European Radiology

, Volume 28, Issue 10, pp 4288–4295 | Cite as

Evaluation of T categories for pure ground-glass nodules with semi-automatic volumetry: is mass a better predictor of invasive part size than other volumetric parameters?

  • Hyungjin Kim
  • Jin Mo GooEmail author
  • Chang Min Park



This study aimed to investigate the diagnostic advantage of nodule mass in differentiating invasive pulmonary adenocarcinomas (IPAs) among pure ground-glass nodules (pGGNs) over other volumetric measurements. Another aim of this study was to analyse the correlation between volumetric measurements on computed tomography (CT) scans and the pathological invasive component size.


This Institutional Review Board-approved retrospective study included 117 patients (men:women = 53:64; mean age, 57.3 years) with 117 pGGNs. Semi-automatic segmentation was performed for all nodules, and volumetric measurements, such as nodule volume, attenuation, mass, two-dimensional (2D) average diameter and three-dimensional (3D) longest diameter, were obtained. Receiver operating characteristic (ROC) curve analyses were performed to evaluate the diagnostic performances of the volumetric parameters in discriminating IPAs. Spearman correlation coefficients were calculated between the volumetric measurements and the invasive component size.


Area under the ROC curve for mass was 0.792 (95% CI, 0.691-0.872) in non-enhanced CT and 0.730 (95% CI, 0.607-0.832) in contrast-enhanced CT. Nodule mass was not superior to 2D average diameter for the differentiation of IPAs in both non-enhanced (0.792 vs 0.780; p = 0.501) CT and contrast-enhanced CT scans (0.730 vs 0.700; p = 0.319). The correlation between the volumetric measurements (mass, 3D longest diameter and 2D average diameter) and the invasive component size was moderate (Spearman’s rho, 0.401-0.422) in non-enhanced CT and weak (Spearman’s rho, 0.276-0.310) in contrast-enhanced CT.


Nodule mass measurement had no strength over other volumetric parameters for the prediction of pathological invasiveness in the diagnosis of pGGNs.

Key Points

• Mass is not superior to other volumetric measurements for the diagnosis of pure ground-glass nodules.

• Mass and two-dimensional average diameter exhibited comparable performance for the discrimination of invasive adenocarcinomas among pure ground-glass nodules.

• The diagnostic performance of volumetric measurements was lower on contrast-enhanced CT scans.

• The correlation between the volumetric measurements and the invasive component size was moderate on non-enhanced CT scans and weak on contrast-enhanced CT scans.


Non-small-cell lung carcinoma Adenocarcinoma Multidetector computed tomography Computer-assisted diagnosis Neoplasm staging 



Invasive pulmonary adenocarcinoma


Pure ground-glass nodule


Part-solid nodule


Subsolid nodule



This study has received funding by a grant from the National R&D Program for Cancer Control, Ministry for Health and Welfare, Republic of Korea (1520230).

Compliance with ethical standards


The scientific guarantor of this publication is Jin Mo Goo.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in journal articles (Eur Radiol 2016, 26:4465-4474; Eur J Radiol 2016, 85:1174-1180; Eur Radiol 2017, 27:3266-3274; Eur Radiol 2017, doi:10.1007/s00330-017-5171-7; Eur Radiol 2017, 27:1369-1376).


  • retrospective

  • diagnostic or prognostic study

  • performed at one institution

Supplementary material

330_2018_5440_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 20 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation MedicineSeoul National University Medical Research CenterSeoulKorea
  2. 2.Cancer Research InstituteSeoul National UniversitySeoulKorea

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