Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Milan, Italy.
Post-graduation School in Radiodiagnostics, University of Milan, Milan, Italy.
Eur Radiol. 2019 Jul;29(7):3862-3870. doi: 10.1007/s00330-019-06243-3. Epub 2019 May 6.
Pulmonary nodules and masses are the typical presentations of lung cancer. However, a spectrum of focal opacities cannot be defined as either "pulmonary nodule" or "mass," despite representing cancer. We aimed to assess the morphology of screening-detected lung cancers at low-dose computed tomography LDTC and to evaluate inter-observer agreement in their classification.
Four radiologists with different experiences in thoracic imaging retrospectively reviewed 273 screening-detected lung cancers. Readers were asked to assess if morphology at the time of diagnosis was consistent with the Fleischner Society definition of pulmonary "nodule" or "mass." Cancers not consistent were defined as "non-nodular/non-mass" (NN/NM) and sub-classified as follows: associated with cystic airspaces, stripe-like, scar-like, endobronchial, or not otherwise defined (NOD). Inter-observer agreement was evaluated using Cohen's K statistic among pairs of readers and modified Fleiss' kappa statistic for overall agreement.
Two hundred forty-one of the 273 (88%) lesions were defined as pulmonary nodule or mass by complete agreement, while 20/273 (7.3%) were defined as NN/NM. Six (2.2%) of 273 were sub-classified as lesions associated with cystic airspace, six (2.2%) as scar-like, five (1.8%) as endobronchial, and one (0.7%) as NOD by complete agreement. The concordance in defining morphology was excellent (261/273; 96%, 95%CI 92-98%; k 0.85, 95%CI 0.75-0.92) and also in the sub-classification (18/20; 90%, 95%CI 68-99%, k 0.93, 95%CI 0.86-1.00). There was incomplete agreement regarding lesion morphology in 4.4% (12/273) of cases.
A non-negligible percentage of screening-detected lung cancers has a NN/NM appearance at LDCT. The concordance in defining lesion morphology was excellent. The awareness of various presentations can avoid missed or delayed diagnosis.
• A non-negligible percentage of screening-detected lung cancers have neither nodular nor mass appearance at low-dose CT. • The awareness of various LDCT presentations of lung cancer can avoid missed or delayed diagnosis. • Optimal protocol management in CT screening should take into consideration lung nodules as well as various other focal abnormalities.
肺部结节和肿块是肺癌的典型表现。然而，尽管代表癌症，但存在一系列局灶性不透明性，不能简单地定义为“肺部结节”或“肿块”。我们旨在评估低剂量计算机断层扫描（LDCT）筛查发现的肺癌的形态，并评估其分类的观察者间一致性。
四位在胸部成像方面具有不同经验的放射科医生回顾性分析了 273 例筛查发现的肺癌。要求读者评估在诊断时的形态是否符合 Fleischner 学会对肺部“结节”或“肿块”的定义。不符合的癌症被定义为“非结节/非肿块”（NN/NM），并进一步分为以下几类：伴有囊性气腔、条纹状、瘢痕样、支气管内或无法明确分类（NOD）。通过 Cohen's K 统计量评估观察者间的一致性，并使用改良的 Fleiss' kappa 统计量评估总体一致性。
273 个病灶中有 241 个（88%）通过完全一致被定义为肺部结节或肿块，而 20/273（7.3%）被定义为 NN/NM。6/273（2.2%）被归类为伴有囊性气腔的病变，6/273（2.2%）为瘢痕样，5/273（1.8%）为支气管内，1/273（0.7%）为 NOD。在定义形态方面的一致性非常好（261/273；96%，95%CI 92-98%；k=0.85，95%CI 0.75-0.92），在分类方面也非常好（18/20；90%，95%CI 68-99%，k=0.93，95%CI 0.86-1.00）。在 4.4%（12/273）的病例中，对病变形态的判断存在不完全一致。
在 LDCT 中，相当一部分筛查发现的肺癌表现为 NN/NM 外观。在定义病变形态方面的一致性非常好。对各种表现的认识可以避免漏诊或误诊。
在低剂量 CT 中，相当一部分筛查发现的肺癌既没有结节也没有肿块的表现。
对肺癌 LDCT 各种表现的认识可以避免漏诊或误诊。
CT 筛查的最佳方案管理应同时考虑肺结节和各种其他局灶性异常。
