Han Daiwei, Heuvelmans Marjolein A, Vliegenthart Rozemarijn, Rook Mieneke, Dorrius Monique D, de Jonge Gonda J, Walter Joan E, van Ooijen Peter M A, de Koning Harry J, Oudkerk Matthijs
1 University of Groningen, University Medical Center Groningen, Center for Medical Imaging-North East Netherlands , Groningen , Netherlands.
2 Department of Pulmonology, Medisch Spectrum Twente , Enschede , Netherlands.
Br J Radiol. 2018 Oct;91(1090):20170405. doi: 10.1259/bjr.20170405. Epub 2017 Nov 8.
: To evaluate the influence of nodule margin on inter- and intrareader variability in manual diameter measurements and semi-automatic volume measurements of solid nodules detected in low-dose CT lung cancer screening.
: 25 nodules of each morphological category (smooth, lobulated, spiculated and irregular) were randomly selected from 93 participants of the Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON). Semi-automatic volume measurements were performed using Syngo LungCARE® software (Version Somaris/5 VB10A-W, Siemens, Forchheim, Germany). Three radiologists independently measured mean diameters manually. Impact of nodule margin on interreader variability was evaluated based on systematic error and 95% limits of agreement. Interreader variability was compared with the nodule growth cut-off as used in Lung CT Screening Reporting and Data System (LungRADS; +1.5-mm diameter) and the Dutch-Belgian Randomized Lung Cancer Screening Trial(acronym: NELSON) /British Thoracic Society (+25% volume).
: For manual diameter measurements, a significant systematic error (up to 1.2 mm) between readers was found in all morphological categories. For semi-automatic volume measurements, no statistically significant systematic error was found. The interreader variability in mean diameter measurements exceeded the 1.5-mm cut-off for nodule growth for all morphological categories [smooth: ±1.9 mm (+27%), lobulated: ±2.0 mm (+33%), spiculated: ±3.5 mm (+133%), irregular: ±4.5 mm (+200%)]. The 25% vol growth cut-off was exceeded slightly for spiculated [28% (+12%)] and irregular [27% (+8%)] nodules.
: Lung nodule sizing based on manual diameter measurement is affected by nodule margin. Interreader variability increases especially for nodules with spiculated and irregular margins, and causes substantial misclassification of nodule growth. This effect is almost neglectable for semi-automated volume measurements. Semi-automatic volume measurements are superior for both size and growth determination of pulmonary nodules.
: Nodule assessment based on manual diameter measurements is susceptible to nodule margin. This effect is almost neglectable for semi-automated volume measurements. The larger interreader variability for manual diameter measurement results in inaccurate lung nodule growth detection and size classification.
评估在低剂量CT肺癌筛查中检测到的实性结节的结节边缘对手动直径测量和半自动体积测量的阅片者间及阅片者内变异性的影响。
从荷兰-比利时随机肺癌筛查试验（NELSON）的93名参与者中，随机选取每种形态学类别（光滑、分叶、毛刺状和不规则）的25个结节。使用Syngo LungCARE®软件（版本Somaris/5 VB10A-W，西门子，德国福希海姆）进行半自动体积测量。三名放射科医生独立手动测量平均直径。基于系统误差和95%一致性界限，评估结节边缘对阅片者间变异性的影响。将阅片者间变异性与肺部CT筛查报告和数据系统（LungRADS；直径增加1.5毫米）以及荷兰-比利时随机肺癌筛查试验（简称：NELSON）/英国胸科学会（体积增加25%）中使用的结节生长截断值进行比较。
对于手动直径测量，在所有形态学类别中，阅片者之间均发现显著的系统误差（高达1.2毫米）。对于半自动体积测量，未发现统计学上显著的系统误差。所有形态学类别中平均直径测量的阅片者间变异性均超过了结节生长的1.5毫米截断值[光滑：±1.9毫米（增加27%），分叶：±2.0毫米（增加33%），毛刺状：±3.5毫米（增加133%），不规则：±4.5毫米（增加200%）]。毛刺状[28%（增加12%）]和不规则[27%（增加8%）]结节略微超过了25%体积增长截断值。
基于手动直径测量的肺结节大小测量受结节边缘影响。阅片者间变异性尤其在具有毛刺状和不规则边缘的结节中增加，并导致结节生长的大量错误分类。对于半自动体积测量，这种影响几乎可以忽略不计。半自动体积测量在肺结节大小和生长测定方面均更具优势。
基于手动直径测量的结节评估易受结节边缘影响。对于半自动体积测量，这种影响几乎可以忽略不计。手动直径测量中较大的阅片者间变异性导致肺结节生长检测和大小分类不准确。
