Burns Judah, Haramati Linda B, Whitney Kathleen, Zelefsky Melvin N
Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center and Jacobi Medical Center, Bronx, NY, USA.
Acad Radiol. 2004 Feb;11(2):233-7. doi: 10.1016/s1076-6332(03)00573-7.
To assess the consistency of chest computed tomography (CT) reports in describing basic characteristics of lung nodules and masses.
We retrospectively identified 107 consecutive patients with preoperative chest CT scans before resection of a lung nodule or mass over a 4-year period within a single institution. There were 54 men and 53 women with a mean age of 64 years (range, 37-86) years. The CT scans were reported by a cohort of 20 board-certified radiologists, three of whom reviewed more than 10 CT scans (n = 60 exams). The CT reports were reviewed for lesion characteristics including size, location, and description of margins, presence or absence of calcification, fat and cavitation, and the diagnosis or differential diagnosis. Pathology reports were reviewed for the same characteristics and the final diagnosis. Both CT and pathologic reports of emphysema were noted in lobectomy specimens. The differences between the interpreting radiologists were also sought.
A diagnosis or differential diagnosis was provided in 90% (96/107) of CT reports. The diagnosis of bronchogenic carcinoma was made in 78% (59/76) of those with bronchogenic carcinoma, compared with 65% (20/31) of those with other diagnoses (P = NS). Radiologists described the margins of the nodule or mass in 64% (68/107) of cases, similar in frequency to 66% of pathologists (71/107). Radiologic description of an irregular/spiculated margins predicted bronchogenic carcinoma in 86% of cases (42/49), while a smooth/lobulated margins predicted a diagnosis other than bronchogenic carcinoma in 58% (11/19; P < .05). The presence or absence of calcification was noted in 7% (5/76) of cases of bronchogenic carcinoma and 32% (10/31) of those with other diagnoses (P < .05, chi square). Both radiologists and pathologists consistently reported the size of the lesions with a correlation coefficient between radiology and pathology reports of 0.88. CT reporting of the characteristics of the lesion did not differ among lesions of different sizes. There was no significant difference between major reporters (more than 10 cases) in this study. Emphysema in the surrounding lung was reported in 25% (20/81) of radiology and 38% (31/81) of pathology reports (P = NS).
This series demonstrates a lack of consistent reporting of the margins of resected lung nodules both on CT and on pathologic specimens. The presence or absence of calcification was inconsistently reported, although more frequently noted in diagnoses other than bronchogenic carcinoma. As large-scale CT screening for lung cancer becomes more common, radiologists should prioritize developing and adopting standardized reporting criteria for the CT evaluation of lung nodules.
评估胸部计算机断层扫描（CT）报告在描述肺结节和肿块基本特征方面的一致性。
我们回顾性纳入了在单一机构内4年期间连续107例在肺结节或肿块切除术前进行胸部CT扫描的患者。其中男性54例，女性53例，平均年龄64岁（范围37 - 86岁）。CT扫描由20名获得委员会认证的放射科医生进行报告，其中3人审查了超过10份CT扫描（共60次检查）。对CT报告进行审查，以获取病变特征，包括大小、位置、边缘描述、有无钙化、脂肪和空洞形成，以及诊断或鉴别诊断。对病理报告进行相同特征及最终诊断的审查。在肺叶切除标本中记录肺气肿的CT和病理报告。同时探寻解读放射科医生之间的差异。
90%（96/107）的CT报告提供了诊断或鉴别诊断。在诊断为支气管源性癌的患者中，78%（59/76）的CT报告诊断为支气管源性癌，而在其他诊断的患者中这一比例为65%（20/31）（P = 无显著性差异）。放射科医生在64%（68/107）的病例中描述了结节或肿块的边缘，与病理科医生的66%（71/107）频率相似。放射学描述为不规则/毛刺状边缘的病例中，86%（42/49）诊断为支气管源性癌，而光滑/分叶状边缘的病例中，58%（11/19）诊断为非支气管源性癌（P <.05）。在支气管源性癌病例中，7%（5/76）记录了有无钙化，而在其他诊断的病例中这一比例为32%（10/31）（P <.05，卡方检验）。放射科医生和病理科医生对病变大小的报告一致，放射学与病理报告之间的相关系数为0.88。不同大小病变的CT报告中病变特征无显著差异。本研究中主要报告者（超过10例）之间无显著差异。放射学报告中25%（20/81）的病例周围肺组织有肺气肿，病理报告中这一比例为38%（31/81）（P = 无显著性差异）。
本系列研究表明，无论是CT还是病理标本，对于切除的肺结节边缘的报告缺乏一致性。钙化的有无报告不一致，尽管在支气管源性癌以外的诊断中更常被提及。随着肺癌大规模CT筛查变得更加普遍，放射科医生应优先制定并采用标准化的报告标准用于肺结节的CT评估。
