CT Evaluation for Clinical Lung Cancer Staging: Do Multiplanar Measurements Better Reflect Pathologic T-Stage than Axial Measurements?

Objective: To retrospectively investigate whether tumor size assessment on multiplanar reconstruction (MPR) CT images better reflects pathologic T-stage than evaluation on axial images and evaluate the additional value of measurement in three-dimensional (3D) space.

Materials and methods: From 1661 patients who had undergone surgical resection for primary lung cancer between June 2013 and November 2016, 210 patients (145 men; mean age, 64.4 years) were randomly selected and 30 were assigned to each pathologic T-stage. Two readers independently measured the maximal lesion diameters on MPR CT. The longest diameters on 3D were obtained using volume segmentation. T-stages determined on CT images were compared with pathologic T-stages (overall and subgroup-Group 1, T1a/b; Group 2, T1c or higher), with differences in accuracy evaluated using McNemar's test. Agreement between readers was evaluated with intraclass correlation coefficients (ICC).

Results: The diagnostic accuracy of MPR measurements for determining T-stage was significantly higher than that of axial measurement alone for both reader 1 (74.3% [156/210] vs. 63.8% [134/210]; p = 0.001) and reader 2 (68.1% [143/210] vs. 61.9% [130/210]; p = 0.049). In the subgroup analysis, diagnostic accuracy with MPR diameter was significantly higher than that with axial diameter in only Group 2 (p < 0.05). Inter-reader agreements for the ICCs on axial and MPR measurements were 0.98 and 0.98. The longest diameter on 3D images showed a significantly lower performance than MPR, with an accuracy of 54.8% (115/210) (p < 0.05).

Conclusion: Size measurement on MPR CT better reflected the pathological T-stage, specifically for T1c or higher stage lung cancer. Measurements in a 3D plane showed no added value.