Uchida Tsuyoshi, Matsubara Hirochika, Onuki Yuichiro, Matsuoka Hiroyasu, Ichihara Tomofumi, Nakajima Hiroyuki
Department of General Thoracic Surgery, Yamanashi University, Yamanashi, Japan.
Medicine (Baltimore). 2020 Jun 26;99(26):e20594. doi: 10.1097/MD.0000000000020594.
The recently published 8th edition of the tumor node and metastasis Classification of Lung Cancer proposes using the maximum dimension of the solid component of a ground glass nodule (GGN) for the T categorization. However, few studies have investigated the collection of this information when using mediastinal window settings. In this study, we evaluated tumor measurement data obtained from computed tomography (CT) scans when using mediastinal window settings.This study included 202 selected patients with persistent, partly solid GGNs detected on thin-slice CT after surgical treatment between 2004 and 2013. We compared the differences in tumor diameters measured by 2 different radiologists using a repeated-measures analysis of variance. We divided the patients into 2 groups based on the clinical T stage (T1a+T1b vs T1c) and estimated the probability of overall survival (OS) and disease-free survival (DFS) using Kaplan-Meier curves.The study included 94 male and 108 female patients. The inter-reviewer differences between tumor diameters were significantly smaller when the consolidation to maximum tumor diameter ratio was ≤0.5. The 2 clinical groups classified by clinical T stage differed significantly with respect to DFS when using the mediastinal window settings. However, no significant differences in OS or DFS were observed when using the lung window setting.Our study yielded 2 major findings. First, the diameters of GGNs could be measured more accurately using the mediastinal window setting. Second, measurements obtained using the mediastinal window setting more clearly depicted the effect of clinical T stage on DFS.
最近发布的肺癌肿瘤、淋巴结及转移分类第8版建议使用磨玻璃结节（GGN）实性成分的最大径进行T分期。然而，很少有研究探讨在使用纵隔窗设置时该信息的采集情况。在本研究中，我们评估了使用纵隔窗设置时从计算机断层扫描（CT）图像获得的肿瘤测量数据。
本研究纳入了2004年至2013年间手术治疗后在薄层CT上发现的202例持续性部分实性GGN患者。我们使用重复测量方差分析比较了2位不同放射科医生测量的肿瘤直径差异。我们根据临床T分期（T1a+T1b与T1c）将患者分为2组，并使用Kaplan-Meier曲线估计总生存（OS）和无病生存（DFS）概率。
该研究包括94例男性和108例女性患者。当实变与最大肿瘤直径之比≤0.5时，不同审阅者之间肿瘤直径的差异显著更小。使用纵隔窗设置时，根据临床T分期分类的2个临床组在DFS方面存在显著差异。然而，使用肺窗设置时，OS或DFS未观察到显著差异。
我们的研究得出了2个主要发现。第一，使用纵隔窗设置可以更准确地测量GGN的直径。第二，使用纵隔窗设置获得的测量结果更清楚地显示了临床T分期对DFS的影响。
