Abstract
Lung adenocarcinoma (ADC), the most common lung cancer type, is recognized increasingly as a disease spectrum. To guide individualized patient care, a non-invasive means of distinguishing indolent from aggressive ADC subtypes is needed urgently. Computer-Aided Nodule Assessment and Risk Yield (CANARY) is a novel computed tomography (CT) tool that characterizes early ADCs by detecting nine distinct CT voxel classes, representing a spectrum of lepidic to invasive growth, within an ADC. CANARY characterization has been shown to correlate with ADC histology and patient outcomes. This study evaluated the inter-observer variability of CANARY analysis. Three novice observers segmented and analyzed independently 95 biopsy-confirmed lung ADCs from Vanderbilt University Medical Center/Nashville Veterans Administration Tennessee Valley Healthcare system (VUMC/TVHS) and the Mayo Clinic (Mayo). Inter-observer variability was measured using intra-class correlation coefficient (ICC). The average ICC for all CANARY classes was 0.828 (95% CI 0.76, 0.895) for the VUMC/TVHS cohort, and 0.852 (95% CI 0.804, 0.901) for the Mayo cohort. The most invasive voxel classes had the highest ICC values. To determine whether nodule size influenced inter-observer variability, an additional cohort of 49 sub-centimeter nodules from Mayo were also segmented by three observers, with similar ICC results. Our study demonstrates that CANARY ADC classification between novice CANARY users has an acceptably low degree of variability, and supports the further development of CANARY for clinical application.
Highlights
That screening for lung cancer is nationally recommended in most guidelines, the incidence of early lung cancer detection is likely to rise [1]
An estimated 20% of cancers diagnosed during the National Lung Screening Trial (NLST) were felt to be slow growing and clinically insignificant, and most of those cancers belonged to the adenocarcinoma (ADC) classification [2,3,4]
Lung ADC is increasingly recognized as a disease spectrum with varying degrees of aggressiveness, ranging from minimally invasive adenocarcinoma (MIA) and adenocarcinoma in situ (AIS) with nearly 100% post-resection survival to invasive adenocarcinoma (IA) that behaves to other non-small cell lung cancers [5]
Summary
That screening for lung cancer is nationally recommended in most guidelines, the incidence of early lung cancer detection is likely to rise [1]. While this offers a remarkable opportunity to intervene early in the disease course, individualized management of lung cancer therapy will require appropriate risk stratification. Lung ADC is increasingly recognized as a disease spectrum with varying degrees of aggressiveness, ranging from minimally invasive adenocarcinoma (MIA) and adenocarcinoma in situ (AIS) with nearly 100% post-resection survival to invasive adenocarcinoma (IA) that behaves to other non-small cell lung cancers [5].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
