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Zhao M, Deng J, Wang T, Li Y, Wu J, Zhong Y, Sun X, Jiang G, She Y, Zhu Y, Xie D, Chen C. Impact of computed tomography window settings on clinical T classifications and prognostic evaluation of patients with subsolid nodules. Eur J Cardiothorac Surg 2021; 59:1295-1303. [PMID: 33338198 DOI: 10.1093/ejcts/ezaa457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/03/2020] [Accepted: 11/15/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate the impact of lung window (LW) and mediastinal window (MW) settings on the clinical T classifications and prognostic prediction of patients with subsolid nodules. METHODS Seven hundred and nineteen surgically resected subsolid nodules were reviewed, grouping into pure ground-glass nodules (n = 179) or part-solid nodules (n = 540) using LW. Interobserver agreement on nodule classifications was assessed via kappa-value, and predictive performance of the solid portion measurement in LW and MW for pathological invasiveness and malignancy were compared using receiver-operating characteristic analysis. Cox regression was used to identify prognostic factors. Prognostic significance of T classifications based on LW (c[l]T) and MW (c[m]T) was evaluated by Kaplan-Meier method after propensity score matching. The performance of c(m)T for discrimination survival was estimated via the concordance index (C-index), net reclassification improvement and integrated-discrimination improvement. RESULTS By adopting MW, 124 part-solid nodules were reclassified as pure ground-glass nodules, and interobserver agreement improved to 0.917 (95% confidence interval 0.888-0.946). The solid portion size under MW more strongly predicted pathological invasiveness (P = 0.030), but did not better predict pathological malignancy. For remaining 416 part-solid nodules, c(l)T and c(m)T were both independent risk factors. c(m)T led to T classifications shifts in 321 nodules (14 upstaged and 307 downstaged) with no significant prognostic difference existing between the shifted c(m)T and matching c(l)T group after propensity score matching. The corrected C-index was improved to 0.695 (0.620-1.000) when adopting c(m)T with no significant difference in net reclassification improvement (P = 0.098) and integrated-discrimination improvement (P = 0.13) analysis. CONCLUSIONS As there is no significant benefit provided by MW in evaluating clinical T classification and prognosis, the current usage of LW is appropriate for assessing subsolid nodules.
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Affiliation(s)
- Mengmeng Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Tingting Wang
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yingze Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Junqi Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yifang Zhong
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xiwen Sun
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
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Clinical T categorization in stage IA lung adenocarcinomas: prognostic implications of CT display window settings for solid portion measurement. Eur Radiol 2019; 29:6069-6079. [DOI: 10.1007/s00330-019-06216-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/04/2019] [Accepted: 04/02/2019] [Indexed: 12/17/2022]
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Measurement of Multiple Solid Portions in Part-Solid Nodules for T Categorization: Evaluation of Prognostic Implication. J Thorac Oncol 2018; 13:1864-1872. [DOI: 10.1016/j.jtho.2018.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/26/2018] [Accepted: 09/07/2018] [Indexed: 12/17/2022]
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Kim H, Park CM, Song YS, Sunwoo L, Choi YR, Kim JI, Kim JH, Bae JS, Lee JH, Goo JM. Measurement Variability of Persistent Pulmonary Subsolid Nodules on Same-Day Repeat CT: What Is the Threshold to Determine True Nodule Growth during Follow-Up? PLoS One 2016; 11:e0148853. [PMID: 26859665 PMCID: PMC4747473 DOI: 10.1371/journal.pone.0148853] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 01/25/2016] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To assess the measurement variability of subsolid nodules (SSNs) in follow-up situations and to compare the degree of variability between measurement metrics. METHODS Two same-day repeat-CT scans of 69 patients (24 men and 45 women) with 69 SSNs were randomly assigned as initial or follow-up scans and were read by the same (situation 1) or different readers (situation 2). SSN size and solid portion size were measured in both situations. Measurement variability was calculated and coefficients of variation were used for comparisons. RESULTS Measurement variability for the longest and average diameter of SSNs was ±1.3 mm (±13.0%) and ±1.3 mm (±14.4%) in situation 1, and ±2.2 mm (±21.0%) and ±2.1 mm (±21.3%) in situation 2, respectively. For solid portion, measurement variability on lung and mediastinal windows was ±1.2 mm (±27.1%) and ±0.8 mm (±24.0%) in situation 1, and ±3.7 mm (±61.0%) and ±1.5 mm (±47.3%) in situation 2, respectively. There were no significant differences in the degree of variability between the longest and average diameters and between the lung and mediastinal window settings (p>0.05). However, measurement variability significantly increased when the follow-up and initial CT readers were different (p<0.001). CONCLUSIONS A cutoff of ±2.2 mm can be reliably used to determine true nodule growth on follow-up CT. Solid portion measurements were not reliable in evaluating SSNs' change when readers of initial and follow-up CT were different.
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Affiliation(s)
- Hyungjin Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Aerospace Medical Group, Air Force Education and Training Command, Jinju, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- * E-mail:
| | - Yong Sub Song
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Leonard Sunwoo
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Ye Ra Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jung Im Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Seok Bae
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Hyuk Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
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Penn A, Ma M, Chou BB, Tseng JR, Phan P. Inter-reader variability when applying the 2013 Fleischner guidelines for potential solitary subsolid lung nodules. Acta Radiol 2015; 56:1180-6. [PMID: 25293951 DOI: 10.1177/0284185114551975] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/27/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND In 2013, the Fleischner Society published recommendations for managing subsolid pulmonary nodules. Inter-reader variability has not yet been defined and has potential implications for the ease and reproducibility of applying the guidelines to clinical practice. PURPOSE To evaluate inter-reader variability when applying the 2013 Fleischner guidelines for potential solitary subsolid lung nodules. MATERIAL AND METHODS Potential nodules were identified through a systematic retrospective review of CT studies that reported a ground-glass lesion. Three radiologists decided whether these lesions fit criteria of a subsolid nodule and thus merit application of the Fleischner Society guidelines, determined if a solid component was present, and measured each component in two dimensions. Final management recommendations were based on these intermediate decisions. Inter-reader variability for management was calculated and Fleiss' kappa was used to determine significance. Logistic regression and Fisher's exact test determined whether management was contingent on each intermediate decision. RESULTS Forty-four nodules with mean diameter of 9.4 mm were evaluated by three radiologists. Final management recommendations were in agreement for 93 out of 132 cases (70.4%, kappa = 0.56). Inter-reader variability in management recommendation was contingent on disagreement over whether a pulmonary lesion fit criteria of a subsolid nodule for 24 cases (P < 0.01), whether there was a solid component for 10 cases (P = 0.01), and whether the measurement met the threshold of 5 mm for five cases (P = 0.12). CONCLUSION There is moderate inter-reader variability when applying the 2013 Fleischner Society management recommendations. Significant contributors of variability include whether the potential lesions fit subsolid nodule criteria and whether a solid component is present. Measurement variability does not significantly affect the final management decisions.
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Affiliation(s)
- Alex Penn
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Mingming Ma
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Benjamin B Chou
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Jeffrey R Tseng
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Peter Phan
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
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Yanagawa M, Tanaka Y, Leung AN, Morii E, Kusumoto M, Watanabe S, Watanabe H, Inoue M, Okumura M, Gyobu T, Ueda K, Honda O, Sumikawa H, Johkoh T, Tomiyama N. Prognostic Importance of Volumetric Measurements in Stage I Lung Adenocarcinoma. Radiology 2014; 272:557-67. [DOI: 10.1148/radiol.14131903] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Kim H, Park CM, Kim SH, Lee SM, Park SJ, Lee KH, Goo JM. Persistent pulmonary subsolid nodules: model-based iterative reconstruction for nodule classification and measurement variability on low-dose CT. Eur Radiol 2014; 24:2700-8. [DOI: 10.1007/s00330-014-3306-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/21/2014] [Accepted: 07/02/2014] [Indexed: 01/15/2023]
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