Variability of lung tumor measurements on repeat computed tomography scans taken within 15 minutes Journal Article


Authors: Oxnard, G. R.; Zhao, B.; Sima, C. S.; Ginsberg, M. S.; James, L. P.; Lefkowitz, R. A.; Guo, P.; Kris, M. G.; Schwartz, L. H.; Riely, G. J.
Article Title: Variability of lung tumor measurements on repeat computed tomography scans taken within 15 minutes
Abstract: Purpose: We use changes in tumor measurements to assess response and progression, both in routine care and as the primary objective of clinical trials. However, the variability of computed tomography (CT) -based tumor measurement has not been comprehensively evaluated. In this study, we assess the variability of lung tumor measurement using repeat CT scans performed within 15 minutes of each other and discuss the implications of this variability in a clinical context. Patients and Methods: Patients with non-small-cell lung cancer and a target lung lesion ≥ 1 cm consented to undergo two CT scans within a period of minutes. Three experienced radiologists measured the diameter of the target lesion on the two scans in a side-by-side fashion, and differences were compared. Results: Fifty-seven percent of changes exceeded 1 mm in magnitude, and 33% of changes exceeded 2 mm. Median increase and decrease in tumor measurements were +4.3% and -4.2%, respectively, and ranged from 23% shrinkage to 31% growth. Measurement changes were within ± 10% for 84% of measurements, whereas 3% met criteria for progression according to Response Evaluation Criteria in Solid Tumors (RECIST; ≥ 20% increase). Smaller lesions had greater variability of percent measurement change (P = .005). Conclusion: Apparent changes in tumor diameter exceeding 1 to 2 mm are common on immediate reimaging. Increases and decreases less than 10% can be a result of the inherent variability of reimaging. Caution should be exercised in interpreting the significance of small changes in lesion size in the care of individual patients and in the interpretation of clinical trial results. © 2011 by American Society of Clinical Oncology.
Keywords: adult; clinical article; human tissue; cancer staging; computer assisted tomography; tumor volume; lung non small cell cancer; contrast medium; lung lesion
Journal Title: Journal of Clinical Oncology
Volume: 29
Issue: 23
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2011-08-10
Start Page: 3114
End Page: 3119
Language: English
DOI: 10.1200/jco.2010.33.7071
PROVIDER: scopus
PMCID: PMC3157977
PUBMED: 21730273
DOI/URL:
Notes: --- - "Cited By (since 1996): 1" - "Export Date: 3 October 2011" - "CODEN: JCOND" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Camelia S Sima
    204 Sima
  2. Michelle S Ginsberg
    158 Ginsberg
  3. Lawrence H Schwartz
    281 Schwartz
  4. Leonard Philip James
    13 James
  5. Pingzhen Guo
    10 Guo
  6. Binsheng Zhao
    46 Zhao
  7. Gregory J Riely
    344 Riely
  8. Geoffrey R Oxnard
    24 Oxnard
  9. Mark Kris
    598 Kris