Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China; University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands.
Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre of Cancer, Key Laboratory of Cancer Prevention and Therapy, Department of Radiology, Tianjin, People's Republic of China.
Eur J Radiol. 2020 Jul;128:108981. doi: 10.1016/j.ejrad.2020.108981. Epub 2020 Apr 25.
To evaluate the optimal window setting to diagnose the invasiveness of lung adenocarcinoma in sub-solid nodules (SSNs).
We retrospectively included 437 SSNs and randomly divided them 3:1 into a training group (327) and a testing group (110). The presence of a solid component was regarded as indicator of invasiveness. At fixed window level (WL) of 35 Hounsfield Units (HU), two readers adjusted the window width (WW) in the training group and recorded once a solid component appeared or disappeared on CT images acquired at 120 kVp. The optimal WW cut-off value to differentiate between invasive and pre-invasive lesions, based on the receiver operating characteristic (ROC) curve, was defined as "core" WW. The diagnostic performances of the mediastinal window setting (WW/WL, 350/35 HU) and core window setting were then compared in the testing group.
Of the 437 SSNs, 88 were pre-invasive [17 atypical adenomatous hyperplasia (AAH) and 71 adenocarcinoma in situ (AIS)], 349 were invasive [233 minimally invasive adenocarcinoma (MIA), 116 invasive adenocarcinoma (IA)]. In training group, the core WW of 1175 HU was the optimal cut-off to detect solid components of SSNs (AUC:0.79). In testing group, the sensitivity, specificity, positive, negative predictive value, and diagnostic accuracy for SSN invasiveness were 49.4%, 90.5%, 95.7%, 29.7%, and 57.3% for mediastinal window setting, and 87.6%, 76.2%, 91.6%, 76.2%, and 85.5% for core window setting.
At 120 kVp, core window setting (WW/WL, 1175/35 HU) outperformed the traditional mediastinal window setting to diagnose the invasiveness of SSNs.
评估诊断肺腺癌亚实性结节（SSNs）侵袭性的最佳窗宽设置。
我们回顾性纳入了 437 个 SSNs，并将其随机分为 3:1 的训练组（327 个）和测试组（110 个）。实性成分的存在被视为侵袭性的指标。在固定窗位（WL）为 35 亨斯菲尔德单位（HU）的情况下，两名读者在训练组中调整窗宽（WW），并记录在 120 kVp 采集的 CT 图像上实性成分出现或消失的一次。基于受试者工作特征（ROC）曲线，定义区分侵袭性和非侵袭性病变的最佳 WW 截断值为“核心” WW。然后在测试组中比较纵隔窗设置（WW/WL，350/35 HU）和核心窗设置的诊断性能。
在 437 个 SSNs 中，88 个为非侵袭性[17 个不典型腺瘤样增生（AAH）和 71 个原位腺癌（AIS）]，349 个为侵袭性[233 个微浸润腺癌（MIA），116 个浸润性腺癌（IA）]。在训练组中，1175 HU 的核心 WW 是检测 SSNs 实性成分的最佳截断值（AUC：0.79）。在测试组中，纵隔窗设置对 SSN 侵袭性的敏感性、特异性、阳性预测值、阴性预测值和诊断准确性分别为 49.4%、90.5%、95.7%、29.7%和 57.3%，而核心窗设置分别为 87.6%、76.2%、91.6%、76.2%和 85.5%。
在 120 kVp 下，核心窗设置（WW/WL，1175/35 HU）优于传统的纵隔窗设置，可诊断 SSNs 的侵袭性。
