Skip to main content
SpringerLink
Log in

Inadequacy of manual measurements compared to automated CT volumetry in assessment of treatment response of pulmonary metastases using RECIST criteria

  • Chest
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

The purpose of this study was to compare relative values of manual unidimensional measurements (MD) and automated volumetry (AV) for longitudinal treatment response assessment in patients with pulmonary metastases. Fifty consecutive patients with pulmonary metastases and repeat chest multidetector-row CT (median interval=2 months) were independently assessed by two radiologists for treatment response using Response Evaluation Criteria In Solid Tumours (RECIST). Statistics included relative measurement errors (RME), intra-/interobserver correlations, limits of agreement (95% LoA), and kappa. A total of 202 metastases (median volume=182.22 mm3; range=3.16–5,195.13 mm3) were evaluated. RMEs were significantly higher for MD than for AV (intraobserver RME=2.34–3.73% and 0.15–0.22% for MD and AV respectively; P<0.05. Interobserver RME=3.53–3.76% and 0.22–0.29% for MD and AV respectively; P<0.05). Overall correlation was significantly better for AV than for MD (P<0.05). Intraobserver 95% LoAs were −1.85 to 1.75 mm for MD and −11.28 to 9.84 mm3 for AV. The interobserver 95% LoA were −1.46 to 1.92 mm for MD and −11.17 to 9.33 mm3 for AV. There was total intra-/interobserver agreement on response using AV (κ=1). MD intra- and interobserver agreements were 0.73–0.84 and 0.77–0.80 respectively. Of the 200 MD response ratings, 28 (14/50 patients) were discordant. Agreement using MD dropped significantly from total remission to progressive disease (P<0.05). We therefore conclude that AV allows for better reproducibility of response evaluation in pulmonary metastases and should be preferred to MD in these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1a–d
Fig. 2a–d
Fig. 3a–d

Similar content being viewed by others

References

  1. Miller AB, Hogestraeten B, Staquet M, Winkler A (1981) Reporting results of cancer treatment. Cancer 47:207–214

    Google Scholar 

  2. Warr D, McKinney S, Tannock I (1984) Influence of measurement error on assessment of response to anticancer chemotherapy: proposal for new criteria of tumour response. J Clin Oncol 2:1040–1046

    Google Scholar 

  3. Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS et al. (2000) New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst 92:205–216

    Google Scholar 

  4. Ratain M (2004) Phase II studies of modern drugs directed against new targets: if you are fazed, too, then resist RECIST. J Clin Oncol 22:4442–4444

    Google Scholar 

  5. Revel MP, Bissery A, Bienvenu M, Aycard L, Lefort C, Frija G (2004) Are two-dimensional CT measurements of small noncalcified pulmonary nodules reliable? Radiology 231:453–458

    Google Scholar 

  6. Kostis WJ, Yankelevitz DF, Reeves AP, Fluture SC, Henschke CI (2004) Small pulmonary nodules: reproducibility of three-dimensional volumetric measurement and estimation of time to follow-up CT. Radiology 231:446–452

    Google Scholar 

  7. Wormanns D, Kohl G, Klotz E et al. (2004) Volumetric measurement of pulmonary nodules at multi-row detector CT: in vivo reproducibility. Eur Radiol 14:86–92

    Google Scholar 

  8. Fan L, Qian J, Odry BL et al. (2002) Automatic segmentation of pulmonary nodules by using dynamic cross-correlation for interactive CAD systems. In: Sonka M, Fitzpatrick JM (eds) Medical imaging: image processing. Proc SPIE 4684:1362–1396

  9. Bland M, Altman DG (1986) Statistical methods for assessing the difference between two methods of measurement. Lancet i:307–310

    Google Scholar 

  10. Fleiss JL, Nee CM, Landis JR (1979) Large sample variance of kappa in the case of different sets of raters. Psychol Bull 86:974–977

    Google Scholar 

  11. Fleiss JL (1981) Statistical methods for rates and proportions, 2nd edition. Wiley, New York

    Google Scholar 

  12. Altman DG (1991) Practical statistics for medical research. Chapman and Hall, London

    Google Scholar 

  13. Thiesse P, Ollivier L, Di Stefano-Louineau D et al. (1997) Response rate accuracy in oncology trials: reasons for interobserver variability. J Clin Oncol 15:3507–3514

    Google Scholar 

  14. Gwyther SJ, Aapro MS, Hatty SR, Postmus PE, Smith IE (1999) Results of an independent oncology review board of pivotal clinical trials of gemcitabine in nonsmall cell lung cancer. Anticancer Drugs 10:693–698

    Google Scholar 

  15. Biganzoli L, Lohrisch C, Paridaens R, Therasse P, Piccart M (2002) Analysis of two EORTC trials in metastatic breast cancer (MBC) support the recommendation of external response review (ERR) in trials with response rate (RR) as primary endpoint. Eur J Cancer 36(Suppl 5):S90

    Google Scholar 

  16. Marten K, Grillhösl A, Seyfarth T, Obenauer S, Rummeny EJ, Engelke C (2005) Computer-assisted detection of pulmonary nodules: evaluation of diagnostic performance using an expert knowledge-based detection system with variable reconstruction slice thickness settings. Eur Radiol 15:203–212

    Google Scholar 

  17. Marten K, Seyfarth T, Auer F, Wiener E, Grillhösl A, Obenauer S, Rummeny EJ, Engelke C (2004) Computer-assisted detection of pulmonary nodules: performance evaluation of an expert knowledge-based detection system in consensus reading with experienced and inexperienced chest radiologists. Eur Radiol 14:1930–1938

    Google Scholar 

  18. Sohaib SA, Turner B, Hanson JA, Farquharson M, Oliver RTD, Reznek RH (2000) CT assessment of tumour response to treatment: comparison of linear, cross-sectional and volumetric measures of tumour size. Brit J Radiol 73:1178–1184

    Google Scholar 

  19. Prasad SR, Jhaveri KS, Saini S, Hahn PF, Halpern EF, Sumner JE (2002) CT tumour measurement for therapeutic response assessment: comparison of unidimensional, bidimensional and volumetric techniques—initial observations. Radiology 225:416–419

    Google Scholar 

  20. Yankelevitz DF, Gupta R, Zhao B, Henschke CI (2000) Small pulmonary nodules: volumetrically determined growth rates based on CT evaluation. Radiology 217:251–256

    Google Scholar 

  21. Erasmus JJ, Gladish GW, Broemeling L, Sabloff BS, Truong MT, Herbst RS, Munden RF (2003) Interobserver and intraobserver variability in measurement of nonsmall-cell carcinoma of the lung lesions: implications for assessment of tumour response. J Clin Oncol 21:2574–2582

    Google Scholar 

  22. Schwartz M (1961) A biomathematical approach to clinical tumour growth. Cancer 14:1272–1294

    Google Scholar 

  23. Tran LN, Brown MS, Goldin JG et al. (2004) Comparison of treatment response classifications between unidimensional, bidimensional, and volumetric measurements of metastatic lung lesions on chest computed tomography. Acad Radiol 11:1355–1360

    Google Scholar 

  24. Werner-Wasik M, Xiao Y, Pequignot E, Curran WJ, Hauck W (2001) Assessment of lung cancer response after nonoperative therapy: tumour diameter, bidimensional product, and volume. A serial CT scan-based study. Int J Radiat Oncol Biol Phys 51:56–61

    Google Scholar 

Download references

Acknowledgements

We would like to thank Professor John Martin Bland from the Department of Health Sciences, University of York, UK, for invaluable advice on the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Radiology, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany

    Katharina Marten, Florian Auer, Stefan Schmidt, Ernst J. Rummeny & Christoph Engelke

  2. Department CTS W, Siemens Medical Solutions, Siemensstr. 1, 91301, Forchheim, Germany

    Gerhard Kohl

Authors
  1. Katharina Marten
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Florian Auer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefan Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gerhard Kohl
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ernst J. Rummeny
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christoph Engelke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katharina Marten.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marten, K., Auer, F., Schmidt, S. et al. Inadequacy of manual measurements compared to automated CT volumetry in assessment of treatment response of pulmonary metastases using RECIST criteria. Eur Radiol 16, 781–790 (2006). https://doi.org/10.1007/s00330-005-0036-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-005-0036-x

Keywords

Search

Navigation