European Radiology

, Volume 29, Issue 11, pp 6069–6079 | Cite as

Clinical T categorization in stage IA lung adenocarcinomas: prognostic implications of CT display window settings for solid portion measurement

  • Hyungjin Kim
  • Jin Mo Goo
  • Young Tae Kim
  • Chang Min ParkEmail author



Our study aimed at evaluating the prognostic implications of lung and mediastinal CT display window settings for solid portion measurements on the eighth-edition lung cancer staging system’s clinical T (cT) categorization.


We retrospectively analyzed 691 surgically treated patients from 2009 to 2015 for clinical stage IA lung adenocarcinomas. Solid portions were measured at the lung and mediastinal window settings, respectively, and cT categories were determined for each measurement (cTlung and cTmediastinum). The prognostic power of the two cT factors for disease-free survival (DFS) was assessed using Cox regression, and concordance indices (C-indices) were compared using the Student t test. Subsequently, the patients were split into training and validation cohorts to calculate optimal cutoffs for the cT categorization of mediastinal window–based solid portions (cToptimal) and validate its prognostic performance.


Both cTlung ((cT1b: adjusted HR, 3.547; p = 0.017), (cT1c: adjusted HR, 9.439; p < 0.001)) and cTmediastinum ((cT1b: adjusted HR, 4.635; p < 0.001), (cT1c: adjusted HR, 11.235; p < 0.001)) were significantly associated with DFS for each multivariable Cox model. The C-indices were 0.772 (95% CI, 0.702–0.842) for cTlung and 0.787 (95% CI, 0.726–0.848) for cTmediastinum (p = 0.789). The optimal cutoffs for cT categorization of the mediastinal window–based solid portions were 0.9 cm and 1.8 cm. However, there were no significant differences in the C-indices among cTlung, cTmediastinum, and cToptimal (p > 0.05).


The prognostic performances of the cT categorizations at the lung and mediastinal windows were not significantly different. The current cT categorization based on the lung window measurement is appropriate as it stands.

Key Points

• Discriminatory power of the eighth-edition clinical T category was not significantly affected by the CT display window settings.

• Given the facts that the lung window setting enables more sensitive detection of the solid portions and higher correlation with the pathological invasive components, our findings may support adherence to the usage of the lung window setting for the solid portion measurement per the current recommendations.


Non–small cell lung carcinoma Adenocarcinoma Multidetector computed tomography Neoplasm staging Disease-free survival 



Akaike’s information criterion


Concordance index


Clinical T categorization based on solid portion measurement with the lung window setting using the eighth-edition T coding system


Clinical T categorization based on solid portion measurement with the mediastinal window setting using the eighth-edition T coding system


Clinical T categorization for the mediastinal window–based solid portion using optimal cutoffs


Disease-free survival


Electronic medical record


Interquartile range


Tumor disappearance ratio



We sincerely express our gratitude to Myunghee Lee and Ju Young Jeong for their help in data acquisition.


This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Science, ICT & Future Planning (grant number: 2017R1A2B4008517).

Compliance with ethical standards


The scientific guarantor of this publication is Chang Min Park.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in a journal article (Kim et al; in press).


• retrospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

330_2019_6216_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 15 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologySeoul National University College of MedicineSeoulSouth Korea
  2. 2.Institute of Radiation MedicineSeoul National University Medical Research CenterSeoulSouth Korea
  3. 3.Cancer Research InstituteSeoul National UniversitySeoulSouth Korea
  4. 4.Department of Thoracic and Cardiovascular SurgerySeoul National University College of MedicineSeoulSouth Korea

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