title: Pleural invasion by peripheral lung cancer: prediction with three-dimensional CT.
abstract: OBJECTIVE
  To evaluate the clinical utility of three-dimensional (3D) computed tomography (CT) for predicting pleural invasion by peripheral lung cancer.
  
  
  METHODS
  CT findings (tumor size, vertical diameter, length and area of the interface between tumor and the pleura, ratios of length and area [Rarea] of interface between tumor and the pleura to tumor size, angle between the tumor and adjacent pleura, presence or absence of pleural thickening, and originally developed 3D pleural patterns) in 201 consecutive patients with lung cancer of ≤3 cm in contact with pleural surface were correlated with pathologic findings. Logistic modeling was used for determining the significant factors for prediction of pleural invasion, and receiver operating characteristic (ROC) curves were used for investigating diagnostic capability of significant factors, resulting in a recommendation to the optimal criteria for predicting pleural invasion and to the optimal threshold for differentiating parietal from visceral invasion.
  
  
  RESULTS
  Sixty-one (30%) of the 201 patients had pathologically verified pleural invasion. Logistic modeling revealed that the 3D pleural pattern was the only significant factor (P < .001; relative risk of 7.34). Among every combination of the 3D patterns, skirt-like pattern showed the highest accuracy of 77% for predicting pleural invasion. In differentiating parietal from visceral pleural invasion, ROC analysis revealed that Rarea was optimal for differentiating parietal from visceral pleural invasion, and the highest accuracy of 77% was obtained with a cut-off value of 13.4 for this criterion.
  
  
  CONCLUSIONS
  Computer-aided 3D CT analysis of the pleura was useful for predicting pleural invasion.
authors.affiliation: Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan. Electronic address: kiyoharu0825@yahoo.co.jp.
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Ebara
authors.affiliation: Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Shodayu
authors.initials: S
authors.lastname: Takashima
authors.affiliation: Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Binghu
authors.initials: B
authors.lastname: Jiang
authors.affiliation: Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Hodaka
authors.initials: H
authors.lastname: Numasaki
authors.affiliation: Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: Mai
authors.initials: M
authors.lastname: Fujino
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tomita
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, Japan.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Nakanishi
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Higashiyama
mesh_terms: D000368:Aged; D003287:Contrast Media; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D015588:Observer Variation; D010994:Pleura / Q000000981:diagnostic imaging; D010997:Pleural Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary*; D011237:Predictive Value of Tests; D012372:ROC Curve; D011856:Radiographic Image Enhancement; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media
keywords: 3D CT; computer-aided diagnosis; lung cancer; pleural invasion