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.

Potential of artificial intelligence based on chest computed tomography to predict the nature of part‐solid nodules

“…It has been argued persuasively that good agreement between radiologists, pulmonologists and observers and between residents and peers in measuring the solid component has been achieved. 14 This provides a strong theoretical support for the measurement of the solid component. The critical value of the size of the solid component was calculated as 3.95 mm in this study.…”

“…For the CT setting, lung window imaging was used to measure the longest diameter of the solid component on the transverse section, referencing the revised guideline published in 2017. It has been argued persuasively that good agreement between radiologists, pulmonologists and observers and between residents and peers in measuring the solid component has been achieved 14 . This provides a strong theoretical support for the measurement of the solid component.…”

“…This approach has considerable interobserver consistency and moderate accuracy in the prediction of pathological invasive components. 14 Wu et al demonstrated similar diagnostic performance between the mediastinal and lung windows for the solid component. 15 …”

“…This approach has considerable interobserver consistency and moderate accuracy in the prediction of pathological invasive components. 14 Wu et al demonstrated similar diagnostic performance between the mediastinal and lung windows for the solid component. 15 To date, the research on computer-aided diagnostic (CAD) systems for detection of pulmonary nodules has entered a mature stage, but their use for diagnosis is still exploratory.…”

“…Choi et al have suggested that the lung window setting may be superior to the mediastinal window for the measurement of invasive components. This approach has considerable interobserver consistency and moderate accuracy in the prediction of pathological invasive components 14 . Wu et al demonstrated similar diagnostic performance between the mediastinal and lung windows for the solid component 15 …”