Variability in the detection of enlarged mediastinal lymph nodes in staging lung cancer: a comparison of contrast-enhanced and unenhanced CT.
Variability in the detection of enlarged mediastinal lymph nodes in staging lung cancer: a comparison of contrast-enhanced and unenhanced CT.
复制标题
肺癌分期中肿大纵隔淋巴结检测的变异性：对比增强和未增强 CT 的比较。
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发表时间：
1998
期刊：
影响因子：
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通讯作者：
M. Korobkin
中科院分区：
文献类型：
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作者：
P. Cascade;B. Gross;E. Kazerooni;L. Quint;I. Francis;Myla Strawderman;M. Korobkin
客观化
因为用于肺癌分期的CT方案各不相同，而且关于静脉注射的诊断重要性的信息很少。对比剂，我们的目的是评价观察者内部和观察者间在检测纵隔淋巴结肿大方面的一致性，比较静脉注射。增强和平扫CT。
研究对象和方法
对50例确诊或怀疑为肺癌的患者行胸部CT平扫和增强扫描。三名观察者注意到增大的淋巴结(短轴为10 mm)，并将增大的淋巴结指定为美国胸科学会结节站名称。肿大的淋巴结通过两种方式分组：通过分配发现的肿大淋巴结的确切数量(0、1、2、3、4或更多)，以及通过分配是否在一个站发现至少一个或没有发现纵隔淋巴结肿大(“一个或没有”)。使用加权kappa统计和McNemar检验确定了观察员间和观察员内口译的一致程度。
结果
增强CT检查的肿大淋巴结数目比平扫检查高11%(418对377；p=.044)。5个站的淋巴结肿大数目不同，但除右上气管旁站(2R)外，其余均较少(增强扫描有68个增大的淋巴结；平扫有44个增大的淋巴结；p=0.014)。对于所有站在一起的研究，对比增强和平扫研究之间的观察者内部一致性几乎是完美的(kappa范围，.85-.94)，并且没有发现任何观察者在至少一个淋巴结肿大的患者比例上的差异。观察者之间对于增大的淋巴结总数的一致性是实质性的或几乎完美的。对于特定的站点，最低卡伯值在2R处为0.48。一位观察者报告了更多的患者，至少有一个肿大的淋巴结在2R站有对比增强(p=.031)。2R站的两名观察者在对比度增强和不增强之间有更大的一致性(kappa=.85对.48；p=.02)。结论匹配，对估计的kappa值的计算给出了类似的结果，用于确定一个站点和“一个或没有”类别的肿大淋巴结的具体数目。
结论
我们发现对比剂增强和平扫CT的观察者内部和观察者间的解释高度一致，尽管对比剂增强CT显示更多的淋巴结肿大，特别是在2R站。
OBJECTIVE
Because CT protocols for staging lung cancer vary and little information exists regarding the diagnostic importance of using i.v. contrast material, our intent was to evaluate intra- and interobserver agreement in the detection of enlarged mediastinal lymph nodes, comparing i.v. contrast-enhanced and unenhanced CT.
SUBJECTS AND METHODS
Fifty patients with known or suspected bronchogenic carcinoma underwent unenhanced thoracic CT followed by contrast-enhanced CT. Three observers noted enlarged lymph nodes (> 10 mm in the short axis) and assigned the enlarged nodes to American Thoracic Society nodal station designations. Enlarged lymph nodes were grouped two ways: by assigning the exact number of enlarged lymph nodes found (zero, one, two, three, four or more), and by assigning whether at least one, or no, enlarged mediastinal lymph nodes were found at a station ("one or none"). Agreement levels were determined for inter- and intraobserver interpretations using weighted kappa statistics and the McNemar test.
RESULTS
The number of enlarged lymph nodes with enhanced CT was 11% higher than on unenhanced studies (418 versus 377; p = .044). Numbers of enlarged lymph nodes were different for five stations; however, the numbers were small except for the right upper paratracheal station (2R) (contrast-enhanced, 68 enlarged lymph nodes; unenhanced, 44 enlarged lymph nodes; p = .014). With regard to all stations together, intraobserver agreement between contrast-enhanced and unenhanced studies was almost perfect (kappa range, .85-.94), and no difference was found for any observer in the proportion of patients with at least one enlarged lymph node. Interobserver agreement was substantial or almost perfect for the total number of enlarged lymph nodes. For specific stations, the lowest kappa value was .48 at 2R. One observer reported more patients with at least one enlarged lymph node with contrast enhancement at station 2R (p = .031). Greater agreement existed between two observers at station 2R with contrast enhancement versus no enhancement (kappa = .85 versus .48; p = .02). Conclusions matched, and calculations of estimated kappa values gave similar results for determination of the specific number of enlarged lymph nodes at a station and the "one or none" category.
CONCLUSION
We found high agreement for intra- and interobserver interpretations for contrast-enhanced and unenhanced CT, although contrast-enhanced CT revealed more enlarged lymph nodes, especially at station 2R.