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Lim RS, Rosenberg J, Willemink MJ, Cheng SN, Guo HH, Hollett PD, Lin MC, Madani MH, Martin L, Pogatchnik BP, Pohlen M, Shen J, Tsai EB, Berry GJ, Scott G, Leung AN. Volumetric Analysis: Effect on Diagnosis and Management of Indeterminate Solid Pulmonary Nodules in Routine Clinical Practice. J Comput Assist Tomogr 2024:00004728-990000000-00335. [PMID: 38968327 DOI: 10.1097/rct.0000000000001630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
OBJECTIVE To evaluate the effect of volumetric analysis on the diagnosis and management of indeterminate solid pulmonary nodules in routine clinical practice. METHODS This was a retrospective study with 107 computed tomography (CT) cases of solid pulmonary nodules (range, 6-15 mm), 57 pathology-proven malignancies (lung cancer, n = 34; metastasis, n = 23), and 50 benign nodules. Nodules were evaluated on a total of 309 CT scans (average number of CTs/nodule, 2.9 [range, 2-7]). CT scans were from multiple institutions with variable technique. Nine radiologists (attendings, n = 3; fellows, n = 3; residents, n = 3) were asked their level of suspicion for malignancy (low/moderate or high) and management recommendation (no follow-up, CT follow-up, or care escalation) for baseline and follow-up studies first without and then with volumetric analysis data. Effect of volumetry on diagnosis and management was assessed by generalized linear and logistic regression models. RESULTS Volumetric analysis improved sensitivity (P = 0.009) and allowed earlier recognition (P < 0.05) of malignant nodules. Attending radiologists showed higher sensitivity in recognition of malignant nodules (P = 0.03) and recommendation of care escalation (P < 0.001) compared with trainees. Volumetric analysis altered management of high suspicion nodules only in the fellow group (P = 0.008). κ Statistics for suspicion for malignancy and recommended management were fair to substantial (0.38-0.66) and fair to moderate (0.33-0.50). Volumetric analysis improved interobserver variability for identification of nodule malignancy from 0.52 to 0.66 (P = 0.004) only on the second follow-up study. CONCLUSIONS Volumetric analysis of indeterminate solid pulmonary nodules in routine clinical practice can result in improved sensitivity and earlier identification of malignant nodules. The effect of volumetric analysis on management recommendations is variable and influenced by reader experience.
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Affiliation(s)
| | - Jarrett Rosenberg
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Martin J Willemink
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Sarah N Cheng
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Henry H Guo
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Philip D Hollett
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Margaret C Lin
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | | | - Lynne Martin
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Brian P Pogatchnik
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Michael Pohlen
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Jody Shen
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Emily B Tsai
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Gerald J Berry
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | | | - Ann N Leung
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
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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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Morris JM, Wentworth A, Houdek MT, Karim SM, Clarke MJ, Daniels DJ, Rose PS. The Role of 3D Printing in Treatment Planning of Spine and Sacral Tumors. Neuroimaging Clin N Am 2023; 33:507-529. [PMID: 37356866 DOI: 10.1016/j.nic.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Three-dimensional (3D) printing technology has proven to have many advantages in spine and sacrum surgery. 3D printing allows the manufacturing of life-size patient-specific anatomic and pathologic models to improve preoperative understanding of patient anatomy and pathology. Additionally, virtual surgical planning using medical computer-aided design software has enabled surgeons to create patient-specific surgical plans and simulate procedures in a virtual environment. This has resulted in reduced operative times, decreased complications, and improved patient outcomes. Combined with new surgical techniques, 3D-printed custom medical devices and instruments using titanium and biocompatible resins and polyamides have allowed innovative reconstructions.
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Affiliation(s)
- Jonathan M Morris
- Division of Neuroradiology, Department of Radiology, Anatomic Modeling Unit, Biomedical and Scientific Visualization, Mayo Clinic, 200 1st Street, Southwest, Rochester, MN, 55905, USA.
| | - Adam Wentworth
- Department of Radiology, Anatomic Modeling Unit, Mayo Clinic, Rochester, MN, USA
| | - Matthew T Houdek
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - S Mohammed Karim
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Peter S Rose
- Division of Orthopedic Oncology, Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Gross CF, Jungblut L, Schindera S, Messerli M, Fretz V, Frauenfelder T, Martini K. Comparability of Pulmonary Nodule Size Measurements among Different Scanners and Protocols: Should Diameter Be Favorized over Volume? Diagnostics (Basel) 2023; 13:diagnostics13040631. [PMID: 36832118 PMCID: PMC9955074 DOI: 10.3390/diagnostics13040631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND To assess the impact of the lung cancer screening protocol recommended by the European Society of Thoracic Imaging (ESTI) on nodule diameter, volume, and density throughout different computed tomography (CT) scanners. METHODS An anthropomorphic chest phantom containing fourteen different-sized (range 3-12 mm) and CT-attenuated (100 HU, -630 HU and -800 HU, termed as solid, GG1 and GG2) pulmonary nodules was imaged on five CT scanners with institute-specific standard protocols (PS) and the lung cancer screening protocol recommended by ESTI (ESTI protocol, PE). Images were reconstructed with filtered back projection (FBP) and iterative reconstruction (REC). Image noise, nodule density and size (diameter/volume) were measured. Absolute percentage errors (APEs) of measurements were calculated. RESULTS Using PE, dosage variance between different scanners tended to decrease compared to PS, and the mean differences were statistically insignificant (p = 0.48). PS and PE(REC) showed significantly less image noise than PE(FBP) (p < 0.001). The smallest size measurement errors were noted with volumetric measurements in PE(REC) and highest with diametric measurements in PE(FBP). Volume performed better than diameter measurements in solid and GG1 nodules (p < 0.001). However, in GG2 nodules, this could not be observed (p = 0.20). Regarding nodule density, REC values were more consistent throughout different scanners and protocols. CONCLUSION Considering radiation dose, image noise, nodule size, and density measurements, we fully endorse the ESTI screening protocol including the use of REC. For size measurements, volume should be preferred over diameter.
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Affiliation(s)
- Colin F. Gross
- Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
| | - Lisa Jungblut
- Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
| | | | - Michael Messerli
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Valentin Fretz
- Division for Radiology and Nuclear Medicine, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Thomas Frauenfelder
- Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
| | - Katharina Martini
- Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Correspondence:
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Establishing a Point-of-Care Virtual Planning and 3D Printing Program. Semin Plast Surg 2022; 36:133-148. [PMID: 36506280 PMCID: PMC9729064 DOI: 10.1055/s-0042-1754351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Virtual surgical planning (VSP) and three-dimensional (3D) printing have become a standard of care at our institution, transforming the surgical care of complex patients. Patient-specific, anatomic models and surgical guides are clinically used to improve multidisciplinary communication, presurgical planning, intraoperative guidance, and the patient informed consent. Recent innovations have allowed both VSP and 3D printing to become more accessible to various sized hospital systems. Insourcing such work has several advantages including quicker turnaround times and increased innovation through collaborative multidisciplinary teams. Centralizing 3D printing programs at the point-of-care provides a greater cost-efficient investment for institutions. The following article will detail capital equipment needs, institutional structure, operational personnel, and other considerations necessary in the establishment of a POC manufacturing program.
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A segmentation tool for pulmonary nodules in lung cancer screening: Testing and clinical usage. Phys Med 2021; 90:23-29. [PMID: 34530212 DOI: 10.1016/j.ejmp.2021.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/28/2021] [Accepted: 08/21/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE With the future goal of defining a large dataset based on low-dose CT with labelled pulmonary lesions for lung cancer screening (LCS) research, the aim of this work is to propose and evaluate into a clinical context a tool for semi-automatic segmentation able to facilitate the process of labels collection from a LCS study (COSMOS, Continuous Observation of SMOking Subjects). METHODS Considering a preliminary set of manual annotations, a segmentation model based on a 2D-Unet was trained from scratch. Contour quality of the final 2D-Unet was assessed on an internal test set of manual annotations and on a subset of the public available LIDC dataset used as external test set. The tool for semi-automatic segmentation was then designed integrating the tested model into a Graphical User Interface. According to the opinion of two clinical users, the percentage of lesions properly contoured through the tool was quantified (Acceptance Rate, AR). The variability between segmentations derived by the two readers was estimated as mean percentage of difference (MPD) between the two sets of volumes and comparing the likelihood of malignancy derived from Volume Doubling Time (VDT). RESULTS Performance in test sets were found similar (DICE ~ 0.75(0.15)). Accordingly, a good mean AR (80.1%) resulted from the two readers. Variability in terms of MPD was equal to 23.6% while 2.7% was the VDTs percentage of disagreement. CONCLUSIONS A semi-automatic segmentation tool was developed and its applicability evaluated into a clinical context demonstrating the efficacy of the tool in facilitating the collection of labelled data.
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Lung-RADS Version 1.1: Challenges and a Look Ahead, From the AJR Special Series on Radiology Reporting and Data Systems. AJR Am J Roentgenol 2021; 216:1411-1422. [PMID: 33470834 DOI: 10.2214/ajr.20.24807] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In 2014, the American College of Radiology (ACR) created Lung-RADS 1.0. The system was updated to Lung-RADS 1.1 in 2019, and further updates are anticipated as additional data become available. Lung-RADS provides a common lexicon and standardized nodule follow-up management paradigm for use when reporting lung cancer screening (LCS) low-dose CT (LDCT) chest examinations and serves as a quality assurance and outcome monitoring tool. The use of Lung-RADS is intended to improve LCS performance and lead to better patient outcomes. To date, the ACR's Lung Cancer Screening Registry is the only LCS registry approved by the Centers for Medicare & Medicaid Services and requires the use of Lung-RADS categories for reimbursement. Numerous challenges have emerged regarding the use of Lung-RADS in clinical practice, including the timing of return to LCS after planned follow-up diagnostic evaluation; potential substitution of interval diagnostic CT for future LDCT; role of volumetric analysis in assessing nodule size; assessment of nodule growth; assessment of cavitary, subpleural, and category 4X nodules; and variability in reporting of the S modifier. This article highlights the major updates between versions 1.0 and 1.1 of Lung-RADS, describes the system's ongoing challenges, and summarizes current evidence and recommendations.
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8
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Radiologists and Clinical Trials: Part 1 The Truth About Reader Disagreements. Ther Innov Regul Sci 2021; 55:1111-1121. [PMID: 34228319 PMCID: PMC8259547 DOI: 10.1007/s43441-021-00316-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 06/18/2021] [Indexed: 02/06/2023]
Abstract
The debate over human visual perception and how medical images should be interpreted have persisted since X-rays were the only imaging technique available. Concerns over rates of disagreement between expert image readers are associated with much of the clinical research and at times driven by the belief that any image endpoint variability is problematic. The deeper understanding of the reasons, value, and risk of disagreement are somewhat siloed, leading, at times, to costly and risky approaches, especially in clinical trials. Although artificial intelligence promises some relief from mistakes, its routine application for assessing tumors within cancer trials is still an aspiration. Our consortium of international experts in medical imaging for drug development research, the Pharma Imaging Network for Therapeutics and Diagnostics (PINTAD), tapped the collective knowledge of its members to ground expectations, summarize common reasons for reader discordance, identify what factors can be controlled and which actions are likely to be effective in reducing discordance. Reinforced by an exhaustive literature review, our work defines the forces that shape reader variability. This review article aims to produce a singular authoritative resource outlining reader performance's practical realities within cancer trials, whether they occur within a clinical or an independent central review.
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Jia B, Zhang X, Mo Y, Chen B, Long H, Rong T, Su X. The Study of Tumor Volume as a Prognostic Factor in T Staging System for Non-Small Cell Lung Cancer: An Exploratory Study. Technol Cancer Res Treat 2020; 19:1533033820980106. [PMID: 33297855 PMCID: PMC7734535 DOI: 10.1177/1533033820980106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: This study aimed to evaluate T staging system for non-small cell lung cancer (NSCLC) using tumor volume (TV) and other prognostic factors. Methods: This study included 1309 cases. The TV and greatest tumor diameter (GTD) were semi-automatically measured. The receiver operating characteristic (ROC) curves of TV and GTD were used to predict survival. The regression analysis was used to describe the correlation between GTD and TV. Overall survival (OS) was analyzed using the Kaplan-Meier method. Cox’s proportional hazards regression model was applied for multivariate analysis. Results: Using the OS in pN0M0 patients (997 cases), we obtained 4 optimal cutoff values and divided all cases into 5 TV groups (V1: TV ≤ 2.80 cm3; V2: TV > 2.80–6.40 cm3; V3: TV > 6.40–12.9 cm3; V4: TV > 12.9–55.01 cm3; V5: TV > 55.01 cm3) with significant OS (P < 0.001). Multivariate analysis showed that age, visceral pleural invasion (VPI), and all TV cutoff points were independent factors of OS (P < 0.05). For V3 and V4 groups, the OS in patients without VPI was better than that in patients with VPI. Using the values of TV, VPI, and N stages, we classified all cases into 5 stages from I to V depending on the OS. The OS in I, II, III, IV, and V stages were 71.3%, 65.5%, 59.8%, 47.7%, and 35.1% respectively (P < 0.001). Conclusions: We proposed a new T staging system using TV as the main prognostic descriptor in NSCLC patients, which may provide a better comprehensive clinical value than GTD in clinical applications.
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Affiliation(s)
- Bei Jia
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, People's Republic of China
| | - Xu Zhang
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, People's Republic of China
| | - Yunxian Mo
- State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Imaging and Interventional Center, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Biao Chen
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, People's Republic of China
| | - Hao Long
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, People's Republic of China
| | - Tiehua Rong
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, People's Republic of China
| | - Xiaodong Su
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, People's Republic of China
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Gierada DS, Rydzak CE, Zei M, Rhea L. Improved Interobserver Agreement on Lung-RADS Classification of Solid Nodules Using Semiautomated CT Volumetry. Radiology 2020; 297:675-684. [PMID: 32930652 PMCID: PMC7706890 DOI: 10.1148/radiol.2020200302] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/05/2020] [Accepted: 07/29/2020] [Indexed: 11/11/2022]
Abstract
Background Classification of lung cancer screening CT scans depends on measurement of lung nodule size. Information about interobserver agreement is limited. Purpose To assess interobserver agreement in the measurements and American College of Radiology Lung CT Screening Reporting and Data System (Lung-RADS) classifications of solid lung nodules detected at lung cancer screening using manual measurements of average diameter and computer-aided semiautomated measurements of average diameter and volume (CT volumetry). Materials and Methods Two radiologists and one radiology resident retrospectively measured lung nodules from screening CT scans obtained between September 2016 and June 2018 with a Lung-RADS (version 1.0) classification of 2, 3, 4A, or 4B in the clinical setting. Average manual diameter and semiautomated computer-aided diameter and volume measurements were converted to the corresponding Lung-RADS categories. Interobserver agreement in raw measurements was assessed using intraclass correlation and Bland-Altman indexes, and interobserver agreement in Lung-RADS classification was assessed using bi-rater κ. Results One hundred twenty patients (mean age, 63 years ± 6 [standard deviation]; 67 women) were evaluated. All manual, semiautomated diameter, and semiautomated volume measurements were obtained by all three readers in 120 of 147 nodules (82%). Intraclass correlation coefficients were greater than or equal to 0.95 for all reader pairs using all measurement methods and were highest using volumetry. Bias and 95% limits of agreement for average diameter were smaller with semiautomated measurements than with manual measurements. κ values across all Lung-RADS classifications were greater than or equal to 0.81, with the lowest being for manual measurements and the highest being for volumetric measurements. Forty-three of 120 (36%) of the nodules were classified into a lower Lung-RADS category on the basis of volumetry compared with using manual diameter measurements by at least one reader, whereas the reverse occurred for four of 120 (3%) of the nodules. Conclusion Interobserver agreement was high with manual diameter measurements and increased with semiautomated CT volumetric measurements. Semiautomated CT volumetry enabled classification of more nodules into lower Lung CT Screening Reporting and Data System categories than manual or semiautomated diameter measurements. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Nishino in this issue.
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Affiliation(s)
- David S. Gierada
- From the Mallinckrodt Institute of Radiology (D.S.G., C.E.R., M.Z.) and Department of Biostatistics (L.R.), School of Medicine, Washington University, 510 S Kingshighway Blvd, St Louis, MO 63110
| | | | - Markus Zei
- From the Mallinckrodt Institute of Radiology (D.S.G., C.E.R., M.Z.) and Department of Biostatistics (L.R.), School of Medicine, Washington University, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Lee Rhea
- From the Mallinckrodt Institute of Radiology (D.S.G., C.E.R., M.Z.) and Department of Biostatistics (L.R.), School of Medicine, Washington University, 510 S Kingshighway Blvd, St Louis, MO 63110
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Tumor volume is more reliable to predict nodal metastasis in non-small cell lung cancer of 3.0 cm or less in the greatest tumor diameter. World J Surg Oncol 2020; 18:168. [PMID: 32669129 PMCID: PMC7364500 DOI: 10.1186/s12957-020-01946-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/03/2020] [Indexed: 01/08/2023] Open
Abstract
Background In this study, we sought to evaluate the correlation between TV, GTD, and lymph node metastases in NSCLC patients with tumors of GTD ≤ 3.0 cm. Methods We retrospectively analyzed the characteristics of clinicopathologic variables for lymph node involvement in 285 NSCLC patients with tumors of GTD ≤ 3.0 cm who accepted curative surgical resection. The TVs were semi-automatically measured by a software, and optimal cutoff points were obtained using the X-tile software. The relationship between GTD and TV were described using non-linear regression. The correlation between GTD, TV, and N stages was analyzed using the Pearson correlation coefficient. The one-way ANOVA was used to compare the GTD and TV of different lymph node stage groups. Results The relationship between GTD and TV accorded with the exponential growth model: y = 0.113e1.455x (y = TV, x = GTD). TV for patients with node metastases (4.78 cm3) was significantly greater than those without metastases (3.57 cm3) (P < 0.001). However, there were no obvious GTD differences in cases with or without lymph node metastases (P = 0.054). We divided all cases into three TV groups using the two cutoff values (0.9 cm3 and 3.9 cm3), and there was an obvious difference in the lymphatic involvement rate between the groups (P < 0.001). The tendency to metastasize was greater with higher TV especially when the TV was > 0.9–14.2 cm3 (P = 0.010). Conclusions For NSCLC tumors with GTD ≤ 3.0 cm, TV is a more sensitive marker than GTD in predicting the positive lymph node metastases. The likelihood for metastasis increases with an increasing TV especially when GTD is > 2.0–3.0 cm.
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12
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Gierada DS, Black WC, Chiles C, Pinsky PF, Yankelevitz DF. Low-Dose CT Screening for Lung Cancer: Evidence from 2 Decades of Study. Radiol Imaging Cancer 2020; 2:e190058. [PMID: 32300760 DOI: 10.1148/rycan.2020190058] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/15/2019] [Accepted: 11/20/2019] [Indexed: 12/17/2022]
Abstract
Lung cancer remains the overwhelmingly greatest cause of cancer death in the United States, accounting for more annual deaths than breast, prostate, and colon cancer combined. Accumulated evidence since the mid to late 1990s, however, indicates that low-dose CT screening of high-risk patients enables detection of lung cancer at an early stage and can reduce the risk of dying from lung cancer. CT screening is now a recommended clinical service in the United States, subject to guidelines and reimbursement requirements intended to standardize practice and optimize the balance of benefits and risks. In this review, the evidence on the effectiveness of CT screening will be summarized and the current guidelines and standards will be described in the context of knowledge gained from lung cancer screening studies. In addition, an overview of the potential advances that may improve CT screening will be presented, and the need to better understand the performance in clinical practice outside of the research trial setting will be discussed. © RSNA, 2020.
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Affiliation(s)
- David S Gierada
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| | - William C Black
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| | - Caroline Chiles
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| | - Paul F Pinsky
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
| | - David F Yankelevitz
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St Louis, MO 63110 (D.S.G.); Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (W.C.B.); Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC (C.C.); Division of Cancer Prevention, National Cancer Institute, Bethesda, Md (P.F.P.); and Department of Radiology, Mount Sinai School of Medicine, New York, NY (D.F.Y.)
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13
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Woo M, Lowe SC, Devane AM, Gimbel RW. Intervention to Reduce Interobserver Variability in Computed Tomographic Measurement of Cancer Lesions Among Experienced Radiologists. Curr Probl Diagn Radiol 2020; 50:321-327. [PMID: 32014355 DOI: 10.1067/j.cpradiol.2020.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/01/2020] [Accepted: 01/06/2020] [Indexed: 11/22/2022]
Abstract
While a growing number of research studies have reported the inter-observer variability in computed tomographic (CT) measurements, there are very few interventional studies performed. We aimed to assess whether a peer benchmarking intervention tool may have an influence on reducing interobserver variability in CT measurements and identify possible barriers to the intervention. In this retrospective study, 13 board-certified radiologists repeatedly reviewed 10 CT image sets of lung lesions and hepatic metastases during 3 noncontiguous time periods (T1, T2, T3). Each preselected case contained normal anatomy cephalad and caudal to the lesion of interest. Lesion size measurement under RECISTS 1.1 guidelines, choice of CT slice, and time spent on measurement were captured. Prior to their final measurements, the participants were exposed to the intervention designed to reduce the number of measurements deviating from the median. Chi-square test was performed to identify radiologist-dependent factors associated with the variability. The percent of deviating measurements during T1 and T2 were 20.0% and 23.1%, respectively. There was no statistically significant change in the number of deviating measurements upon the presentation of the intervention despite the decrease in percent from 23.1% to 17.7%. The identified barriers to the intervention include clinical disagreements among radiologists. Specifically, the inter-observer variability was associated with the controversy over the choice of CT image slice (P = 0.045) and selection of start-point, axis, and end-point (P = 0.011). Clinical disagreements rather than random errors were barriers to reducing interobserver variability in CT measurement among experienced radiologists. Future interventions could aim to resolve the disagreement in an interactive approach.
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Affiliation(s)
- MinJae Woo
- Department of Public Health Sciences, Clemson University, SC
| | | | | | - Ronald W Gimbel
- Department of Public Health Sciences, Clemson University, SC.
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14
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Zhang X, Su XD. ASO Author Reflections: Which Is a Better Way to Describe Tumor Size of Lung Cancer: Tumor Volume or Diameter? Ann Surg Oncol 2019; 26:790-791. [PMID: 31620940 DOI: 10.1245/s10434-019-07938-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Xu Zhang
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, People's Republic of China.,Department of Radiology, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Xiao-Dong Su
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China. .,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China. .,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, People's Republic of China. .,Department of Radiology, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China.
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15
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Xie HJ, Zhang X, Mo YX, Long H, Rong TH, Su XD. Tumor Volume Is Better Than Diameter for Predicting the Prognosis of Patients with Early-Stage Non-small Cell Lung Cancer. Ann Surg Oncol 2019; 26:2401-2408. [PMID: 31054041 DOI: 10.1245/s10434-019-07412-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study aimed to investigate whether tumor volume (TV) is better than diameter for predicting the prognosis of patients with early-stage non-small cell lung cancer (NSCLC) after complete resection. METHODS This study retrospectively reviewed the clinicopathologic characteristics of 274 patients with early-stage NSCLC who had received pretreatment computed tomography (CT) scans and complete resection. TV was semi-automatically measured from CT scans using an imaging software program. The optimal cutoff of TV was determined by X-tile software. Disease-free survival (DFS) and overall survival (OS) were assessed by the Kaplan-Meier method. The prognostic significance of TV and other variables was assessed by Cox proportional hazards regression analysis. RESULTS Using 3.046 cm3 and 8.078 cm3 as optimal cutoff values of TV, the patients were separated into three groups. A larger TV was significantly associated with poor DFS and OS in the multivariable analysis. Kaplan-Meier curves of DFS and OS showed significant differences on the basis of TV among patients with stage 1a disease, greatest tumor diameter (GTD) of 2 cm or smaller, and GTD of 2-3 cm, respectively. Using two TV cutoff points, three categories of TV were created. In 54 cases (19.7%), patients migrated from the GTD categories of 2 cm or smaller, 2-3 cm, and larger than 3 cm into the TV categories of 3.046 cm3 or smaller, 3.046-8.078 cm3, and larger than 8.078 cm3. CONCLUSION TV is an independent prognostic factor of DFS and OS for early-stage NSCLC. The findings show that TV is better than GTD for predicting the prognosis of patients with early-stage NSCLC.
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Affiliation(s)
- Hao-Jun Xie
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, China
| | - Xu Zhang
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, China
| | - Yun-Xian Mo
- State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Radiology, Sun Yat Sen University Cancer Center, Guangzhou, China
| | - Hao Long
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, China
| | - Tie-Hua Rong
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China.,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, China
| | - Xiao-Dong Su
- Department of Thoracic Surgery, Sun Yat Sen University Cancer Center, Guangzhou, People's Republic of China. .,State Key Laboratory of Oncology in Southern China and Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. .,Lung Cancer Institute, Sun Yat Sen University, Guangzhou, China.
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16
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McNulty W, Baldwin D. Management of pulmonary nodules. BJR Open 2019; 1:20180051. [PMID: 33178935 PMCID: PMC7592490 DOI: 10.1259/bjro.20180051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 11/05/2022] Open
Abstract
Pulmonary nodules are frequently detected during clinical practice and require a structured approach in their management in order to identify early lung cancers and avoid harm from over investigation. The article reviews the 2015 British Thoracic Society guidelines for the management of pulmonary nodules and the evidence behind them.
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Affiliation(s)
- William McNulty
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - David Baldwin
- Nottingham University Hospitals NHS Trust, City Campus, Hucknall Road, Nottingham, England
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17
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Chung H, Ko H, Jeon SJ, Yoon KH, Lee J. Automatic Lung Segmentation With Juxta-Pleural Nodule Identification Using Active Contour Model and Bayesian Approach. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2018; 6:1800513. [PMID: 29910995 PMCID: PMC6001848 DOI: 10.1109/jtehm.2018.2837901] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 03/28/2018] [Accepted: 05/06/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE chest computed tomography (CT) images and their quantitative analyses have become increasingly important for a variety of purposes, including lung parenchyma density analysis, airway analysis, diaphragm mechanics analysis, and nodule detection for cancer screening. Lung segmentation is an important prerequisite step for automatic image analysis. We propose a novel lung segmentation method to minimize the juxta-pleural nodule issue, a notorious challenge in the applications. METHOD we initially used the Chan-Vese (CV) model for active lung contours and adopted a Bayesian approach based on the CV model results, which predicts the lung image based on the segmented lung contour in the previous frame image or neighboring upper frame image. Among the resultant juxta-pleural nodule candidates, false positives were eliminated through concave points detection and circle/ellipse Hough transform. Finally, the lung contour was modified by adding the final nodule candidates to the area of the CV model results. RESULTS to evaluate the proposed method, we collected chest CT digital imaging and communications in medicine images of 84 anonymous subjects, including 42 subjects with juxta-pleural nodules. There were 16 873 images in total. Among the images, 314 included juxta-pleural nodules. Our method exhibited a disc similarity coefficient of 0.9809, modified hausdorff distance of 0.4806, sensitivity of 0.9785, specificity of 0.9981, accuracy of 0.9964, and juxta-pleural nodule detection rate of 96%. It outperformed existing methods, such as the CV model used alone, the normalized CV model, and the snake algorithm. Clinical impact: the high accuracy with the juxta-pleural nodule detection in the lung segmentation can be beneficial for any computer aided diagnosis system that uses lung segmentation as an initial step.
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Affiliation(s)
- Heewon Chung
- Department of Biomedical EngineeringWonkwang University College of MedicineIksan54538South Korea
| | - Hoon Ko
- Department of Biomedical EngineeringWonkwang University College of MedicineIksan54538South Korea
| | - Se Jeong Jeon
- Department of RadiologyWonkwang University College of MedicineIksan54538South Korea
| | - Kwon-Ha Yoon
- Department of RadiologyWonkwang University College of MedicineIksan54538South Korea
| | - Jinseok Lee
- Department of Biomedical EngineeringWonkwang University College of MedicineIksan54538South Korea
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18
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Kim H, Goo JM, Park CM. Evaluation of T categories for pure ground-glass nodules with semi-automatic volumetry: is mass a better predictor of invasive part size than other volumetric parameters? Eur Radiol 2018; 28:4288-4295. [PMID: 29713766 DOI: 10.1007/s00330-018-5440-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/02/2018] [Accepted: 03/19/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study aimed to investigate the diagnostic advantage of nodule mass in differentiating invasive pulmonary adenocarcinomas (IPAs) among pure ground-glass nodules (pGGNs) over other volumetric measurements. Another aim of this study was to analyse the correlation between volumetric measurements on computed tomography (CT) scans and the pathological invasive component size. METHODS This Institutional Review Board-approved retrospective study included 117 patients (men:women = 53:64; mean age, 57.3 years) with 117 pGGNs. Semi-automatic segmentation was performed for all nodules, and volumetric measurements, such as nodule volume, attenuation, mass, two-dimensional (2D) average diameter and three-dimensional (3D) longest diameter, were obtained. Receiver operating characteristic (ROC) curve analyses were performed to evaluate the diagnostic performances of the volumetric parameters in discriminating IPAs. Spearman correlation coefficients were calculated between the volumetric measurements and the invasive component size. RESULTS Area under the ROC curve for mass was 0.792 (95% CI, 0.691-0.872) in non-enhanced CT and 0.730 (95% CI, 0.607-0.832) in contrast-enhanced CT. Nodule mass was not superior to 2D average diameter for the differentiation of IPAs in both non-enhanced (0.792 vs 0.780; p = 0.501) CT and contrast-enhanced CT scans (0.730 vs 0.700; p = 0.319). The correlation between the volumetric measurements (mass, 3D longest diameter and 2D average diameter) and the invasive component size was moderate (Spearman's rho, 0.401-0.422) in non-enhanced CT and weak (Spearman's rho, 0.276-0.310) in contrast-enhanced CT. CONCLUSIONS Nodule mass measurement had no strength over other volumetric parameters for the prediction of pathological invasiveness in the diagnosis of pGGNs. KEY POINTS • Mass is not superior to other volumetric measurements for the diagnosis of pure ground-glass nodules. • Mass and two-dimensional average diameter exhibited comparable performance for the discrimination of invasive adenocarcinomas among pure ground-glass nodules. • The diagnostic performance of volumetric measurements was lower on contrast-enhanced CT scans. • The correlation between the volumetric measurements and the invasive component size was moderate on non-enhanced CT scans and weak on contrast-enhanced CT scans.
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Affiliation(s)
- Hyungjin Kim
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea. .,Cancer Research Institute, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Cancer Research Institute, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
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19
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Godoy MCB, Odisio EGLC, Truong MT, de Groot PM, Shroff GS, Erasmus JJ. Pulmonary Nodule Management in Lung Cancer Screening: A Pictorial Review of Lung-RADS Version 1.0. Radiol Clin North Am 2018; 56:353-363. [PMID: 29622071 DOI: 10.1016/j.rcl.2018.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The number of screening-detected lung nodules is expected to increase as low-dose computed tomography screening is implemented nationally. Standardized guidelines for image acquisition, interpretation, and screen-detected nodule workup are essential to ensure a high standard of medical care and that lung cancer screening is implemented safely and cost effectively. In this article, we review the current guidelines for pulmonary nodule management in the lung cancer screening setting.
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Affiliation(s)
- Myrna C B Godoy
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 371, Houston, TX 77030, USA.
| | - Erika G L C Odisio
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 371, Houston, TX 77030, USA
| | - Mylene T Truong
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 371, Houston, TX 77030, USA
| | - Patricia M de Groot
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 371, Houston, TX 77030, USA
| | - Girish S Shroff
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 371, Houston, TX 77030, USA
| | - Jeremy J Erasmus
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 371, Houston, TX 77030, USA
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20
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Milanese G, Eberhard M, Martini K, Vittoria De Martini I, Frauenfelder T. Vessel suppressed chest Computed Tomography for semi-automated volumetric measurements of solid pulmonary nodules. Eur J Radiol 2018; 101:97-102. [PMID: 29571809 DOI: 10.1016/j.ejrad.2018.02.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/09/2018] [Accepted: 02/14/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate whether vessel-suppressed computed tomography (VSCT) can be reliably used for semi-automated volumetric measurements of solid pulmonary nodules, as compared to standard CT (SCT) MATERIAL AND METHODS: Ninety-three SCT were elaborated by dedicated software (ClearRead CT, Riverain Technologies, Miamisburg, OH, USA), that allows subtracting vessels from lung parenchyma. Semi-automated volumetric measurements of 65 solid nodules were compared between SCT and VSCT. The measurements were repeated by two readers. For each solid nodule, volume measured on SCT by Reader 1 and Reader 2 was averaged and the average volume between readers acted as standard of reference value. Concordance between measurements was assessed using Lin's Concordance Correlation Coefficient (CCC). Limits of agreement (LoA) between readers and CT datasets were evaluated. RESULTS Standard of reference nodule volume ranged from 13 to 366 mm3. The mean overestimation between readers was 3 mm3 and 2.9 mm3 on SCT and VSCT, respectively. Semi-automated volumetric measurements on VSCT showed substantial agreement with the standard of reference (Lin's CCC = 0.990 for Reader 1; 0.985 for Reader 2). The upper and lower LoA between readers' measurements were (16.3, -22.4 mm3) and (15.5, -21.4 mm3) for SCT and VSCT, respectively. CONCLUSIONS VSCT datasets are feasible for the measurements of solid nodules, showing an almost perfect concordance between readers and with measurements on SCT.
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Affiliation(s)
- Gianluca Milanese
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
| | - Matthias Eberhard
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
| | - Katharina Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
| | - Ilaria Vittoria De Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
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21
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Kakinuma R, Muramatsu Y, Yamamichi J, Gomi S, Oubel E, Moriyama N. Evaluation of the 95% limits of agreement of the volumes of 5-year clinically stable solid nodules for the development of a follow-up system for indeterminate solid nodules in CT lung cancer screening. J Thorac Dis 2018; 10:175-189. [PMID: 29600047 DOI: 10.21037/jtd.2017.11.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study sought to evaluate the 95% limits of agreement of the volumes of 5-year clinically stable solid nodules for the development of a follow-up system for indeterminate solid nodules. Methods The volumes of 226 solid nodules that had been clinically stable for 5 years were measured in 186 patients (53 female never-smokers, 36 male never-smokers, 51 males with <30 pack-years, and 46 males with ≥30 pack-years) using a three-dimensional semiautomated method. Volume changes were evaluated using three methods: percent change, proportional change and growth rate. The 95% limits of agreement were evaluated using the Bland-Altman method. Results The 95% limits of agreement were as follows: range of percent change, from ±34.5% to ±37.8%; range of proportional change, from ±34.1% to ±36.8%; and range of growth rate, from ±39.2% to ±47.4%. Percent change-based, proportional change-based, and growth rate-based diagnoses of an increase or decrease in ten solid nodules were made at a mean of 302±402, 367±455, and 329±496 days, respectively, compared with a clinical diagnosis made at 809±616 days (P<0.05). Conclusions The 95% limits of agreement for volume change in 5-year stable solid nodules may enable the detection of an increase or decrease in the solid nodule at an earlier stage than that enabled by a clinical diagnosis, possibly contributing to the development of a follow-up system for reducing the number of additional Computed tomography (CT) scans performed during the follow-up period.
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Affiliation(s)
- Ryutaro Kakinuma
- Division of Cancer Screening, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.,Cancer Screening Center, National Cancer Center, Tokyo, Japan.,Department of Pulmonology, Tokyo General Hospital, Tokyo, Japan
| | - Yukio Muramatsu
- Division of Cancer Screening, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.,Department of Radiology, E-Medical Tokyo, Tokyo, Japan
| | - Junta Yamamichi
- Division of Cancer Screening, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.,Global Healthcare IT Project, Medical Equipment Group, Canon Inc., Tokyo, Japan
| | - Shiho Gomi
- Division of Cancer Screening, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.,Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Estanislao Oubel
- MEDIAN Technologies, Valbonne Sophia Antipolis, Valbonne, France
| | - Noriyuki Moriyama
- Division of Cancer Screening, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.,Department of Radiology, Tokyo Midtown Medical Center, Tokyo, Japan
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22
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Larici AR, Farchione A, Franchi P, Ciliberto M, Cicchetti G, Calandriello L, del Ciello A, Bonomo L. Lung nodules: size still matters. Eur Respir Rev 2017; 26:26/146/170025. [DOI: 10.1183/16000617.0025-2017] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 10/28/2017] [Indexed: 12/18/2022] Open
Abstract
The incidence of indeterminate pulmonary nodules has risen constantly over the past few years. Determination of lung nodule malignancy is pivotal, because the early diagnosis of lung cancer could lead to a definitive intervention. According to the current international guidelines, size and growth rate represent the main indicators to determine the nature of a pulmonary nodule. However, there are some limitations in evaluating and characterising nodules when only their dimensions are taken into account. There is no single method for measuring nodules, and intrinsic errors, which can determine variations in nodule measurement and in growth assessment, do exist when performing measurements either manually or with automated or semi-automated methods. When considering subsolid nodules the presence and size of a solid component is the major determinant of malignancy and nodule management, as reported in the latest guidelines. Nevertheless, other nodule morphological characteristics have been associated with an increased risk of malignancy. In addition, the clinical context should not be overlooked in determining the probability of malignancy. Predictive models have been proposed as a potential means to overcome the limitations of a sized-based assessment of the malignancy risk for indeterminate pulmonary nodules.
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23
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Han D, Heuvelmans MA, Vliegenthart R, Rook M, Dorrius MD, de Jonge GJ, Walter JE, van Ooijen PMA, de Koning HJ, Oudkerk M. Influence of lung nodule margin on volume- and diameter-based reader variability in CT lung cancer screening. Br J Radiol 2017; 91:20170405. [PMID: 28972803 DOI: 10.1259/bjr.20170405] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: To evaluate the influence of nodule margin on inter- and intrareader variability in manual diameter measurements and semi-automatic volume measurements of solid nodules detected in low-dose CT lung cancer screening. METHODS: 25 nodules of each morphological category (smooth, lobulated, spiculated and irregular) were randomly selected from 93 participants of the Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON). Semi-automatic volume measurements were performed using Syngo LungCARE® software (Version Somaris/5 VB10A-W, Siemens, Forchheim, Germany). Three radiologists independently measured mean diameters manually. Impact of nodule margin on interreader variability was evaluated based on systematic error and 95% limits of agreement. Interreader variability was compared with the nodule growth cut-off as used in Lung CT Screening Reporting and Data System (LungRADS; +1.5-mm diameter) and the Dutch-Belgian Randomized Lung Cancer Screening Trial(acronym: NELSON) /British Thoracic Society (+25% volume). RESULTS: For manual diameter measurements, a significant systematic error (up to 1.2 mm) between readers was found in all morphological categories. For semi-automatic volume measurements, no statistically significant systematic error was found. The interreader variability in mean diameter measurements exceeded the 1.5-mm cut-off for nodule growth for all morphological categories [smooth: ±1.9 mm (+27%), lobulated: ±2.0 mm (+33%), spiculated: ±3.5 mm (+133%), irregular: ±4.5 mm (+200%)]. The 25% vol growth cut-off was exceeded slightly for spiculated [28% (+12%)] and irregular [27% (+8%)] nodules. CONCLUSION: Lung nodule sizing based on manual diameter measurement is affected by nodule margin. Interreader variability increases especially for nodules with spiculated and irregular margins, and causes substantial misclassification of nodule growth. This effect is almost neglectable for semi-automated volume measurements. Semi-automatic volume measurements are superior for both size and growth determination of pulmonary nodules. ADVANCES IN KNOWLEDGE: Nodule assessment based on manual diameter measurements is susceptible to nodule margin. This effect is almost neglectable for semi-automated volume measurements. The larger interreader variability for manual diameter measurement results in inaccurate lung nodule growth detection and size classification.
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Affiliation(s)
- Daiwei Han
- 1 University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands , Groningen , Netherlands
| | - Marjolein A Heuvelmans
- 1 University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands , Groningen , Netherlands.,2 Department of Pulmonology, Medisch Spectrum Twente , Enschede , Netherlands
| | - Rozemarijn Vliegenthart
- 1 University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands , Groningen , Netherlands.,3 Department of Radiology, University of Groningen, University Medical Center Groningen , Groningen , Netherlands
| | - Mieneke Rook
- 1 University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands , Groningen , Netherlands
| | - Monique D Dorrius
- 1 University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands , Groningen , Netherlands.,3 Department of Radiology, University of Groningen, University Medical Center Groningen , Groningen , Netherlands
| | - Gonda J de Jonge
- 3 Department of Radiology, University of Groningen, University Medical Center Groningen , Groningen , Netherlands
| | - Joan E Walter
- 1 University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands , Groningen , Netherlands
| | - Peter M A van Ooijen
- 1 University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands , Groningen , Netherlands.,3 Department of Radiology, University of Groningen, University Medical Center Groningen , Groningen , Netherlands
| | - Harry J de Koning
- 4 Department of Public Health, Erasmus University Rotterdam, University Medical Center Rotterdam , Rotterdam , Netherlands
| | - Matthijs Oudkerk
- 1 University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands , Groningen , Netherlands
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Bankier AA, MacMahon H, Goo JM, Rubin GD, Schaefer-Prokop CM, Naidich DP. Recommendations for Measuring Pulmonary Nodules at CT: A Statement from the Fleischner Society. Radiology 2017. [DOI: 10.1148/radiol.2017162894] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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25
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Su D, Wang Y. [Growth Evaluation of Pulmonary Nodules on Chest CT]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:584-588. [PMID: 28855041 PMCID: PMC5973007 DOI: 10.3779/j.issn.1009-3419.2017.08.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
对肺结节行计算机断层扫描(computed tomography, CT)随访并确定结节生长特性是临床针对不定性肺结节常采用的策略。依据肿瘤生长指数模型,常采用体积或质量倍增时间量化结节的生长速率。本文拟对肺癌的指数生长模型、肺结节生长量化评价的方法学、不同类型肺结节的生长特性进行综述。
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Affiliation(s)
- Datong Su
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ying Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
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Abstract
OBJECTIVE The objective of this study is to evaluate measurement variability in volumetric assessment of pulmonary nodules on low-dose CT images with a view toward determining how this variability is influenced by nodule size. MATERIALS AND METHODS A large CT screening database was reviewed to identify solid pulmonary nodules that had remained stable in size on the basis of findings from at least three scans obtained over a 2-year period. Two software packages (Lung VCAR and syngo.via) were used to assess the nodule volume on the two most recent CT scans, which were obtained at a slice thickness of 0.625 mm. The percentage of volume change was calculated for each nodule. The SD of the percentage of volume change was determined for nodules in each of the following nodule diameter size categories: less than 4 mm, 4-5 mm, 6-9 mm, and 10 mm or larger. The diameter was the mean of the length and width in the CT image that represented the largest cross-sectional area of the nodule. RESULTS The 171 stable nodules that were identified in 117 CT screening participants (median age, 61 years) ranged in size from 2.2 to 18.7 mm. The time between acquisition of the first and last CT images ranged from 3.7 to 17.8 years (median, 11.5 years). For each of the four categories of diameter size (< 4, 4-5, 6-9, and ≥ 10 mm), the SD of the percentage of volume change was 20.4%, 17.7%, 14.6%, and 3.7%, with the use of Lung VCAR, and 59.5%, 24.3%, 9.1%, and 6.2%, with the use of syngo.via, respectively. The SD decreased with increasing nodule diameter, with the use of both software packages. CONCLUSION Measurement variability decreased with increasing nodule diameter for both software packages and was different between the two software packages.
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Su XD, Xie HJ, Liu QW, Mo YX, Long H, Rong TH. The prognostic impact of tumor volume on stage I non-small cell lung cancer. Lung Cancer 2017; 104:91-97. [DOI: 10.1016/j.lungcan.2016.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/17/2016] [Accepted: 12/20/2016] [Indexed: 12/25/2022]
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Han D, Heuvelmans MA, Oudkerk M. Volume versus diameter assessment of small pulmonary nodules in CT lung cancer screening. Transl Lung Cancer Res 2017; 6:52-61. [PMID: 28331824 DOI: 10.21037/tlcr.2017.01.05] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Currently, lung cancer screening by low-dose chest CT is implemented in the United States for high-risk persons. A disadvantage of lung cancer screening is the large number of small-to-intermediate sized lung nodules, detected in around 50% of all participants, the large majority being benign. Accurate estimation of nodule size and growth is essential in the classification of lung nodules. Currently, manual diameter measurements are the standard for lung cancer screening programs and routine clinical care. However, European screening studies using semi-automated volume measurements have shown higher accuracy and reproducibility compared to diameter measurements. In addition to this, with the optimization of CT scan techniques and reconstruction parameters, as well as advances in segmentation software, the accuracy of nodule volume measurement can be improved even further. The positive results of previous studies on volume and diameter measurements of lung nodules suggest that manual measurements of nodule diameter may be replaced by semi-automated volume measurements in the (near) future.
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Affiliation(s)
- Daiwei Han
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen, the Netherlands
| | - Marjolein A Heuvelmans
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen, the Netherlands
| | - Matthijs Oudkerk
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen, the Netherlands
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Jiang B, Zhou D, Sun Y, Wang J. Systematic analysis of measurement variability in lung cancer with multidetector computed tomography. Ann Thorac Med 2017; 12:95-100. [PMID: 28469719 PMCID: PMC5399697 DOI: 10.4103/1817-1737.203750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE: To systematically analyze the nature of measurement variability in lung cancer with multidetector computed tomography (CT) scans. METHODS: Multidetector CT scans of 67 lung cancer patients were analyzed. Unidimensional (Response Evaluation Criteria in Solid Tumor criteria), bidimensional (World Health Organization criteria), and volumetric measurements were performed independently by ten radiologists and were repeated after at least 5 months. Repeatability and reproducibility measurement variations were estimated by analyzing reliability, agreement, variation coefficient, and misclassification statistically. The relationship of measurement variability with various sources was also analyzed. RESULTS: Analyses of 69 lung tumors with an average size of 1.1–12.1 cm (mean 4.3 cm) indicated that volumetric technique had the minimum measurement variability compared to the unidimensional or bidimensional technique. Tumor characteristics (object effect) could be the primary factor to influence measurement variability while the effect of raters (subjective effect) was faint. Segmentation and size in tumor characteristics were associated with measurement variability, and some mathematical function was established between the volumetric variability and tumor size. CONCLUSION: Volumetric technique has the minimum variability in measuring lung cancer, and measurement variability is associated with tumor size by nonlinear mathematical function.
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Affiliation(s)
- Binghu Jiang
- Department of Radiology, Sir Run Run Hospital Affiliated with Nanjing Medical University, Nanjing, China
| | - Dan Zhou
- Department of Radiology, BenQ Medical Center, Nanjing Medical University, Nanjing, China
| | - Yujie Sun
- Department of Cell Biology, Collaborative Innovation Center for Cancer Personalized Medicine, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Cancer Center, Key Laboratory of Human Functional Genomics of Jiangsu Province, Nanjing Medical University, Nanjing, China
| | - Jichen Wang
- Department of Radiology, BenQ Medical Center, Nanjing Medical University, Nanjing, China
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Walter JE, Heuvelmans MA, de Jong PA, Vliegenthart R, van Ooijen PMA, Peters RB, ten Haaf K, Yousaf-Khan U, van der Aalst CM, de Bock GH, Mali W, Groen HJM, de Koning HJ, Oudkerk M. Occurrence and lung cancer probability of new solid nodules at incidence screening with low-dose CT: analysis of data from the randomised, controlled NELSON trial. Lancet Oncol 2016; 17:907-916. [DOI: 10.1016/s1470-2045(16)30069-9] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 12/17/2022]
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Rampinelli C, Calloni SF, Minotti M, Bellomi M. Spectrum of early lung cancer presentation in low-dose screening CT: a pictorial review. Insights Imaging 2016; 7:449-59. [PMID: 27188380 PMCID: PMC4877352 DOI: 10.1007/s13244-016-0487-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/20/2016] [Accepted: 03/18/2016] [Indexed: 12/14/2022] Open
Abstract
The typical presentation of early stage lung cancers on low-dose CT screening are non-calcified pulmonary nodules. However, there is a wide spectrum of unusual focal abnormalities that can be early presentations of lung cancer. These abnormalities include, for example, cancers associated with 'cystic airspaces' or scar-like cancers. The detection of lung cancer with low-dose CT can be affected by the absence of intravenous contrast medium. As a consequence, endobronchial and central lesions can be difficult to recognize, raising the potential for missed cancers. Focal lesions arising within pre-existing lung disease, such as lung fibrosis or apical scars, can also be early lung cancer manifestations and deserve particular consideration as recognition of these lesions may be hindered by the underlying disease. Furthermore, the unpredictable growth rate of lung cancer, which ranges from indolent to aggressive cancers, necessitates attention to the wide spectrum of progression in lung cancer appearance on serial low-dose CT scans. In this pictorial review we discuss the spectrum of early lung cancer presentation in low-dose CT screening, highlighting typical as well as unusual radiological features and the varied growth rates of early lung cancer. Teaching Points • There is a wide spectrum of early presentations of lung cancer on LDCT. • Low radiation dose and the absence of contrast medium injection can affect lung cancer detection. • Lung cancer growth shows various behaviours, ranging from indolent to aggressive cancers. • Familiarity with LDCT technique can improve CT screening effectiveness and avoid missed diagnosis.
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Affiliation(s)
- Cristiano Rampinelli
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy.
| | | | - Marta Minotti
- School of Medicine, University of Milan, Milan, Italy
| | - Massimo Bellomi
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy
- School of Medicine, University of Milan, Milan, Italy
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Travis WD, Asamura H, Bankier AA, Beasley MB, Detterbeck F, Flieder DB, Goo JM, MacMahon H, Naidich D, Nicholson AG, Powell CA, Prokop M, Rami-Porta R, Rusch V, van Schil P, Yatabe Y. The IASLC Lung Cancer Staging Project: Proposals for Coding T Categories for Subsolid Nodules and Assessment of Tumor Size in Part-Solid Tumors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2016; 11:1204-1223. [PMID: 27107787 DOI: 10.1016/j.jtho.2016.03.025] [Citation(s) in RCA: 473] [Impact Index Per Article: 59.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 12/15/2022]
Abstract
This article proposes codes for the primary tumor categories of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) and a uniform way to measure tumor size in part-solid tumors for the eighth edition of the tumor, node, and metastasis classification of lung cancer. In 2011, new entities of AIS, MIA, and lepidic predominant adenocarcinoma were defined, and they were later incorporated into the 2015 World Health Organization classification of lung cancer. To fit these entities into the T component of the staging system, the Tis category is proposed for AIS, with Tis (AIS) specified if it is to be distinguished from squamous cell carcinoma in situ (SCIS), which is to be designated Tis (SCIS). We also propose that MIA be classified as T1mi. Furthermore, the use of the invasive size for T descriptor size follows a recommendation made in three editions of the Union for International Cancer Control tumor, node, and metastasis supplement since 2003. For tumor size, the greatest dimension should be reported both clinically and pathologically. In nonmucinous lung adenocarcinomas, the computed tomography (CT) findings of ground glass versus solid opacities tend to correspond respectively to lepidic versus invasive patterns seen pathologically. However, this correlation is not absolute; so when CT features suggest nonmucinous AIS, MIA, and lepidic predominant adenocarcinoma, the suspected diagnosis and clinical staging should be regarded as a preliminary assessment that is subject to revision after pathologic evaluation of resected specimens. The ability to predict invasive versus noninvasive size on the basis of solid versus ground glass components is not applicable to mucinous AIS, MIA, or invasive mucinous adenocarcinomas because they generally show solid nodules or consolidation on CT.
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University, School of Medicine, Tokyo, Japan
| | - Alexander A Bankier
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mary Beth Beasley
- Department of Pathology, Ichan School of Medicine at Mount Sinai, New York, New York
| | - Frank Detterbeck
- Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Douglas B Flieder
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Heber MacMahon
- Department of Radiology, University of Chicago, Chicago, Illinois
| | - David Naidich
- Department of Radiology, New York University Langone Medical Center, New York University, New York, New York
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, United Kingdom
| | - Charles A Powell
- Pulmonary Critical Care and Sleep Medicine, Ichan School of Medicine, New York, New York
| | - Mathias Prokop
- Department of Radiology, Radboud University Nymegen Medical Center, Nymegen, The Netherlands
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain; CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain
| | - Valerie Rusch
- Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
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Sui X, Meinel FG, Song W, Xu X, Wang Z, Wang Y, Jin Z, Chen J, Vliegenthart R, Schoepf UJ. Detection and size measurements of pulmonary nodules in ultra-low-dose CT with iterative reconstruction compared to low dose CT. Eur J Radiol 2016; 85:564-70. [PMID: 26860668 DOI: 10.1016/j.ejrad.2015.12.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/12/2015] [Accepted: 12/16/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Xin Sui
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
| | - Felix G Meinel
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
| | - Wei Song
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoli Xu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
| | - Zixing Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China.
| | - Yuyan Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China.
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
| | | | - Rozemarijn Vliegenthart
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Department of Radiology, Groningen, The Netherlands.
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.
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Beaumont H, Souchet S, Labatte JM, Iannessi A, Tolcher AW. Changes of lung tumour volume on CT - prediction of the reliability of assessments. Cancer Imaging 2015; 15:17. [PMID: 26521238 PMCID: PMC4628325 DOI: 10.1186/s40644-015-0052-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/02/2015] [Indexed: 11/12/2022] Open
Abstract
Background For oncological evaluations, quantitative radiology gives clinicians significant insight into patients’ response to therapy. In regard to the Response Evaluation Criteria in Solid Tumours (RECIST), the classification of disease evolution partly consists in applying thresholds to the measurement of the relative change of tumour. In the case of tumour volumetry, response thresholds have not yet been established. This study proposes and validates a model for calculating thresholds for the detection of minimal tumour change when using the volume of pulmonary lesions on CT as imaging biomarker. Methods Our work is based on the reliability analysis of tumour volume measurements documented by the Quantitative Imaging Biomarker Alliance. Statistics of measurements were entered into a multi-parametric mathematical model of the relative changes derived from the Geary-Hinkley transformation. The consistency of the model was tested by comparing modelled thresholds against Monte Carlo simulations of tumour volume measurements with additive random error. The model has been validated by repeating measurements on real patient follow ups. Results For unchanged tumour volume, relying on a normal distribution of error, the agreement between model and simulations featured a type I error of 5.25 %. Thus, we established that a threshold of 35 % of volume reduction corresponds to a partial response (PR) and a 55 % volume increase corresponds to progressive disease (PD). Changes between −35 and +55 % are categorized as stable disease (SD). Tested on real clinical data, 97.1 % [95.7; 98.0] of assessments fall into the range of variability predicted by our model of confidence interval. Conclusions Our study indicates that the Geary Hinkley model, using published statistics, is appropriate to predict response thresholds for the volume of pulmonary lesions on CT.
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Affiliation(s)
- Hubert Beaumont
- MEDIAN Technologies - Sciences, 1800 route des crêtes Les Deux Arcs Bat B, Valbonne, 06560, France.
| | - Simon Souchet
- Université d'Angers - Mathematics, Angers, 49000, France.
| | | | - Antoine Iannessi
- Centre Anticancer Antoine Lacassagne - Radiology, Nice, 06100, France.
| | - Anthony William Tolcher
- START - South Texas Accelerated Research Therapeutics, LLC - Clinical Research, San Antonio, TX, USA.
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Fintelmann FJ, Bernheim A, Digumarthy SR, Lennes IT, Kalra MK, Gilman MD, Sharma A, Flores EJ, Muse VV, Shepard JAO. The 10 Pillars of Lung Cancer Screening: Rationale and Logistics of a Lung Cancer Screening Program. Radiographics 2015; 35:1893-908. [PMID: 26495797 DOI: 10.1148/rg.2015150079] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
On the basis of the National Lung Screening Trial data released in 2011, the U.S. Preventive Services Task Force made lung cancer screening (LCS) with low-dose computed tomography (CT) a public health recommendation in 2013. The Centers for Medicare and Medicaid Services (CMS) currently reimburse LCS for asymptomatic individuals aged 55-77 years who have a tobacco smoking history of at least 30 pack-years and who are either currently smoking or had quit less than 15 years earlier. Commercial insurers reimburse the cost of LCS for individuals aged 55-80 years with the same smoking history. Effective care for the millions of Americans who qualify for LCS requires an organized step-wise approach. The 10-pillar model reflects the elements required to support a successful LCS program: eligibility, education, examination ordering, image acquisition, image review, communication, referral network, quality improvement, reimbursement, and research frontiers. Examination ordering can be coupled with decision support to ensure that only eligible individuals undergo LCS. Communication of results revolves around the Lung Imaging Reporting and Data System (Lung-RADS) from the American College of Radiology. Lung-RADS is a structured decision-oriented reporting system designed to minimize the rate of false-positive screening examination results. With nodule size and morphology as discriminators, Lung-RADS links nodule management pathways to the variety of nodules present on LCS CT studies. Tracking of patient outcomes is facilitated by a CMS-approved national registry maintained by the American College of Radiology. Online supplemental material is available for this article.
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Affiliation(s)
- Florian J Fintelmann
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Adam Bernheim
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Subba R Digumarthy
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Inga T Lennes
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Mannudeep K Kalra
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Matthew D Gilman
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Amita Sharma
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Efren J Flores
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Victorine V Muse
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
| | - Jo-Anne O Shepard
- From the Department of Radiology (F.J.F., A.B., S.R.D., M.K.K., M.D.G., A.S., E.J.F., V.V.M., J.O.S.) and Cancer Center (I.T.L.), Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114
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Callister MEJ, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, Franks K, Gleeson F, Graham R, Malhotra P, Prokop M, Rodger K, Subesinghe M, Waller D, Woolhouse I. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax 2015; 70 Suppl 2:ii1-ii54. [PMID: 26082159 DOI: 10.1136/thoraxjnl-2015-207168] [Citation(s) in RCA: 545] [Impact Index Per Article: 60.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - D R Baldwin
- Nottingham University Hospitals, Nottingham, UK
| | - A R Akram
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S Barnard
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle, UK
| | - P Cane
- Department of Histopathology, St Thomas' Hospital, London, UK
| | - J Draffan
- University Hospital of North Tees, Stockton on Tees, UK
| | - K Franks
- Clinical Oncology, St James's Institute of Oncology, Leeds, UK
| | - F Gleeson
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - P Malhotra
- St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - M Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - K Rodger
- Respiratory Medicine, St James's University Hospital, Leeds, UK
| | - M Subesinghe
- Department of Radiology, Churchill Hospital, Oxford, UK
| | - D Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - I Woolhouse
- Department of Respiratory Medicine, University Hospitals of Birmingham, Birmingham, UK
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Mehta HJ, Nietert PJ, Tanner NT, Ravenel JG, Silvestri GA. Response. Chest 2014; 146:e70. [PMID: 25091775 DOI: 10.1378/chest.14-0915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Hiren J Mehta
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, FL.
| | | | - Nichole T Tanner
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Charleston, SC
| | - James G Ravenel
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, SC
| | - Gerard A Silvestri
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Charleston, SC
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Stember JN. The normal mode analysis shape detection method for automated shape determination of lung nodules. J Digit Imaging 2014; 28:224-30. [PMID: 25223520 DOI: 10.1007/s10278-014-9732-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Surface morphology and shape in general are important predictors for the behavior of solid-type lung nodules detected on CT. More broadly, shape analysis is useful in many areas of computer-aided diagnosis and essentially all scientific and engineering disciplines. Automated methods for shape detection have all previously, to the author's knowledge, relied on some sort of geometric measure. I introduce Normal Mode Analysis Shape Detection (NMA-SD), an approach that measures shape indirectly via the motion it would undergo if one imagined the shape to be a pseudomolecule. NMA-SD allows users to visualize internal movements in the imaging object and thereby develop an intuition for which motions are important, and which geometric features give rise to them. This can guide the identification of appropriate classification features to distinguish among classes of interest. I employ normal mode analysis (NMA) to animate pseudomolecules representing simulated lung nodules. Doing so, I am able to assign a testing set of nodules into the classes circular, elliptical, and irregular with roughly 97 % accuracy. This represents a proof-of-principle that one can obtain shape information by treating voxels as pseudoatoms in a pseudomolecule, and analyzing the pseudomolecule's predicted motion.
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Affiliation(s)
- Joseph N Stember
- Department of Radiology, Columbia University Medical Center, 180 Fort Washington Avenue, 3rd Floor Harkness Pavillion, Room 313, New York, NY, 10032, USA,
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Obuchowski NA, Barnhart HX, Buckler AJ, Pennello G, Wang XF, Kalpathy-Cramer J, Kim HJG, Reeves AP. Statistical issues in the comparison of quantitative imaging biomarker algorithms using pulmonary nodule volume as an example. Stat Methods Med Res 2014; 24:107-40. [PMID: 24919828 DOI: 10.1177/0962280214537392] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Quantitative imaging biomarkers are being used increasingly in medicine to diagnose and monitor patients' disease. The computer algorithms that measure quantitative imaging biomarkers have different technical performance characteristics. In this paper we illustrate the appropriate statistical methods for assessing and comparing the bias, precision, and agreement of computer algorithms. We use data from three studies of pulmonary nodules. The first study is a small phantom study used to illustrate metrics for assessing repeatability. The second study is a large phantom study allowing assessment of four algorithms' bias and reproducibility for measuring tumor volume and the change in tumor volume. The third study is a small clinical study of patients whose tumors were measured on two occasions. This study allows a direct assessment of six algorithms' performance for measuring tumor change. With these three examples we compare and contrast study designs and performance metrics, and we illustrate the advantages and limitations of various common statistical methods for quantitative imaging biomarker studies.
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Affiliation(s)
| | | | | | - Gene Pennello
- Food and Drug Administration/CDRH, Washington, DC, USA
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Manos D, Seely JM, Taylor J, Borgaonkar J, Roberts HC, Mayo JR. The Lung Reporting and Data System (LU-RADS): A Proposal for Computed Tomography Screening. Can Assoc Radiol J 2014; 65:121-34. [DOI: 10.1016/j.carj.2014.03.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/12/2014] [Indexed: 02/08/2023] Open
Abstract
Despite the positive outcome of the recent randomized trial of computed tomography (CT) screening for lung cancer, substantial implementation challenges remain, including the clear reporting of relative risk and suggested workup of screen-detected nodules. Based on current literature, we propose a 6-level Lung-Reporting and Data System (LU-RADS) that classifies screening CTs by the nodule with the highest malignancy risk. As the LU-RADS level increases, the risk of malignancy increases. The LU-RADS level is linked directly to suggested follow-up pathways. Compared with current narrative reporting, this structure should improve communication with patients and clinicians, and provide a data collection framework to facilitate screening program evaluation and radiologist training. In overview, category 1 includes CTs with no nodules and returns the subject to routine screening. Category 2 scans harbor minimal risk, including <5 mm, perifissural, or long-term stable nodules that require no further workup before the next routine screening CT. Category 3 scans contain indeterminate nodules and require CT follow up with the interval dependent on nodule size (small [5-9 mm] or large [≥10 mm] and possibly transient). Category 4 scans are suspicious and are subdivided into 4A, low risk of malignancy; 4B, likely low-grade adenocarcinoma; and 4C, likely malignant. The 4B and 4C nodules have a high likelihood of neoplasm simply based on screening CT features, even if positron emission tomography, needle biopsy, and/or bronchoscopy are negative. Category 5 nodules demonstrate frankly malignant behavior on screening CT, and category 6 scans contain tissue-proven malignancies.
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Affiliation(s)
- Daria Manos
- Department of Diagnostic Radiology, QE II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jean M. Seely
- Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Jana Taylor
- McGill Health Center, Montreal General Site, McGill University, Montreal, Quebec, Canada
| | - Joy Borgaonkar
- Department of Diagnostic Radiology, QE II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Heidi C. Roberts
- Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John R. Mayo
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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Christe A, Brönnimann A, Vock P. Volumetric analysis of lung nodules in computed tomography (CT): comparison of two different segmentation algorithm softwares and two different reconstruction filters on automated volume calculation. Acta Radiol 2014; 55:54-61. [PMID: 23864063 DOI: 10.1177/0284185113492454] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND A precise detection of volume change allows for better estimating the biological behavior of the lung nodules. Postprocessing tools with automated detection, segmentation, and volumetric analysis of lung nodules may expedite radiological processes and give additional confidence to the radiologists. PURPOSE To compare two different postprocessing software algorithms (LMS Lung, Median Technologies; LungCARE®, Siemens) in CT volumetric measurement and to analyze the effect of soft (B30) and hard reconstruction filter (B70) on automated volume measurement. MATERIAL AND METHODS Between January 2010 and April 2010, 45 patients with a total of 113 pulmonary nodules were included. The CT exam was performed on a 64-row multidetector CT scanner (Somatom Sensation, Siemens, Erlangen, Germany) with the following parameters: collimation, 24x1.2 mm; pitch, 1.15; voltage, 120 kVp; reference tube current-time, 100 mAs. Automated volumetric measurement of each lung nodule was performed with the two different postprocessing algorithms based on two reconstruction filters (B30 and B70). The average relative volume measurement difference (VME%) and the limits of agreement between two methods were used for comparison. RESULTS At soft reconstruction filters the LMS system produced mean nodule volumes that were 34.1% (P < 0.0001) larger than those by LungCARE® system. The VME% was 42.2% with a limit of agreement between -53.9% and 138.4%.The volume measurement with soft filters (B30) was significantly larger than with hard filters (B70); 11.2% for LMS and 1.6% for LungCARE®, respectively (both with P < 0.05). LMS measured greater volumes with both filters, 13.6% for soft and 3.8% for hard filters, respectively (P < 0.01 and P > 0.05). CONCLUSION There is a substantial inter-software (LMS/LungCARE®) as well as intra-software variability (B30/B70) in lung nodule volume measurement; therefore, it is mandatory to use the same equipment with the same reconstruction filter for the follow-up of lung nodule volume.
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Affiliation(s)
- Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Inselspital, Bern, Switzerland
| | - Alain Brönnimann
- Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Inselspital, Bern, Switzerland
| | - Peter Vock
- Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Inselspital, Bern, Switzerland
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Linning E, Wu S, Wang K, Meng H, Sun D, Wu Z. Computed tomography quantitative analysis of components: a new method monitoring the growth of pulmonary nodule. Acta Radiol 2013; 54:904-8. [PMID: 23761548 DOI: 10.1177/0284185113485572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The estimation of the growth of solitary pulmonary nodules by using non-invasive methods is increasingly gaining clinical importance for performing the timely adequate treatment of these nodules. PURPOSE To evaluate the application value of computed tomography (CT) quantitative analysis of components for dynamic assessment of the growth of solitary pulmonary nodules, and compare this approach with three-dimensional (3D) volumetric measurement of pulmonary nodules. MATERIAL AND METHODS The imaging data of 21 patients who had undergone multiple follow-up CT scans for solitary pulmonary nodules were retrospectively analyzed, and the total volume of pulmonary nodules and the percentage change in the total volume of pulmonary nodules after multiple follow-up CT scans were measured using 3D volume measurement software. The volume of solid components in pulmonary nodules was measured using CT quantitative analysis; the percentage change in the volume of solid components across examinations was calculated; and the percentage change in the total volume of pulmonary nodules was compared and contrasted with the percentage change in the volume of solid components in the pulmonary nodules. RESULTS All 21 cases were malignant adenocarcinomas. In the 21 cases of malignant nodules, the 3D volumes of the nodules and solid components were both increased, with the percentage change in the volume of the solid components (115.78-418.91%, 130.45 ± 119.48) significantly different from the percentage change in the total volume of the nodules (78.56-105.73% , 42.34 ± 32.17) (P = 0.02). CONCLUSION By measuring volume changes in solid components in the nodules, CT quantitative analysis offers more sensitive and earlier evaluation of the dynamic growth of the nodules than measurement of volume changes in the nodules alone.
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Affiliation(s)
- E Linning
- Shanxi Medical University, Shanxi
- Department of Radiology, Shanxi DAYI Hospital, Shanxi, China
| | - Shan Wu
- Shanxi Medical University, Shanxi
- Department of Radiology, Shanxi DAYI Hospital, Shanxi, China
| | - Kai Wang
- Department of Radiology, Shanxi DAYI Hospital, Shanxi, China
| | - Huiqiang Meng
- Department of Radiology, Shanxi DAYI Hospital, Shanxi, China
| | - Dong Sun
- Department of Radiology, Shanxi DAYI Hospital, Shanxi, China
| | - Zhifeng Wu
- Shanxi Medical University, Shanxi
- Department of Radiology, Shanxi DAYI Hospital, Shanxi, China
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Pinsky PF, Gierada DS, Nath PH, Kazerooni E, Amorosa J. National lung screening trial: variability in nodule detection rates in chest CT studies. Radiology 2013; 268:865-73. [PMID: 23592767 PMCID: PMC3750416 DOI: 10.1148/radiol.13121530] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To characterize the variability in radiologists' interpretations of computed tomography (CT) studies in the National Lung Screening Trial (NLST) (including assessment of false-positive rates [FPRs] and sensitivity), to examine factors that contribute to variability, and to evaluate trade-offs between FPRs and sensitivity among different groups of radiologists. MATERIALS AND METHODS The HIPAA-compliant NLST was approved by the institutional review board at each screening center; all participants provided informed consent. NLST radiologists reported overall screening results, nodule-specific findings, and recommendations for diagnostic follow-up. A noncalcified nodule of 4 mm or larger constituted a positive screening result. The FPR was defined as the rate of positive screening examinations in participants without a cancer diagnosis within 1 year. Descriptive analyses and mixed-effects models were utilized. The average odds ratio (OR) for a false-positive result across all pairs of radiologists was used as a measure of variability. RESULTS One hundred twelve radiologists at 32 screening centers each interpreted 100 or more NLST CT studies, interpreting 72 160 of 75 126 total NLST CT studies in aggregate. The mean FPR for radiologists was 28.7% ± 13.7 (standard deviation), with a range of 3.8%-69.0%. The model yielded an average OR of 2.49 across all pairs of radiologists and an OR of 1.83 for pairs within the same screening center. Mean FPRs were similar for academic versus nonacademic centers (27.9% and 26.7%, respectively) and for centers inside (25.0%) versus outside (28.7%) the U.S. "histoplasmosis belt." Aggregate sensitivity was 96.5% for radiologists with FPRs higher than the median (27.1%), compared with 91.9% for those with FPRs lower than the median (P = .02). CONCLUSION There was substantial variability in radiologists' FPRs. Higher FPRs were associated with modestly higher sensitivity.
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Affiliation(s)
- Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, 6130 Executive Blvd, Bethesda, MD 20892, USA.
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Xie X, Willemink MJ, Zhao Y, de Jong PA, van Ooijen PMA, Oudkerk M, Greuter MJW, Vliegenthart R. Inter- and intrascanner variability of pulmonary nodule volumetry on low-dose 64-row CT: an anthropomorphic phantom study. Br J Radiol 2013; 86:20130160. [PMID: 23884758 DOI: 10.1259/bjr.20130160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess inter- and intrascanner variability in volumetry of solid pulmonary nodules in an anthropomorphic thoracic phantom using low-dose CT. METHODS Five spherical solid artificial nodules [diameters 3, 5, 8, 10 and 12 mm; CT density +100 Hounsfield units (HU)] were randomly placed inside an anthropomorphic thoracic phantom in different combinations. The phantom was examined on two 64-row multidetector CT (64-MDCT) systems (CT-A and CT-B) from different vendors with a low-dose protocol. Each CT examination was performed three times. The CT examinations were evaluated twice by independent blinded observers. Nodule volume was semi-automatically measured by dedicated software. Interscanner variability was evaluated by Bland-Altman analysis and expressed as 95% confidence interval (CI) of relative differences. Intrascanner variability was expressed as 95% CI of relative variation from the mean. RESULTS No significant difference in CT-derived volume was found between CT-A and CT-B, except for the 3-mm nodules (p<0.05). The 95% CI of interscanner variability was within ±41.6%, ±18.2% and ±4.9% for 3, 5 and ≥8 mm nodules, respectively. The 95% CI of intrascanner variability was within ±28.6%, ±13.4% and ±2.6% for 3, 5 and ≥8 mm nodules, respectively. CONCLUSION Different 64-MDCT scanners in low-dose settings yield good agreement in volumetry of artificial pulmonary nodules between 5 mm and 12 mm in diameter. Inter- and intrascanner variability decreases at a larger nodule size to a maximum of 4.9% for ≥8 mm nodules. ADVANCES IN KNOWLEDGE The commonly accepted cut-off of 25% to determine nodule growth has the potential to be reduced for ≥8 mm nodules. This offers the possibility of reducing the interval for repeated CT scans in lung cancer screenings.
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Affiliation(s)
- X Xie
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Systematic Approach to the Management of the Newly Found Nodule on Screening Computed Tomography. Thorac Surg Clin 2013; 23:141-52. [DOI: 10.1016/j.thorsurg.2013.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Horeweg N, van der Aalst CM, Thunnissen E, Nackaerts K, Weenink C, Groen HJM, Lammers JWJ, Aerts JG, Scholten ET, van Rosmalen J, Mali W, Oudkerk M, de Koning HJ. Characteristics of Lung Cancers Detected by Computer Tomography Screening in the Randomized NELSON Trial. Am J Respir Crit Care Med 2013; 187:848-54. [DOI: 10.1164/rccm.201209-1651oc] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Willemink MJ, Borstlap J, Takx RAP, Schilham AMR, Leiner T, Budde RPJ, de Jong PA. The effects of computed tomography with iterative reconstruction on solid pulmonary nodule volume quantification. PLoS One 2013; 8:e58053. [PMID: 23460924 PMCID: PMC3584042 DOI: 10.1371/journal.pone.0058053] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 01/30/2013] [Indexed: 12/21/2022] Open
Abstract
Background The objectives of this study were to evaluate the influence of iterative reconstruction (IR) on pulmonary nodule volumetry with chest computed tomography (CT). Methods Twenty patients (12 women and 8 men, mean age 61.9, range 32–87) underwent evaluation of pulmonary nodules with a 64-slice CT-scanner. Data were reconstructed using filtered back projection (FBP) and IR (Philips Healthcare, iDose4-levels 2, 4 and 6) at similar radiation dose. Volumetric nodule measurements were performed with semi-automatic software on thin slice reconstructions. Only solid pulmonary nodules were measured, no additional selection criteria were used for the nature of nodules. For intra-observer and inter-observer variability, measurements were performed once by one observer and twice by another observer. Algorithms were compared using the concordance correlation-coefficient (pc) and Friedman-test, and post-hoc analysis with the Wilcoxon-signed ranks-test with Bonferroni-correction (significance-level p<0.017). Results Seventy-eight nodules were present including 56 small nodules (volume<200 mm3, diameter<8 mm) and 22 large nodules (volume≥200 mm3, diameter≥8 mm). No significant differences in measured pulmonary nodule volumes between FBP, iDose4-levels 2, 4 and 6 were found in both small nodules and large nodules. FBP and iDose4-levels 2, 4 and 6 were correlated with pc-values of 0.98 or higher for both small and large nodules. Pc-values of intra-observer and inter-observer variability were 0.98 or higher. Conclusions Measurements of solid pulmonary nodule volume measured with standard-FBP were comparable with IR, regardless of the IR-level and no significant differences between measured volumes of both small and large solid nodules were found.
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Affiliation(s)
- Martin J Willemink
- Utrecht University Medical Center, Department of Radiology, Utrecht, The Netherlands.
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Rampinelli C, Origgi D, Bellomi M. Low-dose CT: technique, reading methods and image interpretation. Cancer Imaging 2013; 12:548-56. [PMID: 23400217 PMCID: PMC3569671 DOI: 10.1102/1470-7330.2012.0049] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The National Lung Cancer Screening Trial has recently demonstrated that screening of high-risk populations with the use of low-dose computed tomography (LDCT) reduces lung cancer mortality[1]. Based on this encouraging result, the National Comprehensive Cancer Network guidelines recommended LDCT for selected patients at high risk of lung cancer[2]. This suggests that an increasing number of CT screening examinations will be performed. The LDCT technique is relatively simple but some CT parameters are important and should be accurately defined in order to achieve good diagnostic quality and minimize the delivered dose. In addition, LDCT examinations are not as easy to read as they may initially appear; different approaches and tools are available for nodule detection and measurement. Moreover, the management of positive results can be a complex process and can differ significantly from routine clinical practice. Therefore this paper deals with the LDCT technique, reading methods and interpretation in lung cancer screening, particularly for those radiologists who have little experience of the technique.
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Abstract
The increased detection of incidental small pulmonary nodules on multidetector computed tomography has driven attempts to refine the characterization and management of such nodules. A variety of methods have been developed to measure the size and biological activity of nodules to help define their nature, but these have limitations. Several clinical trials have assessed the efficacy of low-dose computed tomography screening for lung cancer and offer some insights into these limitations; however, they also provide evidence that refines existing nodule management strategies. This article reviews the size-based and functional measurement methods that can be used to predict the likelihood of malignancy in noncalcified solid pulmonary nodules and discusses their incorporation into existing algorithms for nodule management. The issue of multiple nodules and the optimum frequency and duration of follow-up are explored.
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Can Low-Dose Unenhanced Chest CT Be Used for Follow-Up of Lung Nodules? AJR Am J Roentgenol 2012; 199:777-80. [DOI: 10.2214/ajr.11.7577] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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