Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
Department of Thoracic Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
Eur J Radiol. 2018 Jan;98:130-135. doi: 10.1016/j.ejrad.2017.11.015. Epub 2017 Nov 22.
To assess the effect of window settings and reconstruction plane on clinical T-stage determined by solid portion size within subsolid nodules (SSNs), based on 8th-edition TNM standards.
This retrospective study included 247 SSNs from 221 patients who underwent surgery for lung adenocarcinomas between Feb 2012 and Oct 2015. Two radiologists independently measured the diameter of the solid portion on axial, coronal, and sagittal planes using lung- and mediastinal-window. The largest diameter among the measurements on the three planes was referred to as multiplanar measurement. Inter-reader agreement as well as the correlation between the CT and pathologic measurements were calculated using intra-class correlation coefficients (ICCs). The proportions of disagreement in clinical T-stage on different measurement methods were measured. The κ values for agreement between clinical- and pathological T-stage were measured.
Inter-reader agreement was moderate-to-excellent (ICC confidence interval [CI] range, 0.51-0.92) in lung-window, while it was good-to-excellent (0.77-0.95) in mediastinal-window. The correlation between the CT and pathologic measurements was good-to-excellent (ICC CI range, 0.63-0.82) in lung-window and fair-to-good (0.25-0.78) in mediastinal-window. The proportions of disagreement between clinical T-stages using mediastinal- and lung-window were 32.0%-41.7% and 33.6%-49.0% with axial and multiplanar measurement, respectively. Multiplanar measurement resulted in upstaging in 12.6%-15.8% and 19.0%-24.3% of cases with mediastinal- and lung-window, respectively, when compared with axial measurement alone. The κ values for agreement between clinical T-stage and pathological T-stage ranged from 0.53 to 0.69.
Mediastinal-window was a more stable method in the aspect of the inter-reader agreement, but the correlation between the CT and pathologic measurement was better in lung-window. The clinical T-stage varied in up to one-half of the cases according to the window setting, and multiplanar measurement resulted in upstaging in up to one-fourth of the cases.
根据第 8 版 TNM 标准，评估窗宽设置和重建平面对亚实性结节（SSN）实性部分大小所确定的临床 T 分期的影响。
本回顾性研究纳入了 2012 年 2 月至 2015 年 10 月期间因肺腺癌行手术治疗的 221 例患者的 247 个 SSN。两名放射科医生分别使用肺窗和纵隔窗在轴位、冠状位和矢状位上测量实性部分的直径。三个平面上的最大直径称为多平面测量。使用组内相关系数（ICC）计算读者间的一致性以及 CT 和病理测量之间的相关性。测量不同测量方法之间临床 T 分期的不一致比例。还测量了临床和病理 T 分期之间的一致性的κ值。
在肺窗中，两位读者之间的一致性为中度至极好（ICC 置信区间 [CI]范围为 0.51-0.92），而在纵隔窗中则为极好（0.77-0.95）。CT 和病理测量之间的相关性在肺窗中为极好至极好（ICC CI 范围为 0.63-0.82），在纵隔窗中为好至极好（0.25-0.78）。使用纵隔窗和肺窗进行轴向和多平面测量时，临床 T 分期之间的不一致比例分别为 32.0%-41.7%和 33.6%-49.0%。与单独使用轴向测量相比，多平面测量导致纵隔窗和肺窗中分别有 12.6%-15.8%和 19.0%-24.3%的病例分期上调。临床 T 分期与病理 T 分期之间的κ值范围为 0.53 至 0.69。
纵隔窗在读者间一致性方面是一种更稳定的方法，但肺窗中 CT 和病理测量之间的相关性更好。根据窗宽设置，多达一半的病例临床 T 分期不同，多平面测量导致多达四分之一的病例分期上调。
