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Tumor size in patients with severe pulmonary emphysema might be underestimated on preoperative CT

  • Chest
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Abstract

Objectives

To evaluate the effect of emphysema on tumor diameter measured on preoperative computed tomography (CT) images versus pathological specimens.

Materials and methods

We investigated patients who underwent primary lung cancer surgery: 55 patients (57 tumors) with severe emphysema and 57 patients (57 tumors) without emphysema. The tumor diameters measured in the postoperative pathological specimens were compared with those measured on the axial CT images and on multiplanar reconstruction (MPR) CT images by two independent radiologists; a subgroup analysis according to tumor size was also performed. A paired or unpaired t test was performed, depending on the tested subjects.

Results

In the emphysema group, the mean axial CT diameter was significantly smaller than the mean pathological diameter (p = 0.025/0.001 for reader 1/2), whereas in the non-emphysema group, the mean axial CT diameter was not significantly different from the pathological one for both readers. The difference between CT axial diameter and pathological diameter (= CT diameter − pathological diameter) was significantly smaller (i.e., had a stronger tendency toward underestimation on radiological measurements) in the emphysema group compared with the non-emphysema group (p = 0.014/0.008 for reader 1/2), and the difference was significantly smaller in tumors sized > 30 mm than tumors sized ≤ 20 mm in both groups.

Conclusions

Tumor size is significantly smaller on preoperative CT in patients with severe emphysema compared to patients without emphysema, especially in the case of large tumors. MPR measurement using the widest of three dimensions should be used to select T-stage for patients with severe emphysema.

Key Points

• The presence of emphysema affects the accuracy of tumor size measurements on CT.

• Compared to patients without emphysema, the tumor size in severe emphysema patients tends to be measured smaller in preoperative CT than the pathological specimen.

• This trend is more evident when large tumors are measured on axial CT images alone.

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Abbreviations

AEC:

Auto exposure control

CI:

Confidence interval

CLE:

Confluent centrilobular emphysema

CT:

Computed tomography

FOV:

Field of view

IASLC:

International Association for the Study of Lung Cancer

ICC:

Intraclass correlation coefficients

MPR:

Multiplanar reconstruction

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Haruto Sugawara, Hirokazu Watanabe & Masahiko Kusumoto

  2. Department of Radiology, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Haruto Sugawara & Akira Kunimatsu

  3. Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Osamu Abe

  4. Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan

    Yasushi Yatabe

  5. Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan

    Shun-ichi Watanabe

Authors
  1. Haruto Sugawara
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  2. Hirokazu Watanabe
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  3. Akira Kunimatsu
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  4. Osamu Abe
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  5. Yasushi Yatabe
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  6. Shun-ichi Watanabe
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  7. Masahiko Kusumoto
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Corresponding author

Correspondence to Haruto Sugawara.

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Guarantor

The scientific guarantor of this publication is Masahiko Kusumoto.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

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.

Methodology

• retrospective

• observational

• performed at one institution

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Sugawara, H., Watanabe, H., Kunimatsu, A. et al. Tumor size in patients with severe pulmonary emphysema might be underestimated on preoperative CT. Eur Radiol 32, 163–173 (2022). https://doi.org/10.1007/s00330-021-08105-3

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  • DOI: https://doi.org/10.1007/s00330-021-08105-3

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