital stay (2.8 vs 1.9 days, p < 0.001). There was no significant difference in time to revision surgery (p = 0.486). CONCLUSIONS CDR and ACDF have both been shown to be effective treatments for cervical spine disease. CDR patients had a shorter average inpatient hospital stay compared with ACDF patients but tended to experience dysphagia more frequently. There was a tendency toward increased survivability of CDR; however, this was not found to be statistically significant at any time point. The large size and heterogeneity of each cohort and the availability of > 10 years of surveillance data differentiate this study from other published literature. This investigation has limitations inherent to large data analysis studies, including the implementation and inaccuracy of diagnosis and procedural coding; however, this reflects real-world use of coding by practitioners.
Utilization Trends of Intraoperative Neuromonitoring for Anterior Cervical Discectomy and Fusion in New York State
Spine, Dec 28, 2022
The Utilization of Intraoperative Neurophysiological Monitoring for Lumbar Decompression and Fusion Surgery in New York State
Spine
Study Design. Retrospective database analysis. Objective. To elucidate trends in the utilization ... more Study Design. Retrospective database analysis. Objective. To elucidate trends in the utilization of intraoperative neurophysiological monitoring (IONM) during elective lumbar surgery procedures and to investigate the association between the use of IONM and surgical outcomes. Background. The routine use of IONM in elective lumbar spine procedures has recently been called into question due to longer operative time, higher cost, and other substitute advanced technologies. Methods. The Statewide Planning and Research Cooperative System database was accessed to perform this retrospective study. The trends of IONM use for lumbar decompression and fusion procedures were investigated from 2007 to 2018. The association between IONM use and surgical outcomes was investigated from 2017 to 2018. Multivariable logistic regression analyses, as well as propensity score matching (PS-matching), were conducted to assess IONM association in neurological deficits reduction. Results. The utilization of ...
Comparative effectiveness of anesthetic technique on outcomes after lumbar spine surgery: a retrospective propensity score-matched analysis of the National Surgical Quality Improvement Program, 2009–2019
Regional Anesthesia & Pain Medicine
BackgroundThe impact of anesthetic technique on spine surgery outcomes is controversial. Using a ... more BackgroundThe impact of anesthetic technique on spine surgery outcomes is controversial. Using a large national sample of patients, we compared outcomes after lumbar decompression under regional anesthesia (RA: spinal or epidural) or general anesthesia (GA).MethodsA retrospective population-based study of American College of Surgeons National Surgical Quality Improvement Program data (2009–2019). Patients were propensity score (PS) matched 3:1 (GA:RA) on demographic and surgical variables. The primary outcome was the association between anesthetic type and any complication (cardiac, pulmonary, renal, transfusion, stroke, infectious, deep vein thrombosis/pulmonary embolus). Secondary outcomes included the association between anesthetic type and individual complications, readmission and length of stay (LOS). Unadjusted comparisons (OR, 95% CI), logistic regression and adjusted generalized linear modeling (parameter estimate, PE, 95% CI) were performed before and after PS matching.Resu...
Abstract 21201: Stent Length Remains an Important Risk for Recurrent Events in Women With or Without Diabetes Mellitus After New Generation DES PCI: From the WIN DES Collaboration
Circulation, 2017
Introduction: New Generation drug eluting stents (DES) have overcome the limitations of bare meta... more Introduction: New Generation drug eluting stents (DES) have overcome the limitations of bare metal stents and first generation DES resulting in lower risk of ischemic events in women. Hypothesis: We sought to compare increasing total stent length per patient for 3-yr outcomes in DM and non-DM women after percutaneous coronary intervention (PCI) with new generation DES. Methods: The WIN-DES collaboration is a pooled database of women undergoing PCI with coronary stents in 26 randomized trials. We compared total stent length per patient treated with new generation DES in quartiles (Among DM - Q1: 8-18mm, Q2: 18-24mm, Q3: 24-38mm and Q4: 38+mm; among non-DM Q1: 8-18mm, Q2: 18-24mm, Q3: 24-36mm and Q4: 36+mm). 3-yr outcomes were analyzed in a time to event manner and adjusted using multivariable methods. Major adverse cardiovascular events (MACE) were defined as a composite of death, myocardial infarction (MI) or target lesion revascularization (TLR). Results: The study sample comprised...
Association of Frailty and Preoperative Hypoalbuminemia with the Risk of Complications, Readmission, and Mortality After Spine Surgery
World Neurosurgery, Jun 1, 2023
Longitudinal Trends of Patient Demographics and Morbidity of Different Approaches in Lumbar Interbody Fusion: An Analysis Using the American College of Surgeons National Surgical Quality Improvement Program Database
World Neurosurgery
STUDY DESIGN Retrospective observational population-based study OBJECTIVES: Aims of this study we... more STUDY DESIGN Retrospective observational population-based study OBJECTIVES: Aims of this study were to determine the time trend of demographics, complications, and outcomes for patients undergoing posterior/transforaminal (PLIF/TLIF) or anterior/lateral lumbar interbody fusion (ALIF/LLIF) and to compare the differences in the time trends between both procedures. METHODS The ACS-NSQIP database was queried for patients undergoing PLIF/TLIF and ALIF/LLIF procedures. Outcomes were analyzed for differences between two time periods in the PLIF/TLIF and ALIF/LLIF cohorts separately (2009-2013 and 2015-2019). Longitudinal time trends of the two procedures were determined by difference-in-differences (DID) analysis. Statistical significance was defined as p<0.05. RESULTS For both approaches, there was an increase in age and ASA class over time, accompanied by a significant decrease in blood transfusions and morbidity. The DID analysis showed a greater change in age (DID:-1.8%; p<0.001) and more patients rated ASA class 3 (DID: -2.4%; p=0.033) in the ALIF/LLIF patients compared to PLIF/TLIF. Length of stay (LOS) declined significantly over time in both cohorts, with a greater reduction observed for patients who underwent ALIF/LLIF compared to PLIF/TLIF (DID: 0.2%; p=0.014). There were no changes in readmission rates over time in either cohort (PLIF/TLIF DID: 0.6%; p=0.080; ALIF/LLIF DID: -0.2%; p=0.696). CONCLUSIONS Time trends for PLIF/TLIF and ALIF/LIIF showed a significant increase in the number of older patients with complex medical status undergoing surgery. Despite these trends, there were decreases in overall postoperative morbidity, incidence of blood transfusion, and LOS, without increasing readmission. These results suggest general improvement in surgical and perioperative management of lumbar fusion over time with greater gains found in ALIF/LLIF specific care compared to PLIF/TLIF.
Effect of Increasing Stent Length on 3-Year Clinical Outcomes in Women Undergoing Percutaneous Coronary Intervention With New-Generation Drug-Eluting Stents: Patient-Level Pooled Analysis of Randomized Trials From the WIN-DES Initiative
JACC. Cardiovascular interventions, Jan 8, 2018
The aim of this study was to examine whether stent length per patient and stent length per lesion... more The aim of this study was to examine whether stent length per patient and stent length per lesion are negative markers for 3-year outcomes in women following percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES). In the era of advanced stent technologies, whether stent length remains a correlate of adverse outcomes is unclear. Women treated with new-generation DES in 14 randomized trials from the WIN-DES (Women in Innovation and Drug-Eluting Stents) pooled database were evaluated. Total stent length per patient, which was available in 5,403 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 24 mm; quartile 3, 24 to 36 mm; quartile 4, ≥36 mm), and stent length per lesion, which was available in 5,232 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 20 mm; quartile 3, 20 to 27 mm; quartile 4, ≥27 mm) were analyzed in quartiles. The primary endpoint was 3-year major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardia...
Interobserver Variability in CT and MR Staging of Lung Cancer
Journal of Computer Assisted Tomography, 1993
Our goal was to assess the interobserver variability in staging non-small cell lung cancer using ... more Our goal was to assess the interobserver variability in staging non-small cell lung cancer using CT and MRI. As part of the Radiologic Diagnostic Oncology Group (RDOG) study of lung cancer staging, the CT and MR examinations of 40 patients suspected of having non-small cell bronchogenic carcinoma were blindly interpreted by four expert observers. The primary tumor and lymph node stages in the 40 study subjects were similar to the final proportions reported in the RDOG study. Assessed abnormalities included the presence of a lung nodule, chest wall invasion, mediastinal invasion, bronchial involvement, lymph node metastasis in specific node stations, and T and N classifications. Percent agreement and kappa-values were calculated for each of these determinations. Depending on the finding assessed and the method of analysis, average agreement rates ranged from 58 to 90% for CT and from 61 to 96% for MRI. Average kappa-values were largely between 0.40 and 0.60 when dichotomous analysis was used; weighted kappa-values were similar. With a single exception, no significant differences were found for kappa-values calculated for CT and MRI. Although interobserver agreement rates are good for determining T and N classification in patients with lung cancer, variability in image interpretation is frequent, even among experienced observers.
OBJECTIVE. The purpose of this study was to correlate findings at MR imaging and transrectal sono... more OBJECTIVE. The purpose of this study was to correlate findings at MR imaging and transrectal sonography with histopathologic findings after surgery in patients with prostatic cancer, to identify the pathologic characteristics of prostatic cancer that improved detection with MR imaging and transrectal sonography, and to identify the imaging characteristics that correlated with detection of true cancers. MATERIALS AND METHODS. Data
American Journal of Roentgenology, 1994
Interobserver Variability in CT and MR Staging of Lung Cancer
Journal of Computer Assisted Tomography, 1993
Our goal was to assess the interobserver variability in staging non-small cell lung cancer using ... more Our goal was to assess the interobserver variability in staging non-small cell lung cancer using CT and MRI. As part of the Radiologic Diagnostic Oncology Group (RDOG) study of lung cancer staging, the CT and MR examinations of 40 patients suspected of having non-small cell bronchogenic carcinoma were blindly interpreted by four expert observers. The primary tumor and lymph node stages in the 40 study subjects were similar to the final proportions reported in the RDOG study. Assessed abnormalities included the presence of a lung nodule, chest wall invasion, mediastinal invasion, bronchial involvement, lymph node metastasis in specific node stations, and T and N classifications. Percent agreement and kappa-values were calculated for each of these determinations. Depending on the finding assessed and the method of analysis, average agreement rates ranged from 58 to 90% for CT and from 61 to 96% for MRI. Average kappa-values were largely between 0.40 and 0.60 when dichotomous analysis was used; weighted kappa-values were similar. With a single exception, no significant differences were found for kappa-values calculated for CT and MRI. Although interobserver agreement rates are good for determining T and N classification in patients with lung cancer, variability in image interpretation is frequent, even among experienced observers.