International Association for the Study of Lung Cancer의 7차 개정판 TNM 분류의 T 요소에서 종양 크기의 평가: 폐암 환자에서 영상의학과 의사와 Computer-Aided Diagnosis System의 일치도

Tumor Size Evaluation according to the T Component of the Seventh Edition of the International Association for the Study of Lung Cancer's TNM Classification: Interobserver Agreement between Radiologists and Computer-Aided Diagnosis System in Patients with Lung Cancer

  • 김진경 (중앙대학교 의과대학 영상의학과학교실) ;
  • 정세민 (중앙대학교 의과대학 영상의학과학교실) ;
  • 서재승 (중앙대학교 의과대학 영상의학과학교실) ;
  • 이선진 (중앙대학교 의과대학 영상의학과학교실) ;
  • 한헌 (강원대학교 의과대학 영상의학과학교실)
  • Kim, Jin-Kyoung (Department of Radiology, Chung-Ang University College of Medicine) ;
  • Chong, Se-Min (Department of Radiology, Chung-Ang University College of Medicine) ;
  • Seo, Jae-Seung (Department of Radiology, Chung-Ang University College of Medicine) ;
  • Lee, Sun-Jin (Department of Radiology, Chung-Ang University College of Medicine) ;
  • Han, Heon (Department of Radiology, Kangwon National University School of Medicine)
  • 발행 : 2011.10.01

초록

목적: 본 연구는 폐암 환자에서 7차 개정판 TNM 분류에 근거한 원발 종양 크기 평가에 있어서 영상의학과 의사와 computer-aided diagnosis (이하 CAD) system의 일치도를 평가하였다. 대상과 방법: 폐암으로 진단되어 엽절제 또는 폐절제를 시행한 20명의 환자를 대상으로 2명의 영상의학과 의사와 CAD system을 이용하여 CT에서 원발 종양의 최대 직경을 측정하였고 7차 개정판 TNM 분류에 따라 T 병기를 결정하였다. 원발 종양의 CT 크기와 T 병기가 각각 병리 크기와 병기와 비교되었고 영상의학과 의사, CAD System 그리고 병리 결과 사이의 원발 종양 크기와 T 병기에 대한 차이를 통계학적으로 분석하였다. 결과: 2명의 영상의학과 의사 사이에서 측정된 원발 종양의 CT 크기, 영상의학과 의사에 의해 측정된 원발 종양의 CT 크기와 병리 크기 및 영상의학과 의사와 CAD를 이용하여 결정된 원발 종양의 CT 병기와 병리 병기 사이에 유의한 차이는 없었다. 그러나 CAD로 측정된 원발 종양의 CT 크기와 병리 크기 사이에 유의한 차이가 있었다(p = 0.003). 결론: 원발 종양의 크기는 영상의학과 의사 사이에 통계적으로 유의한 차이는 없었고 영상의학과 의사와 CAD에 의한 원발 종양의 CT 병기와 병리 병기 사이에 유의한 차이는 없었다.

Purpose: To assess the interobserver agreement for tumor size evaluation between radiologists and the computer-aided diagnosis (CAD) system based on the 7th edition of the TNM classification by the International Association for the Study of Lung Cancer in patients with lung cancer. Materials and Methods: We evaluated 20 patients who underwent a lobectomy or pneumonectomy for primary lung cancer. The maximum diameter of each primary tumor was measured by two radiologists and a CAD system on CT, and was staged based on the 7th edition of the TNM classification. The CT size and T-staging of the primary tumors was compared with the pathologic size and staging and the variability in the sizes and T stages of primary tumors was statistically analyzed between each radiologist's measurement or CAD estimation and the pathologic results. Results: There was no statistically significant interobserver difference for the CT size among the two radiologists, between pathologic and CT size estimated by the radiologists, and between pathologic and CT staging by the radiologists and CAD system. However, there was a statistically significant interobserver difference between pathologic size and the CT size estimated by the CAD system (p = 0.003). Conclusion: No significant differences were found in the measurement of tumor size among radiologists or in the assessment of T-staging by radiologists and the CAD system.

키워드

참고문헌

  1. Tsim S, O'Dowd CA, Milroy R, Davidson S. Staging of non-small cell lung cancer (NSCLC): a review. Respir Med 2010; 104:1767-1774 https://doi.org/10.1016/j.rmed.2010.08.005
  2. Wang Y, van Klaveren RJ, van der Zaag-Loonen HJ, de Bock GH, Gietema HA, Xu DM, et al. Effect of nodule characteristics on variability of semiautomated volume measurements in pulmonary nodules detected in a lung cancancer screening program. Radiology 2008;248:625-631 https://doi.org/10.1148/radiol.2482070957
  3. Nishino M, Guo M, Jackman DM, DiPiro PJ, Yap JT, Ho TK, et al. CT tumor volume measurement in advanced non-small-cell lung cancer: performance characteristics of an emerging clinical tool. Acad Radiol 2011;18:54-62 https://doi.org/10.1016/j.acra.2010.08.021
  4. Iwano S, Okada T, Koike W, Matsuo K, Toya R, Yamazaki M, et al. Semi-automatic volumetric measurement of lung cancer using multi-detector CT effects of nodule characteristics. Acad Radiol 2009;16:1179-1186 https://doi.org/10.1016/j.acra.2009.04.007
  5. Marten K, Auer F, Schmidt S, Kohl G, Rummeny EJ, Engelke C. Inadequacy of manual measurements compared to automated CT volumetry in assessment of treatment response of pulmonary metastases using RECIST criteria. Eur Radiol 2006;16:781-790 https://doi.org/10.1007/s00330-005-0036-x
  6. Rusch VW, Asamura H, Watanabe H, Giroux DJ, Rami-Porta R, Goldstraw P; Members of IASLC Staging Committee. The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol 2009;4:568-577 https://doi.org/10.1097/JTO.0b013e3181a0d82e
  7. Lee HY, Lee KS, Hwang HS, Lee JW, Ahn MJ, Park K, et al. Molecularly targeted therapy using bevacizumab for non-small cell lung cancer: a pilot study for the new CT response criteria. Korean J Radiol 2010;11:618-626 https://doi.org/10.3348/kjr.2010.11.6.618
  8. Tanoue LT, Detterbeck FC. New TNM classification for non-small-cell lung cancer. Expert Rev Anticancer Ther 2009; 9:413-423 https://doi.org/10.1586/era.09.11
  9. Macpherson RE, Higgins GS, Murchison JT, Wallace WA, Price A, Gaffney S, et al. Non-small-cell lung cancer dimensions: CT-pathological correlation and interobserver variation. Br J Radiol 2009;82:421-425 https://doi.org/10.1259/bjr/28687035
  10. Wormanns D, Diederich S, Lentschig MG, Winter F, Heindel W. Spiral CT of pulmonary nodules: interobserver variation in assessment of lesion size. Eur Radiol 2000;10:710-713 https://doi.org/10.1007/s003300050990
  11. Zhao B, James LP, Moskowitz CS, Guo P, Ginsberg MS, Lefkowitz RA, et al. Evaluating variability in tumor measurements from same-day repeat CT scans of patients with non-small cell lung cancer. Radiology 2009;252:263-272 https://doi.org/10.1148/radiol.2522081593