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Clinical T category for lung cancer staging: A pragmatic approach for real-world practice.

ABSTRACT: Background: To determine which components should be measured and which window settings are appropriate for computerized tomography (CT) size measurements of lung adenocarcinoma (ADC) and to explore interobserver agreement and accuracy according to the eighth edition of TNM staging.

Methods: A total of 165 patients with surgically resected lung ADC earlier than stage 3A were included in this study. One radiologist and two pulmonologists independently measured the total and solid sizes of components of tumors on different window settings and assessed solidity. CT measurements were compared with pathologic size measurements.

Results: In categorizing solidity, 25% of the cases showed discordant results among observers. Measuring the total size of a lung adenocarcinoma predicted pathologic invasive components to a degree similar to measuring the solid component. Lung windows were more accurate (intraclass correlation [ICC] = 0.65-0.81) than mediastinal windows (ICC = 0.20-0.72) at predicting pathologic invasive components, especially in a part-solid nodule. Interobserver agreements for measurement of solid components were good with little significant difference (lung windows, ICC = 0.89; mediastinal windows, ICC = 0.91). A high level of interobserver agreement was seen between the radiologist and pulmonologists and between residents (from the division of pulmonology and critical care) versus a fellow (from the division of pulmonology and critical care) on different windows.

Conclusions: A considerable percentage (25%) of discrepancies was encountered in categorizing the solidity of lesions, which may decrease the accuracy of measurements. Lung window settings may be superior to mediastinal windows for measuring lung ADCs, with comparable interobserver agreement and moderate accuracy for predicting pathologic invasive components.

Key points: SIGNIFICANT FINDINGS OF THE STUDY: Lung window settings are better for evaluating part-solid lung adenocarcinoma (ADC), with comparable interobserver agreement and moderate accuracy for predicting pathologic invasive components. The considerable percentage (25%) of discrepancies in categorizing solidity of the lesions may also have decreased the accuracy of measurements.

What this study adds: For accurate measurement and categorization of lung ADC, robust quantitative analysis is needed rather than a simple visual assessment.

SUBMITTER: Choi Y

PROVIDER: S-EPMC7705618 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Clinical T category for lung cancer staging: A pragmatic approach for real-world practice.

Choi Yeonu Y Kim Sun-Hyung SH Kim Ki Hwan KH Choi Yeonseok Y Park Sung Goo SG Sohn Insuk I Kim Hye Seung HS Um Sang-Won SW Lee Ho Yun HY

Thoracic cancer 20201019 12

<h4>Background</h4>To determine which components should be measured and which window settings are appropriate for computerized tomography (CT) size measurements of lung adenocarcinoma (ADC) and to explore interobserver agreement and accuracy according to the eighth edition of TNM staging.<h4>Methods</h4>A total of 165 patients with surgically resected lung ADC earlier than stage 3A were included in this study. One radiologist and two pulmonologists independently measured the total and solid size ...[more]

PMID: 33075213

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Dataset Information

Clinical T category for lung cancer staging: A pragmatic approach for real-world practice.

Publications

Clinical T category for lung cancer staging: A pragmatic approach for real-world practice.

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