Review Article
Volume versus diameter assessment of small pulmonary nodules in CT lung cancer screening Daiwei Han, Marjolein A. Heuvelmans, Matthijs Oudkerk University of Groningen, University Medical Center Groningen, Center for Medical Imaging–North East Netherlands, Groningen, the Netherlands Contributions: (I) Conception and design: All authors; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Marjolein A. Heuvelmans, MD, PhD. CMI-Center for Medical Imaging EB45, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands. Email: [email protected].
Abstract: Currently, lung cancer screening by low-dose chest CT is implemented in the United States for high-risk persons. A disadvantage of lung cancer screening is the large number of small-to-intermediate sized lung nodules, detected in around 50% of all participants, the large majority being benign. Accurate estimation of nodule size and growth is essential in the classification of lung nodules. Currently, manual diameter measurements are the standard for lung cancer screening programs and routine clinical care. However, European screening studies using semi-automated volume measurements have shown higher accuracy and reproducibility compared to diameter measurements. In addition to this, with the optimization of CT scan techniques and reconstruction parameters, as well as advances in segmentation software, the accuracy of nodule volume measurement can be improved even further. The positive results of previous studies on volume and diameter measurements of lung nodules suggest that manual measurements of nodule diameter may be replaced by semi-automated volume measurements in the (near) future. Keywords: Semi-automated volume measurement; manual diameter measurement; small pulmonary nodule Submitted Oct 07, 2016. Accepted for publication Dec 21, 2016. doi: 10.21037/tlcr.2017.01.05 View this article at: http://dx.doi.org/10.21037/tlcr.2017.01.05
Introduction Lung cancer is the leading cause of cancer-related mortality in men and women worldwide (1). This is mainly due to the fact that lung cancer patients are mostly asymptomatic in early stages. Patients presenting with symptoms such as cough or chest pain in the clinics often already have advanced lung cancer with very limited survival time despite of treatment. Therefore, early detection of lung cancer is extremely important. The National Lung Screening Trial (NLST), a large-scale randomized controlled trial including over 53,000 participants, has demonstrated that low-dose computed tomography (LDCT) screening for individuals at high risk for lung cancer, reduced lung cancer mortality by 15–20%, when compared to chest radiographs (2). The result of NLST was translated by several U.S. medical associations,
© Translational lung cancer research. All rights reserved.
including the U.S. Preventive Service Task Force, into recommendation for lung cancer screening using LDCT for high-risk individuals (3,4). Since February 2015, lung cancer screening for high risk individuals is covered by Medicare (5). Despite of the benefits regarding lung cancer related mortality reduction brought by LDCT lung cancer screening, a major drawback of lung cancer screening is its high rate of false-positive screen results. A challenging problem in lung cancer screening is the high prevalence of small-to-intermediate sized (
Volume versus diameter assessment of small pulmonary nodules in CT lung cancer screening Daiwei Han, Marjolein A. Heuvelmans, Matthijs Oudkerk University of Groningen, University Medical Center Groningen, Center for Medical Imaging–North East Netherlands, Groningen, the Netherlands Contributions: (I) Conception and design: All authors; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Marjolein A. Heuvelmans, MD, PhD. CMI-Center for Medical Imaging EB45, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands. Email: [email protected].
Abstract: Currently, lung cancer screening by low-dose chest CT is implemented in the United States for high-risk persons. A disadvantage of lung cancer screening is the large number of small-to-intermediate sized lung nodules, detected in around 50% of all participants, the large majority being benign. Accurate estimation of nodule size and growth is essential in the classification of lung nodules. Currently, manual diameter measurements are the standard for lung cancer screening programs and routine clinical care. However, European screening studies using semi-automated volume measurements have shown higher accuracy and reproducibility compared to diameter measurements. In addition to this, with the optimization of CT scan techniques and reconstruction parameters, as well as advances in segmentation software, the accuracy of nodule volume measurement can be improved even further. The positive results of previous studies on volume and diameter measurements of lung nodules suggest that manual measurements of nodule diameter may be replaced by semi-automated volume measurements in the (near) future. Keywords: Semi-automated volume measurement; manual diameter measurement; small pulmonary nodule Submitted Oct 07, 2016. Accepted for publication Dec 21, 2016. doi: 10.21037/tlcr.2017.01.05 View this article at: http://dx.doi.org/10.21037/tlcr.2017.01.05
Introduction Lung cancer is the leading cause of cancer-related mortality in men and women worldwide (1). This is mainly due to the fact that lung cancer patients are mostly asymptomatic in early stages. Patients presenting with symptoms such as cough or chest pain in the clinics often already have advanced lung cancer with very limited survival time despite of treatment. Therefore, early detection of lung cancer is extremely important. The National Lung Screening Trial (NLST), a large-scale randomized controlled trial including over 53,000 participants, has demonstrated that low-dose computed tomography (LDCT) screening for individuals at high risk for lung cancer, reduced lung cancer mortality by 15–20%, when compared to chest radiographs (2). The result of NLST was translated by several U.S. medical associations,
© Translational lung cancer research. All rights reserved.
including the U.S. Preventive Service Task Force, into recommendation for lung cancer screening using LDCT for high-risk individuals (3,4). Since February 2015, lung cancer screening for high risk individuals is covered by Medicare (5). Despite of the benefits regarding lung cancer related mortality reduction brought by LDCT lung cancer screening, a major drawback of lung cancer screening is its high rate of false-positive screen results. A challenging problem in lung cancer screening is the high prevalence of small-to-intermediate sized (
