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Pulmonary subsolid nodules: value of semi-automatic measurement in diagnostic accuracy, diagnostic reproducibility and nodule classification agreement

  • Chest
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Abstract

Objectives

We hypothesized that semi-automatic diameter measurements would improve the accuracy and reproducibility in discriminating preinvasive lesions and minimally invasive adenocarcinomas from invasive pulmonary adenocarcinomas appearing as subsolid nodules (SSNs) and increase the reproducibility in classifying SSNs.

Methods

Two readers independently performed semi-automatic and manual measurements of the diameters of 102 SSNs and their solid portions. Diagnostic performance in predicting invasive adenocarcinoma based on diameters was tested using logistic regression analysis with subsequent receiver operating characteristic curves. Inter- and intrareader reproducibilities of diagnosis and SSN classification according to Fleischner’s guidelines were investigated for each measurement method using Cohen’s κ statistics.

Results

Semi-automatic effective diameter measurements were superior to manual average diameters for the diagnosis of invasive adenocarcinoma (AUC, 0.905–0.923 for semi-automatic measurement and 0.833–0.864 for manual measurement; p<0.05). Reproducibility of diagnosis between the readers also improved with semi-automatic measurement (κ=0.924 for semi-automatic measurement and 0.690 for manual measurement, p=0.012). Inter-reader SSN classification reproducibility was significantly higher with semi-automatic measurement (κ=0.861 for semi-automatic measurement and 0.683 for manual measurement, p=0.022).

Conclusions

Semi-automatic effective diameter measurement offers an opportunity to improve diagnostic accuracy and reproducibility as well as the classification reproducibility of SSNs.

Key Points

• Semi-automatic effective diameter measurement improves the diagnostic accuracy for pulmonary subsolid nodules.

• Semi-automatic measurement increases the inter-reader agreement on the diagnosis for subsolid nodules.

• Semi-automatic measurement augments the inter-reader reproducibility for the classification of subsolid nodules.

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Fig. 1
Fig. 2

Abbreviations

AIS:

Adenocarcinoma in-situ

AUC:

Area under the curve

CI:

Confidence interval

CTDIvol :

Volume CT dose index

DLP:

Dose-length product

Dsolid :

Diameter of solid portion

DSSN :

Diameter of subsolid nodule

HU:

Hounsfield unit

IPA:

Invasive pulmonary adenocarcinoma

Lung-RADS:

Lung CT Screening Reporting and Data System

MIAs:

Minimally invasive adenocarcinomas

Psolid :

Solid proportion within a nodule

Rdiff :

Percentage relative difference

ROC:

Receiver operating characteristic curve

SSDE:

Size-specific dose estimate

SSN:

Subsolid nodule

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Funding

This study has received funding by the SNUH Research Fund, Seoul National University Hospital, Seoul, Korea (grant number: 05-2016-0050).

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Authors and Affiliations

  1. Department of Radiology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea

    Hyungjin Kim, Chang Min Park, Eui Jin Hwang, Su Yeon Ahn & Jin Mo Goo

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

    Hyungjin Kim, Chang Min Park, Eui Jin Hwang, Su Yeon Ahn & Jin Mo Goo

  3. Seoul National University Cancer Research Institute, Seoul, Korea

    Chang Min Park & Jin Mo Goo

Authors
  1. Hyungjin Kim
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  2. Chang Min Park
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Corresponding author

Correspondence to Chang Min Park.

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Guarantor

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

Part of the study population (36/89) had participated in a previous published study [13].

Methodology

• retrospective

• diagnostic study

• performed at one institution

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Kim, H., Park, C.M., Hwang, E.J. et al. Pulmonary subsolid nodules: value of semi-automatic measurement in diagnostic accuracy, diagnostic reproducibility and nodule classification agreement. Eur Radiol 28, 2124–2133 (2018). https://doi.org/10.1007/s00330-017-5171-7

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  • DOI: https://doi.org/10.1007/s00330-017-5171-7

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