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van Riel SJ, Ciompi F, Winkler Wille MM, Dirksen A, Lam S, Scholten ET, Rossi SE, Sverzellati N, Naqibullah M, Wittenberg R, Hovinga-de Boer MC, Snoeren M, Peters-Bax L, Mets O, Brink M, Prokop M, Schaefer-Prokop C, van Ginneken B. Malignancy risk estimation of pulmonary nodules in screening CTs: Comparison between a computer model and human observers. PLoS One 2017; 12:e0185032. [PMID: 29121063 PMCID: PMC5679538 DOI: 10.1371/journal.pone.0185032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 09/05/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose To compare human observers to a mathematically derived computer model for differentiation between malignant and benign pulmonary nodules detected on baseline screening computed tomography (CT) scans. Methods A case-cohort study design was chosen. The study group consisted of 300 chest CT scans from the Danish Lung Cancer Screening Trial (DLCST). It included all scans with proven malignancies (n = 62) and two subsets of randomly selected baseline scans with benign nodules of all sizes (n = 120) and matched in size to the cancers, respectively (n = 118). Eleven observers and the computer model (PanCan) assigned a malignancy probability score to each nodule. Performances were expressed by area under the ROC curve (AUC). Performance differences were tested using the Dorfman, Berbaum and Metz method. Seven observers assessed morphological nodule characteristics using a predefined list. Differences in morphological features between malignant and size-matched benign nodules were analyzed using chi-square analysis with Bonferroni correction. A significant difference was defined at p < 0.004. Results Performances of the model and observers were equivalent (AUC 0.932 versus 0.910, p = 0.184) for risk-assessment of malignant and benign nodules of all sizes. However, human readers performed superior to the computer model for differentiating malignant nodules from size-matched benign nodules (AUC 0.819 versus 0.706, p < 0.001). Large variations between observers were seen for ROC areas and ranges of risk scores. Morphological findings indicative of malignancy referred to border characteristics (spiculation, p < 0.001) and perinodular architectural deformation (distortion of surrounding lung parenchyma architecture, p < 0.001; pleural retraction, p = 0.002). Conclusions Computer model and human observers perform equivalent for differentiating malignant from randomly selected benign nodules, confirming the high potential of computer models for nodule risk estimation in population based screening studies. However, computer models highly rely on size as discriminator. Incorporation of other morphological criteria used by human observers to superiorly discriminate size-matched malignant from benign nodules, will further improve computer performance.
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Affiliation(s)
- Sarah J. van Riel
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
| | - Francesco Ciompi
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Asger Dirksen
- Department of Pulmonology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Stephen Lam
- Department of Integrative Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Ernst Th. Scholten
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Santiago E. Rossi
- Department of Radiology, Centro de Diagnostico Dr Enrique Rossi, Buenos Aires, Argentina
| | - Nicola Sverzellati
- Department of Clinical Sciences, Division of Radiology, University Hospital of Parma, Parma, Italy
| | - Matiullah Naqibullah
- Department of Pulmonology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Rianne Wittenberg
- Department of Radiology, Vrije Universiteit Medisch Centrum, Amsterdam, the Netherlands
| | | | - Miranda Snoeren
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Liesbeth Peters-Bax
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Onno Mets
- Department of Radiology, UMC Utrecht, Utrecht, the Netherlands
| | - Monique Brink
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cornelia Schaefer-Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands
| | - Bram van Ginneken
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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van Riel SJ, Sánchez CI, Bankier AA, Naidich DP, Verschakelen J, Scholten ET, de Jong PA, Jacobs C, van Rikxoort E, Peters-Bax L, Snoeren M, Prokop M, van Ginneken B, Schaefer-Prokop C. Observer Variability for Classification of Pulmonary Nodules on Low-Dose CT Images and Its Effect on Nodule Management. Radiology 2015; 277:863-71. [PMID: 26020438 DOI: 10.1148/radiol.2015142700] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To examine the factors that affect inter- and intraobserver agreement for pulmonary nodule type classification on low-radiation-dose computed tomographic (CT) images, and their potential effect on patient management. MATERIALS AND METHODS Nodules (n = 160) were randomly selected from the Dutch-Belgian Lung Cancer Screening Trial cohort, with equal numbers of nodule types and similar sizes. Nodules were scored by eight radiologists by using morphologic categories proposed by the Fleischner Society guidelines for management of pulmonary nodules as solid, part solid with a solid component smaller than 5 mm, part solid with a solid component 5 mm or larger, or pure ground glass. Inter- and intraobserver agreement was analyzed by using Cohen κ statistics. Multivariate analysis of variance was performed to assess the effect of nodule characteristics and image quality on observer disagreement. Effect on nodule management was estimated by differentiating CT follow-up for ground-glass nodules, solid nodules 8 mm or smaller, and part-solid nodules smaller than 5 mm from immediate diagnostic work-up for solid nodules larger than 8 mm and part-solid nodules 5 mm or greater. RESULTS Pair-wise inter- and intraobserver agreement was moderate (mean κ, 0.51 [95% confidence interval, 0.30, 0.68] and 0.57 [95% confidence interval, 0.47, 0.71]). Categorization as part-solid nodules and location in the upper lobe significantly reduced observer agreement (P = .012 and P < .001, respectively). By considering all possible reading pairs (28 possible combinations of observer pairs × 160 nodules = 4480 possible agreements or disagreements), a discordant nodule classification was found in 36.4% (1630 of 4480), related to presence or size of a solid component in 88.7% (1446 of 1630). Two-thirds of these discrepant readings (1061 of 1630) would have potentially resulted in different nodule management. CONCLUSION There is moderate inter- and intraobserver agreement for nodule classification by using current recommendations for low-radiation-dose CT examinations of the chest. Discrepancies in nodule categorization were mainly caused by disagreement on the size and presence of a solid component, which may lead to different management in the majority of cases with such discrepancies. (©) RSNA, 2015.
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Affiliation(s)
- Sarah J van Riel
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (S.J.V.R., C.I.S., E.T.S., C.J., E.V.R., L.P.B., M.S., M.P., B.V.G., C.S.P.); Department of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Department of Radiology, NYU Langone Medical Center, New York, NY (D.P.N.); Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium (J.V.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (P.A.D.J.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.)
| | - Clara I Sánchez
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (S.J.V.R., C.I.S., E.T.S., C.J., E.V.R., L.P.B., M.S., M.P., B.V.G., C.S.P.); Department of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Department of Radiology, NYU Langone Medical Center, New York, NY (D.P.N.); Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium (J.V.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (P.A.D.J.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.)
| | - Alexander A Bankier
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (S.J.V.R., C.I.S., E.T.S., C.J., E.V.R., L.P.B., M.S., M.P., B.V.G., C.S.P.); Department of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Department of Radiology, NYU Langone Medical Center, New York, NY (D.P.N.); Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium (J.V.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (P.A.D.J.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.)
| | - David P Naidich
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (S.J.V.R., C.I.S., E.T.S., C.J., E.V.R., L.P.B., M.S., M.P., B.V.G., C.S.P.); Department of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Department of Radiology, NYU Langone Medical Center, New York, NY (D.P.N.); Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium (J.V.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (P.A.D.J.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.)
| | - Johnny Verschakelen
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (S.J.V.R., C.I.S., E.T.S., C.J., E.V.R., L.P.B., M.S., M.P., B.V.G., C.S.P.); Department of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Department of Radiology, NYU Langone Medical Center, New York, NY (D.P.N.); Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium (J.V.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (P.A.D.J.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.)
| | - Ernst T Scholten
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (S.J.V.R., C.I.S., E.T.S., C.J., E.V.R., L.P.B., M.S., M.P., B.V.G., C.S.P.); Department of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Department of Radiology, NYU Langone Medical Center, New York, NY (D.P.N.); Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium (J.V.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (P.A.D.J.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.)
| | - Pim A de Jong
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (S.J.V.R., C.I.S., E.T.S., C.J., E.V.R., L.P.B., M.S., M.P., B.V.G., C.S.P.); Department of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Department of Radiology, NYU Langone Medical Center, New York, NY (D.P.N.); Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium (J.V.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (P.A.D.J.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.)
| | - Colin Jacobs
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (S.J.V.R., C.I.S., E.T.S., C.J., E.V.R., L.P.B., M.S., M.P., B.V.G., C.S.P.); Department of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Department of Radiology, NYU Langone Medical Center, New York, NY (D.P.N.); Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium (J.V.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (P.A.D.J.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.)
| | - Eva van Rikxoort
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (S.J.V.R., C.I.S., E.T.S., C.J., E.V.R., L.P.B., M.S., M.P., B.V.G., C.S.P.); Department of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Department of Radiology, NYU Langone Medical Center, New York, NY (D.P.N.); Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium (J.V.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (P.A.D.J.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.)
| | - Liesbeth Peters-Bax
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (S.J.V.R., C.I.S., E.T.S., C.J., E.V.R., L.P.B., M.S., M.P., B.V.G., C.S.P.); Department of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Department of Radiology, NYU Langone Medical Center, New York, NY (D.P.N.); Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium (J.V.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (P.A.D.J.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.)
| | - Miranda Snoeren
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (S.J.V.R., C.I.S., E.T.S., C.J., E.V.R., L.P.B., M.S., M.P., B.V.G., C.S.P.); Department of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Department of Radiology, NYU Langone Medical Center, New York, NY (D.P.N.); Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium (J.V.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (P.A.D.J.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.)
| | - Mathias Prokop
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (S.J.V.R., C.I.S., E.T.S., C.J., E.V.R., L.P.B., M.S., M.P., B.V.G., C.S.P.); Department of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Department of Radiology, NYU Langone Medical Center, New York, NY (D.P.N.); Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium (J.V.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (P.A.D.J.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.)
| | - Bram van Ginneken
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (S.J.V.R., C.I.S., E.T.S., C.J., E.V.R., L.P.B., M.S., M.P., B.V.G., C.S.P.); Department of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Department of Radiology, NYU Langone Medical Center, New York, NY (D.P.N.); Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium (J.V.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (P.A.D.J.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.)
| | - Cornelia Schaefer-Prokop
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (S.J.V.R., C.I.S., E.T.S., C.J., E.V.R., L.P.B., M.S., M.P., B.V.G., C.S.P.); Department of Cardiothoracic Imaging, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B.); Department of Radiology, NYU Langone Medical Center, New York, NY (D.P.N.); Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium (J.V.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (P.A.D.J.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.)
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