Related Experiment Video
Updated: Jun 21, 2025
Author Spotlight: A 3D Digital Model for the Diagnosis and Treatment of Pulmonary Nodules
Published on: May 19, 2023
Volumetric Analysis: Effect on Diagnosis and Management of Indeterminate Solid Pulmonary Nodules in Routine Clinical
Robert S Lim, Jarrett Rosenberg1, Martin J Willemink1
1From the Department of Radiology, Stanford University School of Medicine, Stanford, CA.
Objective:
To evaluate the effect of volumetric analysis on the diagnosis and management of indeterminate solid pulmonary nodules in routine clinical practice.
Methods:
This was a retrospective study with 107 computed tomography (CT) cases of solid pulmonary nodules (range, 6-15 mm), 57 pathology-proven malignancies (lung cancer, n = 34; metastasis, n = 23), and 50 benign nodules. Nodules were evaluated on a total of 309 CT scans (average number of CTs/nodule, 2.9 [range, 2-7]). CT scans were from multiple institutions with variable technique. Nine radiologists (attendings, n = 3; fellows, n = 3; residents, n = 3) were asked their level of suspicion for malignancy (low/moderate or high) and management recommendation (no follow-up, CT follow-up, or care escalation) for baseline and follow-up studies first without and then with volumetric analysis data. Effect of volumetry on diagnosis and management was assessed by generalized linear and logistic regression models.
Results:
Volumetric analysis improved sensitivity ( P = 0.009) and allowed earlier recognition ( P < 0.05) of malignant nodules. Attending radiologists showed higher sensitivity in recognition of malignant nodules ( P = 0.03) and recommendation of care escalation ( P < 0.001) compared with trainees. Volumetric analysis altered management of high suspicion nodules only in the fellow group ( P = 0.008). κ Statistics for suspicion for malignancy and recommended management were fair to substantial (0.38-0.66) and fair to moderate (0.33-0.50). Volumetric analysis improved interobserver variability for identification of nodule malignancy from 0.52 to 0.66 ( P = 0.004) only on the second follow-up study.
Conclusions:
Volumetric analysis of indeterminate solid pulmonary nodules in routine clinical practice can result in improved sensitivity and earlier identification of malignant nodules. The effect of volumetric analysis on management recommendations is variable and influenced by reader experience.
Related Concept Videos
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
01:26Pulmonary Tuberculosis IV
Several diagnostic approaches are used to detect TB. The conventional method is the Tuberculin Skin Test (TST), also known as the Mantoux test. However, this method has...
01:30Radiological Investigation II: MRI and Ventilation Perfusion Scan
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...
01:15Respiratory Volumes
Tidal Volume (TV) Tidal volume (TV) is the air inhaled or exhaled in a...
01:30Endoscopic Studies I: Bronchoscopy and Thoracoscopy
Bronchoscopy
Description
Bronchoscopy is a procedure that involves direct visualization of the larynx, trachea, and bronchi for diagnostic and therapeutic purposes. A flexible fiber optic or rigid bronchoscope is used to carry out the procedure. The fiber-optic bronchoscope is more frequently used due...
01:30Radiological Investigation I: X-ray and CT