Towards a close computed tomography monitoring approach for screen detected subsolid pulmonary nodules?

Pulmonary subsolid nodules (SSNs) have a high likelihood of malignancy, but are often indolent. A conservative treatment approach may therefore be suitable. The aim of the current study was to evaluate whether close follow-up of SSNs with computed tomography may be a safe approach. The study population consisted of participants of the Dutch-Belgian lung cancer screening trial (Nederlands Leuvens Longkanker Screenings Onderzoek; NELSON). All SSNs detected during the trial were included in this analysis. Retrospectively, all persistent SSNs and SSNs that were resected after first detection were segmented using dedicated software, and maximum diameter, volume and mass were measured. Mass doubling time (MDT) was calculated. In total 7135 volunteers were included in the current analysis. 264 (3.3%) SSNs in 234 participants were detected during the trial. 147 (63%) of these SSNs in 126 participants disappeared at follow-up, leaving 117 persistent or directly resected SSNs in 108 (1.5%) participants available for analysis. The median follow-up time was 95 months (range 20-110 months). 33 (28%) SSNs were resected and 28 of those were (pre-) invasive. None of the non-resected SSNs progressed into a clinically relevant malignancy. Persistent SSNs rarely developed into clinically manifest malignancies unexpectedly. Close follow-up with computed tomography may be a safe option to monitor changes.

Semi-automatic quantification of subsolid pulmonary nodules: comparison with manual measurements.

RATIONALE: Accurate measurement of subsolid pulmonary nodules (SSN) is becoming increasingly important in the management of these nodules. SSNs were previously quantified with time-consuming manual measurements. The aim of the present study is to test the feasibility of semi-automatic SSNs measurements and to compare the results to the manual measurements. METHODS: In 33 lung cancer screening participants with 33 SSNs, the nodules were previously quantified by two observers manually. In the present study two observers quantified these nodules by using semi-automated nodule volumetry software. Nodules were quantified for effective diameter, volume and mass. The manual and semi-automatic measurements were compared using Bland-Altman plots and paired T tests. Observer agreement was calculated as an intraclass correlation coefficient. Data are presented as mean (SD). RESULTS: Semi-automated measurements were feasible in all 33 nodules. Nodule diameter, volume and mass were 11.2 (3.3) mm, 935 (691) ml and 379 (311) milligrams for observer 1 and 11.1 (3.7) mm, 986 (797) ml and 399 (344) milligrams for observer 2, respectively. Agreement between observers and within observer 1 for the semi-automatic measurements was good with an intraclass correlation coefficient >0.89. For observer 1 and observer 2, measured diameter was 8.8% and 10.3% larger (p<0.001), measured volume was 24.3% and 26.5% larger (p<0.001) and measured mass was 10.6% and 12.0% larger (p<0.001) with the semi-automatic program compared to the manual measurements. CONCLUSION: Semi-automated measurement of the diameter, volume and mass of SSNs is feasible with good observer agreement. Semi-automated measurement makes quantification of mass and volume feasible in daily practice.

Increased Micronodule Counts Are More Common in Occupationally Silica Dust-Exposed Smokers Than in Control Smokers.

OBJECTIVE:: To determine the prevalence of increased micronodule counts in silica dust-exposed smokers. METHODS:: We evaluated 54 male smokers with severe silica dust exposure and 54 male control smokers. Both groups underwent low-dose chest computed tomography and lung function testing. Computed tomographic scans were visually evaluated for solid micronodules (<3 mm). The 95th percentile of micronodule count was calculated for the control smokers. Prevalence of an increased micronodule count was assessed for the dust-exposed subjects. RESULTS:: Solid micronodules were present in most participants of both groups. The 95th percentile of micronodule count in the control group was 13. Increased micronodule counts were significantly more common in the exposed group than in the control group (P = 0.01). CONCLUSIONS:: A substantial number of silica-exposed heavy smokers evaluated for silicosis have increased micronodule counts on chest computed tomographic scan. This finding might represent an early stage of silicosis.

Visual versus automated evaluation of chest computed tomography for the presence of chronic obstructive pulmonary disease.

BACKGROUND: Incidental CT findings may provide an opportunity for early detection of chronic obstructive pulmonary disease (COPD), which may prove important in CT-based lung cancer screening setting. We aimed to determine the diagnostic performance of human observers to visually evaluate COPD presence on CT images, in comparison to automated evaluation using quantitative CT measures. METHODS: This study was approved by the Dutch Ministry of Health and the institutional review board. All participants provided written informed consent. We studied 266 heavy smokers enrolled in a lung cancer screening trial. All subjects underwent volumetric inspiratory and expiratory chest computed tomography (CT). Pulmonary function testing was used as the reference standard for COPD. We evaluated the diagnostic performance of eight observers and one automated model based on quantitative CT measures. RESULTS: The prevalence of COPD in the study population was 44% (118/266), of whom 62% (73/118) had mild disease. The diagnostic accuracy was 74.1% in the automated evaluation, and ranged between 58.3% and 74.3% for the visual evaluation of CT images. The positive predictive value was 74.3% in the automated evaluation, and ranged between 52.9% and 74.7% for the visual evaluation. Interobserver variation was substantial, even within the subgroup of experienced observers. Agreement within observers yielded kappa values between 0.28 and 0.68, regardless of the level of expertise. The agreement between the observers and the automated CT model showed kappa values of 0.12-0.35. CONCLUSIONS: Visual evaluation of COPD presence on chest CT images provides at best modest accuracy and is associated with substantial interobserver variation. Automated evaluation of COPD subjects using quantitative CT measures appears superior to visual evaluation by human observers.

Comparing and combining algorithms for computer-aided detection of pulmonary nodules in computed tomography scans: The ANODE09 study.

Numerous publications and commercial systems are available that deal with automatic detection of pulmonary nodules in thoracic computed tomography scans, but a comparative study where many systems are applied to the same data set has not yet been performed. This paper introduces ANODE09 ( http://anode09.isi.uu.nl), a database of 55 scans from a lung cancer screening program and a web-based framework for objective evaluation of nodule detection algorithms. Any team can upload results to facilitate benchmarking. The performance of six algorithms for which results are available are compared; five from academic groups and one commercially available system. A method to combine the output of multiple systems is proposed. Results show a substantial performance difference between algorithms, and demonstrate that combining the output of algorithms leads to marked performance improvements.