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Subsolid Lung Nodule Classification: A CT Criterion for Improving Interobserver Agreement.

Marie-Pierre Revel1, Inès Mannes1, Joseph Benzakoun1

  • 1From the Departments of Radiology (M.P.R., I.M., J.B., C.G., T.L., G.C.), Pathology (A.L.), and Thoracic Surgery (L.F.), Cochin Hospital, Paris V University, Sorbonne Paris Cité, 27 rue du Fg St Jacques, Paris 75014, France; Department of Radiology, Pitié Salpétrière Hospital, Paris VI University, Paris, France (P.G.); Center for Visual Computing, Ecole Centrale Paris, Chatenay Malabry, France (G.C.); and Department of Radiology, Arnaud-de-Villeneuve Hospital, Montpellier University Hospitals, Montpellier, France (S.B.).

Radiology
|August 11, 2017
PubMed
Summary
This summary is machine-generated.

A new computed tomographic (CT) criterion using mediastinal window settings reliably distinguishes part-solid (PS) from nonsolid (NS) lung nodules. This objective method improves radiologist agreement and aids in identifying invasive adenocarcinoma.

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Area of Science:

  • Radiology
  • Pulmonology
  • Oncology

Background:

  • Distinguishing between part-solid (PS) and nonsolid (NS) lung nodules is crucial for accurate diagnosis and treatment planning.
  • Subsolid nodules present a diagnostic challenge due to their varied appearances on computed tomographic (CT) scans.

Purpose of the Study:

  • To establish and evaluate an objective computed tomographic (CT) criterion for differentiating part-solid (PS) from nonsolid (NS) lung nodules.
  • To assess the impact of this criterion on interreader agreement among radiologists.

Main Methods:

  • Preoperative CT scans of 99 subsolid lung nodules were reviewed by radiologists using subjective and objective classification criteria.
  • Nodules were classified as PS if a solid component was visible in the mediastinal window setting.
  • Interreader agreement was quantified using kappa statistics and intraclass correlation coefficients (ICC).

Main Results:

  • Radiologist agreement on PS/NS distinction improved from moderate to excellent after implementing the objective mediastinal window criterion.
  • Excellent interreader agreement was achieved for both PS/NS distinction (ICC = 0.87) and subcategorization (ICC = 0.82).
  • The presence of a measurable solid portion in the mediastinal window showed high specificity (86%-96%) for adenocarcinoma invasiveness.

Conclusions:

  • The detection of a solid portion in the mediastinal window setting provides an objective and reliable method for classifying subsolid nodules as PS.
  • This approach significantly enhances interreader agreement in nodule classification.
  • Measurable solid components identified via this method are strongly associated with invasive adenocarcinoma, aiding in diagnostic accuracy.