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Guedes Pinto E, Penha D, Ravara S, Monaghan C, Hochhegger B, Marchiori E, Taborda-Barata L, Irion K. Factors influencing the outcome of volumetry tools for pulmonary nodule analysis: a systematic review and attempted meta-analysis. Insights Imaging 2023; 14:152. [PMID: 37741928 PMCID: PMC10517915 DOI: 10.1186/s13244-023-01480-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/08/2023] [Indexed: 09/25/2023] Open
Abstract
Health systems worldwide are implementing lung cancer screening programmes to identify early-stage lung cancer and maximise patient survival. Volumetry is recommended for follow-up of pulmonary nodules and outperforms other measurement methods. However, volumetry is known to be influenced by multiple factors. The objectives of this systematic review (PROSPERO CRD42022370233) are to summarise the current knowledge regarding factors that influence volumetry tools used in the analysis of pulmonary nodules, assess for significant clinical impact, identify gaps in current knowledge and suggest future research. Five databases (Medline, Scopus, Journals@Ovid, Embase and Emcare) were searched on the 21st of September, 2022, and 137 original research studies were included, explicitly testing the potential impact of influencing factors on the outcome of volumetry tools. The summary of these studies is tabulated, and a narrative review is provided. A subset of studies (n = 16) reporting clinical significance were selected, and their results were combined, if appropriate, using meta-analysis. Factors with clinical significance include the segmentation algorithm, quality of the segmentation, slice thickness, the level of inspiration for solid nodules, and the reconstruction algorithm and kernel in subsolid nodules. Although there is a large body of evidence in this field, it is unclear how to apply the results from these studies in clinical practice as most studies do not test for clinical relevance. The meta-analysis did not improve our understanding due to the small number and heterogeneity of studies testing for clinical significance. CRITICAL RELEVANCE STATEMENT: Many studies have investigated the influencing factors of pulmonary nodule volumetry, but only 11% of these questioned their clinical relevance in their management. The heterogeneity among these studies presents a challenge in consolidating results and clinical application of the evidence. KEY POINTS: • Factors influencing the volumetry of pulmonary nodules have been extensively investigated. • Just 11% of studies test clinical significance (wrongly diagnosing growth). • Nodule size interacts with most other influencing factors (especially for smaller nodules). • Heterogeneity among studies makes comparison and consolidation of results challenging. • Future research should focus on clinical applicability, screening, and updated technology.
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Affiliation(s)
- Erique Guedes Pinto
- R. Marquês de Ávila E Bolama, Universidade da Beira Interior Faculdade de Ciências da Saúde, 6201-001, Covilhã, Portugal.
| | - Diana Penha
- R. Marquês de Ávila E Bolama, Universidade da Beira Interior Faculdade de Ciências da Saúde, 6201-001, Covilhã, Portugal
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Dr, Liverpool, L14 3PE, UK
| | - Sofia Ravara
- R. Marquês de Ávila E Bolama, Universidade da Beira Interior Faculdade de Ciências da Saúde, 6201-001, Covilhã, Portugal
| | - Colin Monaghan
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Dr, Liverpool, L14 3PE, UK
| | | | - Edson Marchiori
- Faculdade de Medicina, Universidade Federal Do Rio de Janeiro, Bloco K - Av. Carlos Chagas Filho, 373 - 2º Andar, Sala 49 - Cidade Universitária da Universidade Federal Do Rio de Janeiro, Rio de Janeiro - RJ, 21044-020, Brasil
- Faculdade de Medicina, Universidade Federal Fluminense, Av. Marquês Do Paraná, 303 - Centro, Niterói - RJ, 24220-000, Brasil
| | - Luís Taborda-Barata
- R. Marquês de Ávila E Bolama, Universidade da Beira Interior Faculdade de Ciências da Saúde, 6201-001, Covilhã, Portugal
| | - Klaus Irion
- Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Oxford Rd, Manchester, M13 9WL, UK
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Brok JS, Shelmerdine S, Damsgaard F, Smets A, Irtan S, Swinson S, Hedayati V, Jacob J, Nair A, Oostveen M, Pritchard-Jones K, Olsen Ø. The clinical impact of observer variability in lung nodule classification in children with Wilms tumour. Pediatr Blood Cancer 2022; 69:e29759. [PMID: 35652617 PMCID: PMC7615195 DOI: 10.1002/pbc.29759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/10/2022] [Accepted: 04/18/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate the extent to which observer variability of computed tomography (CT) lung nodule assessment may affect clinical treatment stratification in Wilms tumour (WT) patients, according to the recent Société Internationale d'Oncologie Pédiatrique Renal Tumour Study Group (SIOP-RTSG) UMBRELLA protocol. METHODS I: CT thoraces of children with WT submitted for central review were used to estimate size distribution of lung metastases. II: Scans were selected for blinded review by five radiologists to determine intra- and inter-observer variability. They assessed identical scans on two occasions 6 months apart. III: Monte Carlo simulation (MCMC) was used to predict the clinical impact of observer variation when applying the UMBRELLA protocol size criteria. RESULTS Lung nodules were found in 84 out of 360 (23%) children with WT. For 21 identified lung nodules, inter-observer limits of agreement (LOA) for the five readers were ±2.4 and ±1.4 mm (AP diameter), ±1.9 and ±1.8 mm (TS diameter) and ±2.0 and ±2.4 mm (LS diameter) at assessments 1 and 2. Intra-observer LOA across the three dimensions were ±1.5, ±2.2, ±3.5, ±3.1 and ±2.6 mm (readers 1-5). MCMC demonstrated that 17% of the patients with a 'true' nodule size of ≥3 mm will be scored as <3 mm, and 21% of the patients with a 'true' nodule size of <3 mm will be scored as being ≥3 mm. CONCLUSION A significant intra-inter observer variation was found when measuring lung nodules on CT for patients with WT. This may have significant implications on treatment stratification, and thereby outcome, when applying a threshold of ≥3 mm for a lung nodule to dictate metastatic status.
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Affiliation(s)
- Jesper Sune Brok
- Department of Paediatric Haematology and Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Susan Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Frederikke Damsgaard
- Department of Paediatric Haematology and Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Smets
- Department of Radiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Sabine Irtan
- Department of Visceral and Neonatal Paediatric Surgery, Sorbonne University, Armand Trousseau Hospital - APHP, Paris, France
| | | | - Venus Hedayati
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Joseph Jacob
- Centre for Medical Image Computing, University College London, London, UK
- Department of Respiratory Medicine, University College London, London, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Minou Oostveen
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Øystein Olsen
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
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Usefulness of model-based iterative reconstruction in semi-automatic volumetry for ground-glass nodules at ultra-low-dose CT: a phantom study. Radiol Phys Technol 2018; 11:235-241. [DOI: 10.1007/s12194-018-0442-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/20/2018] [Accepted: 01/25/2018] [Indexed: 01/11/2023]
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