Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung, 81362, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.
Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.
Acad Radiol. 2018 Nov;25(11):1439-1445. doi: 10.1016/j.acra.2018.01.011. Epub 2018 Mar 9.
The main aim of this study was to evaluate the clinical validity and correlation with pathologic invasiveness in the pulmonary adenocarcinoma spectrum based on the novel qualitative computed tomography criterion for subsolid nodule (SSN) classification, which classified SSN into pure ground-glass nodule, heterogeneous ground-glass nodule, and part-solid nodule. In addition, we compared the performance of the conventional and novel classifications.
The computed tomography images of 41 SSN nodules were interpreted by six observers independently, and the SSN characteristics were classified according to both the conventional and the novel classification systems. Each observer assessed 41 nodules in two different classifications separated by a minimum of 8 weeks. The kappa (κ) coefficient test was used to determine the reliability. The correlation between pulmonary adenocarcinoma spectrum and the SSN classification was analyzed with Spearman correlation coefficients.
Interobserver agreement (κ) was 0.702 (range 0.42-0.89) and 0.707 (range 0.58-0.88) for the conventional and the novel classifications for SSN, respectively, and intraobserver agreement (κ) was 0.92 and 0.88 for the conventional and the novel classifications for SSN, respectively. The novel SSN classification (correlation coefficient range 0.622-0.732) is more strongly correlated with the pathologic invasiveness degree of lesions in adenocarcinoma spectrum than the conventional SSN classification (correlation coefficient range 0.458-0.644).
The agreement between observers on the novel SSN classification system was good and had better correlation with pathologic invasiveness than the conventional SSN classification. Further studies are needed to confirm these results on interobserver agreement.
本研究的主要目的是评估基于新型定性 CT 标准对肺腺癌谱中亚实性结节（SSN）分类的临床有效性及其与病理性侵袭性的相关性，该标准将 SSN 分为纯磨玻璃结节、混杂性磨玻璃结节和部分实性结节。此外，我们比较了传统和新型分类的性能。
6 名观察者独立对 41 个 SSN 结节的 CT 图像进行解读，并根据传统和新型分类系统对 SSN 特征进行分类。每位观察者在至少 8 周的间隔时间内对 41 个结节进行两种不同分类的评估。采用 Kappa（κ）系数检验来确定可靠性。采用 Spearman 相关系数分析肺腺癌谱与 SSN 分类之间的相关性。
观察者间一致性（κ）分别为 0.702（范围 0.42-0.89）和 0.707（范围 0.58-0.88），用于 SSN 的传统和新型分类，观察者内一致性（κ）分别为 0.92 和 0.88，用于 SSN 的传统和新型分类。新型 SSN 分类（相关系数范围 0.622-0.732）与腺癌谱中病变的病理性侵袭程度的相关性强于传统 SSN 分类（相关系数范围 0.458-0.644）。
观察者对新型 SSN 分类系统的一致性良好，与传统 SSN 分类相比，与病理性侵袭性的相关性更好。需要进一步的研究来确认观察者间一致性的这些结果。
