title: Comparison of treatment response classifications between unidimensional, bidimensional, and volumetric measurements of metastatic lung lesions on chest computed tomography.
abstract: OBJECTIVE
  To study the agreement in treatment response classifications between unidimensional (1D), bidimensional (2D), and volumetric (3D) methods of measuring metastatic lung nodules on chest computed tomography (CT).
  
  
  METHODS
  Chest CT scans of 15 patients undergoing treatment for metastatic colorectal, renal cell, or breast carcinoma to the lungs were analyzed. CT images were acquired with 3 mm collimation and contiguous reconstruction. Two or three lung lesions were selected for each patient. Lesions were analyzed at baseline and two follow-up intervals of 1-4 months. 1D and 2D measurements were made with electronic calipers, while nodule volume was measured using a semiautomated segmentation system. Following the World Health Organization and RECIST (Response Evaluation Criteria in Solid Tumors) criteria, patients were categorized into four treatment response classifications. Volumetric criteria were used to classify response based on 3D measurements.
  
  
  RESULTS
  Thirty-two lesions from 15 patients were analyzed. Because each patient had a baseline and two follow-up scans, this yielded 30 response classifications for each measurement technique. The 1D, 2D, and 3D measurements were concordant in 21 of 30 classifications. The 1D and 3D measurements were concordant in 29 of 30 classifications, while the 2D and 3D measurements were concordant in 23 of 30 classifications. Level of agreement among the three methods was measured using a kappa statistic (K). For 1D compared with 3D, K = 0.739 +/- 0.345 (visits 1, 2) and 0.273 +/- 0.323 (visits 2, 3). For 2D compared with 3D, K = 0.655 +/- 0.325 (visits 1, 2) and 0.200 +/- 0.208 (visits 2, 3). Agreement among the methods for round and ovoid nodules was also fair to poor.
  
  
  CONCLUSIONS
  The three methods of tumor measurement show fair to poor agreement in treatment response classification. These findings have negative implications for the accuracy in which patients are classified under the World Health Organization or RECIST criteria and managed under cancer treatment protocols.
authors.affiliation: Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, B2-168, Center for the Health Sciences, Los Angeles, CA 90095-1721, USA.
authors.forename: Lien N
authors.initials: LN
authors.lastname: Tran
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Brown
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Goldin
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Yan
authors.forename: Richard C
authors.initials: RC
authors.lastname: Pais
authors.forename: Michael F
authors.initials: MF
authors.lastname: McNitt-Gray
authors.forename: David
authors.initials: D
authors.lastname: Gjertson
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Rogers
authors.forename: Denise R
authors.initials: DR
authors.lastname: Aberle
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology; D002292:Carcinoma, Renal Cell / Q000473:pathology; D015179:Colorectal Neoplasms / Q000473:pathology; D018450:Disease Progression; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000628:therapy*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome