Late Breaking Abstract - Deciphering disagreement: sarcoidosis management and the role of FDG-PET/CT

<bold>Background:</bold> Fluoro-2-deoxyglucose-18 (FDG) positron emission tomography (PET/CT) is a novel and effective method of identifying sites of active sarcoidosis. However, the role of FDG-PET/CT in predicting treatment response and guiding therapy, is yet to be completely understood. Physician agreement on FDG-PET/CT utility and management was assessed in this publication through a series of sarcoidosis case vignettes. <bold>Methods:</bold> Survey responders were presented with a series of anonymised sarcoidosis case vignettes. The perceived utility of FDG-PET/CT in each case, as well as the ultimate treatment decision following provision of FDG-PET/CT results was retained. Rater inter-agreement was assessed overall and per case vignette specialty using Krippendorff’s alpha. <bold>Results:</bold> Responders (n=215) were predominantly respiratory physicians (86.78%) experienced in sarcoidosis management (94.39%), many with >20 years’ experience (32.66%). The overall inter-rater agreement assessment of all cases was poor (α=0.419). Rater agreement when filtered for case subspecialty was also poor for all cases of cardiac (α=0.567), respiratory (α=0.347) and multi-system sarcoidosis (α=0.286). FDG-PET/CT imaging was more frequently endorsed for cardiac than pulmonary cases (83% vs. 47%). Immunosuppression was increased in over 80% of cardiac cases, while current treatment plans were typically maintained for pulmonary cases. <bold>Conclusion:</bold> Our results indicate a low agreement between respiratory physicians and their management of pulmonary sarcoidosis following FDG-PET/CT. This highlights a need for further research and clarity over the role of FDG-PET/CT in the therapeutic management of pulmonary sarcoidosis.