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Diagnostic performance and prognostic value of CT-defined visceral pleural invasion in early-stage lung adenocarcinomas

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A Commentary to this article was published on 22 September 2023

Abstract

Objectives

To analyze the diagnostic performance and prognostic value of CT-defined visceral pleural invasion (CT-VPI) in early-stage lung adenocarcinomas.

Methods

Among patients with clinical stage I lung adenocarcinomas, half of patients were randomly selected for a diagnostic study, in which five thoracic radiologists determined the presence of CT-VPI. Probabilities for CT-VPI were obtained using deep learning (DL). Areas under the receiver operating characteristic curve (AUCs) and binary diagnostic measures were calculated and compared. Inter-rater agreement was assessed. For all patients, the prognostic value of CT-VPI by two radiologists and DL (using high-sensitivity and high-specificity cutoffs) was investigated using Cox regression.

Results

In 681 patients (median age, 65 years [interquartile range, 58–71]; 382 women), pathologic VPI was positive in 130 patients. For the diagnostic study (n = 339), the pooled AUC of five radiologists was similar to that of DL (0.78 vs. 0.79; p = 0.76). The binary diagnostic performance of radiologists was variable (sensitivity, 45.3–71.9%; specificity, 71.6–88.7%). Inter-rater agreement was moderate (weighted Fleiss κ, 0.51; 95%CI: 0.43–0.55). For overall survival (n = 680), CT-VPI by radiologists (adjusted hazard ratio [HR], 1.27 and 0.99; 95%CI: 0.84–1.92 and 0.63–1.56; p = 0.26 and 0.97) or DL (HR, 1.44 and 1.06; 95%CI: 0.86–2.42 and 0.67–1.68; p = 0.17 and 0.80) was not prognostic. CT-VPI by an attending radiologist was prognostic only in radiologically solid tumors (HR, 1.82; 95%CI: 1.07–3.07; p = 0.03).

Conclusion

The diagnostic performance and prognostic value of CT-VPI are limited in clinical stage I lung adenocarcinomas. This feature may be applied for radiologically solid tumors, but substantial reader variability should be overcome.

Clinical relevance statement

Although the diagnostic performance and prognostic value of CT-VPI are limited in clinical stage I lung adenocarcinomas, this parameter may be applied for radiologically solid tumors with appropriate caution regarding inter-reader variability.

Key Points

• Use of CT-defined visceral pleural invasion in clinical staging should be cautious, because prognostic value of CT-defined visceral pleural invasion remains unexplored.

• Diagnostic performance and prognostic value of CT-defined visceral pleural invasion varied among radiologists and deep learning.

• Role of CT-defined visceral pleural invasion in clinical staging may be limited to radiologically solid tumors.

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Abbreviations

AUC:

Area under the receiver operating characteristic curve

DL:

Deep learning

HR:

Hazard ratio

IQR:

Interquartile range

NPV:

Negative predictive value

NSCLC:

Non-small cell lung cancer

OS:

Overall survival

PPV:

Positive predictive value

pVPI:

Pathologic VPI

VPI:

Visceral pleural invasion

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Funding

This study was supported by the Seoul National University Hospital Research Fund (grant numbers: 04–2020-2040 and 03–2022-2170) and by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Science and ICT (grant number: NRF-2020R1C1C1003684). However, the funders had no role in the study design; in the collection, analysis, and interpretation of the data; in the writing of the report; and in the decision to submit the article for publication.

Author information

Author notes

  1. Woo Hyeon Lim and Kyung Hee Lee contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, Seoul, Korea

    Woo Hyeon Lim, Jong Hyuk Lee, Hyungin Park, Ju Gang Nam, Eui Jin Hwang, Jin Mo Goo & Hyungjin Kim

  2. Department of Radiology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea

    Kyung Hee Lee, Eui Jin Hwang, Jin Mo Goo & Hyungjin Kim

  3. Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-Do, Korea

    Kyung Hee Lee

  4. Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-Do, Korea

    Jin-Haeng Chung

  5. Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Jin Mo Goo & Young Tae Kim

  6. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea

    Jin Mo Goo

  7. Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea

    Samina Park & Young Tae Kim

  8. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea

    Samina Park & Young Tae Kim

Authors
  1. Woo Hyeon Lim
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Corresponding author

Correspondence to Hyungjin Kim.

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Guarantor

The scientific guarantor of this publication is Pf. Hyungjin Kim.

Conflict of interest

Activities related to the present article: none.

Activities not related to the present article: J.M.G. received research grants from Dong Kook Lifescience, LG Electronics, and Coreline Soft. Y.T.K. received consulting fees from Johnson and Johnson and payment for lectures from AstraZeneca, and holds stock option in Genome Insight. H.K. received consulting fees from RadiSen, and holds stock and stock option in Medical IP.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board of Seoul National University Hospital and Seoul National University Bundang Hospital.

Ethical approval

Institutional Review Board approval was obtained.

Study subject or cohorts overlap

The study patients were reported previously in Lee et al. (2023), https://doi.org/10.1513/AnnalsATS.202210-895OC.

Methodology

  • Retrospective

  • Diagnostic and prognostic study

  • Performed at one institution

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Lim, W.H., Lee, K.H., Lee, J.H. et al. Diagnostic performance and prognostic value of CT-defined visceral pleural invasion in early-stage lung adenocarcinomas. Eur Radiol 34, 1934–1945 (2024). https://doi.org/10.1007/s00330-023-10204-2

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  • DOI: https://doi.org/10.1007/s00330-023-10204-2

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