Influence of lung nodule margin on volume- and diameter-based reader variability in CT lung cancer screening

Han, D., Heuvelmans, M., Vliegenthart, R., Rook, M., Dorrius, M. D., de Jonge, G., Walter, J. E., van Ooijen, P. M. A., de Koning, H. J. & Oudkerk, M., 8-Nov-2017, In : British journal of radiology. 90, 8 p., 20170405.

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OBJECTIVE: To evaluate the influence of nodule margin on inter- and intra-reader variability in manual diameter measurements and semi-automatic volume measurements of solid nodules detected in low-dose CT lung cancer screening.

METHODS: Twenty-five nodules of each morphological category (smooth, lobulated, spiculated and irregular) were randomly selected from 93 participants of the Dutch-Belgian randomized lung cancer screening trial (NELSON). Semi-automatic volume measurements were performed using Syngo LungCARE® software. Three radiologists independently measured mean diameters manually. Impact of nodule margin on inter-reader variability was evaluated based on systematic error and 95% limits of agreement. Inter-reader variability was compared to the nodule growth cutoff as used in Lung-RADS (+1.5mm diameter) and NELSON/British Thoracic Society (+25% volume).

RESULTS: For manual diameter measurements, a significant systematic error (up to 1.2mm) between readers was found in all morphological categories. For semi-automatic volume measurements, no statistically significant systematic error was found. The inter-reader variability in mean diameter measurements exceeded the 1.5mm cut-off for nodule growth for all morphological categories (smooth: ±1.9mm [+27%], lobulated: ±2.0mm [+33%], spiculated: ±3.5mm [+133%], irregular: ±4.5mm [+200%]). The 25%-volume growth cut-off was exceeded slightly for spiculated (28% [+12%]) and irregular (27% [+8%]) nodules.

CONCLUSION: Lung nodule sizing based on manual diameter measurement is affected by nodule margin. Inter-reader variability increases especially for nodules with spiculated and irregular margins, and may cause misclassification of nodule growth. This effect is much smaller for semi-automated volume measurements. Advances in knowledge: Semi-automatic volume measurements are superior for both size and growth determination of pulmonary nodules.

Original languageEnglish
Article number20170405
Number of pages8
JournalBritish journal of radiology
Publication statusPublished - 8-Nov-2017


  • Journal Article
Related Datasets
  1. Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON)

    Oudkerk, M. (Creator), Groen, H. (Creator), Van Klaveren, R. J. (Creator), de Koning, H. J. (Creator), Mali, W. P. T. M. (Creator), Lammers, J. J. (Creator), University of Groningen, 2018


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