No Benefit for Consensus Double Reading at Baseline Screening for Lung Cancer with the Use of Semiautomated Volumetry Software

Wang, Ying; Klaveren, Rob J. van; Bock, Geertruida H. de; Zhao, Yingru; Vernhout, René M.; Leusveld, Anne; Scholten, Ernst Th.; Verschakelen, Johny; Mali, W. P. T. M.; Koning, Harry J. de; Oudkerk, Matthijs

doi:10.1148/radiol.11102289

Cited by 25 publications

(25 citation statements)

References 31 publications

(47 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, in the NELSON trial, each participant was assessed twice in the central and the local site. Two radiologists with more than 6 years' experience performed the evaluation in the central site, and 13 radiologists or residents with variable experiences in the local sites [30]. To closely simulate this clinical practice, we chose one observer for the first round of measurement and two observers for the second measurement.…”

Section: Discussionmentioning

confidence: 99%

Inter- and intrascanner variability of pulmonary nodule volumetry on low-dose 64-row CT: an anthropomorphic phantom study

Xie¹,

Willemink²,

Zhao³

et al. 2013

BJR

View full text Add to dashboard Cite

Objective: To assess inter-and intrascanner variability in volumetry of solid pulmonary nodules in an anthropomorphic thoracic phantom using low-dose CT. Methods: Five spherical solid artificial nodules [diameters 3, 5, 8, 10 and 12 mm; CT density 1100 Hounsfield units (HU)] were randomly placed inside an anthropomorphic thoracic phantom in different combinations. The phantom was examined on two 64-row multidetector CT (64-MDCT) systems (CT-A and CT-B) from different vendors with a low-dose protocol. Each CT examination was performed three times. The CT examinations were evaluated twice by independent blinded observers. Nodule volume was semi-automatically measured by dedicated software. Interscanner variability was evaluated by Bland-Altman analysis and expressed as 95% confidence interval (CI) of relative differences. Intrascanner variability was expressed as 95% CI of relative variation from the mean.Results: No significant difference in CT-derived volume was found between CT-A and CT-B, except for the 3-mm nodules (p,0.05). The 95% CI of interscanner variability was within 641.6%, 618.2% and 64.9% for 3, 5 and $8 mm nodules, respectively. The 95% CI of intrascanner variability was within 628.6%, 613.4% and 62.6% for 3, 5 and $8 mm nodules, respectively. Conclusion: Different 64-MDCT scanners in low-dose settings yield good agreement in volumetry of artificial pulmonary nodules between 5 mm and 12 mm in diameter. Inter-and intrascanner variability decreases at a larger nodule size to a maximum of 4.9% for $8 mm nodules. Advances in knowledge:The commonly accepted cut-off of 25% to determine nodule growth has the potential to be reduced for $8 mm nodules. This offers the possibility of reducing the interval for repeated CT scans in lung cancer screenings.Lung cancer is the primary cancer in males and the second most common cancer in females worldwide, causing 18% of the total number of deaths [1]. Many lung cancers are found at a relatively late stage, resulting in a 5-year survival of only 15% or less [2]. Low-dose CT is a promising screening method for early detection of lung cancer [3][4][5][6][7]. The first result indicates that CT lung cancer screening can reduce lung cancer-specific mortality [8].

show abstract

Section: Discussionmentioning

confidence: 99%

Inter- and intrascanner variability of pulmonary nodule volumetry on low-dose 64-row CT: an anthropomorphic phantom study

Xie¹,

Willemink²,

Zhao³

et al. 2013

BJR

View full text Add to dashboard Cite

show abstract

“…At the time of acquisition (2005), all CT images of the lungs from each examination were independently read by first and second readers (double reading) as part of the NELSON protocol [6, 23]. The first reading was performed by 13 readers (experience in reading thoracic CT varying from 0 to 20 years); the second reading was performed by two readers, each with 6 years of experience.…”

Section: Methodsmentioning

confidence: 99%

“…To reduce the number of missed lesions, double reading has been recommended [5]. Previous studies have found that more pulmonary nodules are detected by double reading than by single reading [5, 6]. However, double reading is not widely used in clinical routine because of limited human resources and cost-effectiveness [7, 8].…”

Section: Introductionmentioning

confidence: 99%

Performance of computer-aided detection of pulmonary nodules in low-dose CT: comparison with double reading by nodule volume

et al. 2012

Self Cite

View full text Add to dashboard Cite

Objective To evaluate performance of computer-aided detection (CAD) beyond double reading for pulmonary nodules on low-dose computed tomography (CT) by nodule volume. Methods A total of 400 low-dose chest CT examinations were randomly selected from the NELSON lung cancer screening trial. CTs were evaluated by two independent readers and processed by CAD. A total of 1,667 findings marked by readers and/or CAD were evaluated by a consensus panel of expert chest radiologists. Performance was evaluated by calculating sensitivity of pulmonary nodule detection and number of false positives, by nodule characteristics and volume. Results According to the screening protocol, 90.9 % of the findings could be excluded from further evaluation, 49.2 % being small nodules (less than 50 mm 3 ). Excluding small nodules reduced false-positive detections by CAD from 3.7 to 1.9 per examination. Of 151 findings that needed further evaluation, 33 (21.9 %) were detected by CAD only, one of them being diagnosed as lung cancer the following year. The sensitivity of nodule detection was 78.1 % for double reading and 96.7 % for CAD. A total of 69.7 % of nodules undetected by readers were attached nodules of which 78.3 % were vessel-attached. Conclusions CAD is valuable in lung cancer screening to improve sensitivity of pulmonary nodule detection beyond double reading, at a low false-positive rate when excluding small nodules. Key Points • Computer-aided detection (CAD) has known advantages for computed tomography (CT). • Combined CAD/nodule size cut-off parameters assist CT lung cancer screening. • This combination improves the sensitivity of pulmonary nodule detection by CT. • It increases the positive predictive value for cancer detection.

show abstract

“…Based on these fi ndings, the fourth screening round image reading in the Dutch-Belgian randomized lung cancer screening trial (NELSON ) is, in fact, performed by only one reader. 6 With the recent grade B recommendation by the US Preventive Task Force for lung cancer screening using low-dose CT imaging, the incidence of pulmonary nodules has the potential to rise dramatically. Because the majority of these nodules are not cancer, volumebased nodule management has been suggested to be more accurate than diameter measurements, with signifi cantly lower false-positive rates.…”

Section: Responsementioning

confidence: 99%

Influences in CT Scan Lung Nodule Volumetry: Response

Mehta

Nietert²,

Tanner³

et al. 2014

Chest

View full text Add to dashboard Cite

We read with great interest the well-written article by Mehta et al 1 in CHEST (March 2014), which reported that the addition of nodule volume to existing malignancy prediction models increases the proportion of correctly classifi ed nodules. However, we would like to highlight some aspects regarding lung nodule volumetry.Lung nodule measurements made with CT imaging are used in clinical practice to assess size changes estimated from serial scans obtained over time to predict the likelihood of malignancy and to monitor the tumor response to treatment. 2 Size measurements need to be accurate and consistent to enable the assessment of nodule changes in a short time interval. Th e precision and accuracy of volume measurements depend on several factors, including the image-acquisition and reconstruction parameters, the nodule characteristics, and the performance of algorithms for nodule segmentation and volume estimation. 2 -4 Goodman et al 3 presented results on the variability of volumetric measurements made with a commercial semiautomated soft ware program (Advantage Lung Analysis; GE Healthcare). Th e evaluation was performed on 50 nodules across three repeat scans read by three observers. Th e second and third scans were acquired during two breath holds performed 10 to 20 min aft er the fi rst scan. Nodule volume was estimated as the average volume measurement of the three observers at the fi rst scan and was used as the baseline truth to measure interobserver variability. Th is measure of interobserver variability is inherently biased because each observer is compared against a standard that is based, in part, on his/her own contours. Interscan variability was measured as the percentage diff erence between the average volume measurements and the estimated volume. Th e results revealed signifi cant interscan variability (on the order of 13%) but minimal interobserver variability. Findings from several other studies have demonstrated diff erences in the volumetric measurement error, ranging from 10% to 40%, between scans acquired with thin and thick section widths. Even with these limitations, we can generally conclude that section thickness/width is one of the most important CT scan acquisition parameters to control. In a recent article about nodule volumetry with phantom correlation, Xie et al 4 reported that the CT scan-derived volume of small nodules is largely underestimated, with considerable variation.Th ese data highlight the need to standardize all variables in CT scanning to obtain a reliable volumetric assessment of the pulmonary nodule. Th is standardization is even more important in studies that will use volumetric CT scanning in the follow-up of these nodules.

show abstract

No Benefit for Consensus Double Reading at Baseline Screening for Lung Cancer with the Use of Semiautomated Volumetry Software

Cited by 25 publications

References 31 publications

Inter- and intrascanner variability of pulmonary nodule volumetry on low-dose 64-row CT: an anthropomorphic phantom study

Inter- and intrascanner variability of pulmonary nodule volumetry on low-dose 64-row CT: an anthropomorphic phantom study

Performance of computer-aided detection of pulmonary nodules in low-dose CT: comparison with double reading by nodule volume

Influences in CT Scan Lung Nodule Volumetry: Response

Contact Info

Product

Resources

About