A Computer-Aided Diagnosis for Evaluating Lung Nodules on Chest CT: the Current Status and Perspective

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Abstract

As the detection and characterization of lung nodules are of paramount importance in thoracic radiology, various tools for making a computer-aided diagnosis (CAD) have been developed to improve the diagnostic performance of radiologists in clinical practice. Numerous studies over the years have shown that the CAD system can effectively help readers identify more nodules. Moreover, nodule malignancy and the response of malignant lung tumors to treatment can also be assessed using nodule volumetry. CAD also has the potential to objectively analyze the morphology of nodules and enhance the workflow during the assessment of follow-up studies. Therefore, understanding the current status and limitations of CAD for evaluating lung nodules is essential to effectively apply CAD in clinical practice.

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Most cited references 56

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Evaluating variability in tumor measurements from same-day repeat CT scans of patients with non-small cell lung cancer.

Y. Qin, Mark Kris, Robert Lefkowitz … (2009)

To evaluate the variability of tumor unidimensional, bidimensional, and volumetric measurements on same-day repeat computed tomographic (CT) scans in patients with non-small cell lung cancer. This HIPAA-compliant study was approved by the institutional review board, with informed patient consent. Thirty-two patients with non-small cell lung cancer, each of whom underwent two CT scans of the chest within 15 minutes by using the same imaging protocol, were included in this study. Three radiologists independently measured the two greatest diameters of each lesion on both scans and, during another session, measured the same tumors on the first scan. In a separate analysis, computer software was applied to assist in the calculation of the two greatest diameters and the volume of each lesion on both scans. Concordance correlation coefficients (CCCs) and Bland-Altman plots were used to assess the agreements between the measurements of the two repeat scans (reproducibility) and between the two repeat readings of the same scan (repeatability). The reproducibility and repeatability of the three radiologists' measurements were high (all CCCs, >or=0.96). The reproducibility of the computer-aided measurements was even higher (all CCCs, 1.00). The 95% limits of agreements for the computer-aided unidimensional, bidimensional, and volumetric measurements on two repeat scans were (-7.3%, 6.2%), (-17.6%, 19.8%), and (-12.1%, 13.4%), respectively. Chest CT scans are well reproducible. Changes in unidimensional lesion size of 8% or greater exceed the measurement variability of the computer method and can be considered significant when estimating the outcome of therapy in a patient. (c) RSNA, 2009.

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Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up.

Chang Min Park, Jin Mo Goo, Hyun Ju Lee … (2015)

The popularization of computed tomography (CT) in clinical practice and the introduction of mass screening for early lung cancer with the use of CT have increased the frequency of findings of subtle nodules or nodular ground-glass opacity. Nodular ground-glass opacity may be observed in malignancies such as bronchioloalveolar carcinoma and adenocarcinoma, as well as in their putative precursors, such as atypical adenomatous hyperplasia. Nodular ground-glass opacity also may be seen in the presence of benign conditions, including focal interstitial fibrosis, inflammation, and hemorrhage. The persistence of nodular ground-glass opacity over time may be strongly suggestive of an early-stage malignancy, especially if the lesion increases in size or includes a solid component that increases in its extent. Persistent nodular ground-glass opacity also may remain stable in size but show increased attenuation. The more extensive the solid portions of the lesion, the higher the probability of malignancy and the poorer the prognosis. An awareness of the clinical setting, in addition to familiarity with the thin-section CT features of nodular ground-glass opacity at initial and follow-up imaging over several months, can help identify malignancy and achieve an accurate diagnosis. A meticulous evaluation of those CT features, and their correlation with specific histopathologic characteristics, also may enable a more accurate prognosis in cases of neoplastic disease. (c) RSNA, 2007.

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Interobserver and intraobserver variability in measurement of non-small-cell carcinoma lung lesions: implications for assessment of tumor response.

G Gladish, Roy S. Herbst, B Sabloff … (2003)

Response of solid malignancies to therapy is usually determined by serial measurements of tumor size. The purpose of our study was to assess the consistency of measurements performed by readers evaluating lung tumors. The study group was composed of 33 patients with lung tumors more than 1.5 cm. Bidimensional (BD) and unidimensional (UD) measurements were performed on computed tomography (CT) scans according to the World Health Organization (WHO) criteria and the Response Evaluation Criteria in Solid Tumors (RECIST), respectively. Measurements were performed independently by five thoracic radiologists using printed film and were repeated after 5 to 7 days. Inter- and intraobserver measurement variations were estimated through statistical modeling. There were 40 tumors with an average size of 1.8 to 8.0 cm (mean, 4.1 cm). Analysis of variance showed a significant difference (P <.05) among readers and among the measured nodules for UD and BD measurements. Interobserver misclassification rates were more than intraobserver misclassification rates using either progressive disease or response criteria. The probability of misclassifying a tumor with the WHO criteria or RECIST was greatest with interobserver measurements when criteria for progression (43% BD, 30% UD) were used and lowest with intraobserver measurements when criteria for response (2.5% BD, 3.0% UD) were used. In addition, interobserver misclassification rates were more than intraobserver misclassification rates for both regular and irregular tumors. Measurements of lung tumor size on CT scans are often inconsistent and can lead to an incorrect interpretation of tumor response. Consistency can be improved if the same reader performs serial measurements for any one patient.

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Author and article information

Journal

Journal ID (nlm-ta): Korean J Radiol

Journal ID (publisher-id): KJR

Title: Korean Journal of Radiology

Publisher: The Korean Society of Radiology

ISSN (Print): 1229-6929

ISSN (Electronic): 2005-8330

Publication date (Print): Mar-Apr 2011

Publication date (Electronic): 03 March 2011

Volume: 12

Issue: 2

Pages: 145-155

Affiliations

Department of Radiology, Seoul National University College of Medicine and the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea.

Author notes

Corresponding author: Jin Mo Goo, MD, Department of Radiology, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, Seoul 110-744, Korea. Tel: (822) 2072-2624, Fax: (822) 743-7418, jmgoo@ 123456plaza.snu.ac.kr

Article

DOI: 10.3348/kjr.2011.12.2.145

PMC ID: 3052604

PubMed ID: 21430930

SO-VID: 3baac45d-d7c2-4710-bfdf-5a417ac8fcec

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

A Computer-Aided Diagnosis for Evaluating Lung Nodules on Chest CT: the Current Status and Perspective

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Most cited references 56

Evaluating variability in tumor measurements from same-day repeat CT scans of patients with non-small cell lung cancer.

Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up.

Interobserver and intraobserver variability in measurement of non-small-cell carcinoma lung lesions: implications for assessment of tumor response.

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