Lung nodule measurement reliability in computed tomography: A retrospective study

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Abstract
Introduction . In the 21st century, medical imaging evolved from simple assessment of the presence of a pathological sign to quantitative assessment of detected changes. Despite the obvious dependence of diagnostic accuracy on the degree of measurement error, modern classifications of radiologic errors do not single out measurement error as a separate cause of discrepancies between specialists. We consider it necessary to study in detail the size of measurement error of radiologists in conditions close to routine practice and to determine the possibility of the influence of such an error on the formation of the correct patient management tactics. Aim . To determine radiologist discrepancy in measuring the pulmonary nodule size during opportunistic screening in chest computed tomography (CT). Materials and methods . A retrospective study was performed on a database containing the 3897 labeled native chest CT studies using a routine protocol. Experts determined the type and mean size of each pulmonary nodule. We used the following statistical methods: intraclass correlation coefficient to evaluate measurement reliability; limits of agreement (Bland-Altman method) to quantify measurement variability. The significance level for all statistical hypotheses was set to 0.05. Results . The final analysis included 87 CT studies, each containing a single solid pulmonary nodule with a diameter ranging from 6 to 30 mm, independently measured by three radiologists. The median nodule size was 10 mm. The intraclass correlation coefficient was 0.95 with 95% CI (0.93; 0.97). The 95% CI for the maximum absolute difference between observers ranged between (1.5; 1.9) mm. Conclusion . The measurement disperancy between three radiologists for solid pulmonary nodule in chest CT did not exceed the methodologically established threshold for pulmonary nodule growth.

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