Interobserver size measurement variability in part-solid lung adenocarcinoma using pre-operative computed tomography
Interobserver size measurement variability in part-solid lung adenocarcinoma using pre-operative computed tomography
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DOI：
10.21037/jtd.2019.07.34
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发表时间：
2019-07-01
影响因子：
2.5
通讯作者：
Ito, Ken-ichi
中科院分区：
文献类型：
--
作者：
Hamanaka, Kazutoshi;Takayama, Hiroki;Ito, Ken-ichi
背景：在目前的肺癌肿瘤-淋巴结-转移分类中，实体瘤大小被用作测量肿瘤直径的致密成分。然而，测量实体瘤的大小有时是困难的，观察者间的变异性可能增加，特别是在具有磨玻璃样阴影(GGO)的部分实性结节中。本研究旨在探讨肺腺癌的观察者间大小测量变异性。方法：在我科自2016年1月至12月接受手术的47例部分实性肺腺癌患者中，5名外科医生和1名放射科医生利用术前轴位CT图像进行了一维实体和总大小的肿瘤测量，并评估了观察者间的测量变异性。根据计算机断层扫描确定的肿瘤形态特征，将变异分为五组，即：(I)微创；(Ii)支气管血管周围；(Iii)毛刺/肺不张；(Iv)邻近囊性病变；(V)弥漫性实变和GGO。结果：观察者间平均变异分别为9.7 mm(实体大小)和7.7 mm(总大小)。对每个患者的最大和最小尺寸值的分析表明，经验最丰富的外科医生和放射科医生测量最小尺寸值的频率更高。为了校正每组肿瘤平均直径的差异，使用标准差与平均值的比率计算的变异系数(CV)进行比较。I组特征对实体大小测量的变异系数值最大。结论：肺腺癌中实体大小的观察者间测量变异大于总大小。I组的大变异性表明低度恶性潜在性结节，如原位腺癌、微侵袭性腺癌和早期浸润性腺癌的大小测量有困难。在决定这些疾病的手术方式时，应认识到不可避免的尺寸测量变异性的可能性。
Background: In the current lung cancer tumor-node-metastasis classification, solid tumor size is used for tumor diameter measurement as the dense component. However, measuring solid tumor size is sometimes difficult and inter-observer variability may increase, particularly in part-solid nodules with ground-glass opacity (GGO). This study aimed to investigate inter-observer size measurement variability in lung adenocarcinoma.Methods: Of 47 patients with part-solid lung adenocarcinoma who had undergone surgery at our department from January to December 2016, five surgeons and one radiologist undertook unidimensional solid and total size tumor measurements using pre-operative axial computed tomography images, and we assessed inter-observer size measurement variability. Variability was then subclassified into five groups, according to computer tomography-identified tumor morphological characteristics, namely: ( I) minimally invasive; (II) peribronchovascular; (III) spiculation/atelectasis; (IV) adjacent to cystic lesion, and; (V) diffuse consolidation and GGO.Results: The mean inter-observer variability was 9.7 mm (solid size) and 7.7 mm (total size). Analysis of the maximum and minimum measurement size values for each patient undertaken showed that the most experienced surgeon and the radiologist measured the minimum size more frequently. To correct for differences in mean tumor diameter in each group, a comparison was made using a coefficient of variation (CV) calculated as the ratio of the standard deviation to the mean. Group I characteristics showed the largest coefficient value for variation in solid size measurement.Conclusions: Inter-observer measurement variability for solid size was larger than for total size in lung adenocarcinoma. Large variability in group I indicated the difficulty of size measurement for low-grade malignant potential nodules such as adenocarcinoma in situ, minimally invasive adenocarcinoma, and early-stage invasive adenocarcinoma. The possibility of unavoidable size measurement variability should be recognized when deciding on surgical procedures for these diseases.