Defining growth in small pulmonary nodules using volumetry: results from a "coffee-break" study and implications for current nodule management guidelines
File(s)
Published version
Author(s)
Bartlett, Emily
Kemp, Samuel
Rawal, Bhavin
Devaraj, Anand
Type
Journal Article
Abstract
Objectives:
An increase in lung nodule volume on serial CT may represent true growth or measurement variation. In nodule guidelines, a 25% increase in nodule volume is frequently used to determine that growth has occurred; this is based on previous same-day, test-retest (coffee-break) studies examining metastatic nodules. Whether results from prior studies apply to small non-metastatic nodules is unknown. This study aimed to establish the interscan variability in the volumetric measurements of small-sized non-metastatic nodules.
Methods:
Institutional review board approval was obtained for this study. Between March 2019-January 2021, 45 adults (25 males; mean age 65yrs, range 37-84yrs) with previously identified pulmonary nodules (30-150mm3) requiring surveillance, without a known primary tumour, underwent two same-day CT scans. Non-calcified solid nodules were measured using commercial volumetry software, and interscan variability of volume measurements was assessed using a Bland-Altman method and limits of agreement.
Results:
One hundred nodules (range 28mm3-170mm3; mean 81.1mm3) were analysed. The lower and upper limits of agreement for the absolute volume difference between the two scans were -14.2mm3 and 12.0mm3 respectively (mean difference 1.09mm3, range -33mm3 – 12mm3). The lower and upper limits of agreement for relative volume difference were -16.4% and 14.6% respectively (mean difference 0.90%, range -24.1% - 32.8%).
Conclusions:
The interscan volume variability in this cohort of small non-metastatic nodules was smaller than in previous studies involving lung metastases of varying sizes. An increase of 15% in nodule volume on sequential CT may represent true growth and closer surveillance of these nodules may be warranted.
An increase in lung nodule volume on serial CT may represent true growth or measurement variation. In nodule guidelines, a 25% increase in nodule volume is frequently used to determine that growth has occurred; this is based on previous same-day, test-retest (coffee-break) studies examining metastatic nodules. Whether results from prior studies apply to small non-metastatic nodules is unknown. This study aimed to establish the interscan variability in the volumetric measurements of small-sized non-metastatic nodules.
Methods:
Institutional review board approval was obtained for this study. Between March 2019-January 2021, 45 adults (25 males; mean age 65yrs, range 37-84yrs) with previously identified pulmonary nodules (30-150mm3) requiring surveillance, without a known primary tumour, underwent two same-day CT scans. Non-calcified solid nodules were measured using commercial volumetry software, and interscan variability of volume measurements was assessed using a Bland-Altman method and limits of agreement.
Results:
One hundred nodules (range 28mm3-170mm3; mean 81.1mm3) were analysed. The lower and upper limits of agreement for the absolute volume difference between the two scans were -14.2mm3 and 12.0mm3 respectively (mean difference 1.09mm3, range -33mm3 – 12mm3). The lower and upper limits of agreement for relative volume difference were -16.4% and 14.6% respectively (mean difference 0.90%, range -24.1% - 32.8%).
Conclusions:
The interscan volume variability in this cohort of small non-metastatic nodules was smaller than in previous studies involving lung metastases of varying sizes. An increase of 15% in nodule volume on sequential CT may represent true growth and closer surveillance of these nodules may be warranted.
Date Issued
2021-09-27
Date Acceptance
2021-08-24
Citation
European Radiology, 2021, 32, pp.1912-1920
ISSN
0938-7994
Publisher
Springer
Start Page
1912
End Page
1920
Journal / Book Title
European Radiology
Volume
32
Copyright Statement
© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
https://link.springer.com/article/10.1007/s00330-021-08302-0
Subjects
Science & Technology
Life Sciences & Biomedicine
Radiology, Nuclear Medicine & Medical Imaging
Multiple pulmonary nodules
Lung neoplasms
Growth
Cancer screening
LUNG-CANCER
BASE-LINE
VARIABILITY
NELSON
STATEMENT
ROUNDS
SIZE
Cancer screening
Growth
Lung neoplasms
Multiple pulmonary nodules
1103 Clinical Sciences
Nuclear Medicine & Medical Imaging
Publication Status
Published
Date Publish Online
2021-09-27