title: North American Multicenter Volumetric CT Study for Clinical Staging of Malignant Pleural Mesothelioma: Feasibility and Logistics of Setting Up a Quantitative Imaging Study.
abstract: Clinical tumor (T), node, and metastasis staging is based on a qualitative assessment of features defining T descriptors and has been found to be suboptimal for predicting the prognosis of patients with malignant pleural mesothelioma (MPM). Previous work suggests that volumetric computed tomography (VolCT) is prognostic and, if found practical and reproducible, could improve clinical MPM classification.
  
  
  
  Six North American institutions electronically submitted clinical, pathologic, and imaging data on patients with stages I to IV MPM to an established multicenter database and biostatistical center. Two reference radiologists blinded to clinical data independently reviewed the scans; calculated clinical T, node, and metastasis stage by standard criteria; performed semiautomated tumor volume calculations using commercially available software; and submitted the findings to the biostatistical center. Study end points included the feasibility of a multi-institutional VolCT network, concordance of independent VolCT assessments, and association of VolCT with pathological T classification.
  
  
  
  Of 164 submitted cases, 129 were evaluated by both reference radiologists. Discordant clinical staging of most cases confirmed the inadequacy of current criteria. The overall correlation between VolCT estimates was good (Spearman correlation 0.822), but some were significantly discordant. Root cause analysis of the most discordant estimates identified four common sources of variability. Despite these limitations, median tumor volume estimates were similar within subgroups of cases representing each pathological T descriptor and increased monotonically for each reference radiologist with increasing pathological T status.
  
  
  
  The good correlation between VolCT estimates obtained for most cases reviewed by two independent radiologists and qualitative association of VolCT with pathological T status combine to encourage further study. The identified sources of user error will inform design of a follow-up prospective trial to more formally assess interobserver variability of VolCT and its potential contribution to clinical MPM staging.
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: rgill@partners.org.
authors.forename: Ritu R
authors.initials: RR
authors.lastname: Gill
authors.affiliation: Department of Radiology, New York University School of Medicine, New York, New York.
authors.forename: David P
authors.initials: DP
authors.lastname: Naidich
authors.affiliation: Cancer Research and Biostatistics, Seattle, Washington.
authors.forename: Alan
authors.initials: A
authors.lastname: Mitchell
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ginsberg
authors.affiliation: Department of Radiology, M. D. Anderson Cancer Center, Houston, Texas.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Erasmus
authors.affiliation: Department of Radiology, The University of Chicago, Chicago, Illinois.
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Armato
authors.affiliation: Department of Radiology, The University of Chicago, Chicago, Illinois.
authors.forename: Christopher
authors.initials: C
authors.lastname: Straus
authors.affiliation: Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Sharyn
authors.initials: S
authors.lastname: Katz
authors.affiliation: Department of Radiology, Toronto General Hospital and Princess Margaret Hospital, Toronto, Canada.
authors.forename: Demetrois
authors.initials: D
authors.lastname: Patios
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: William G
authors.initials: WG
authors.lastname: Richards
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
mesh_terms: D054893:Cone-Beam Computed Tomography; D005240:Feasibility Studies; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008654:Mesothelioma / Q000000981:diagnostic imaging* / Q000473:pathology; D000086002:Mesothelioma, Malignant; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D047368:Tumor Burden
keywords: Clinical staging; MPM; Mesothelioma; Tumor volume; Volumetric CT