Final sample consisted of 84 patients
- 19 men,
65 women;
- age range,
19–84 years; mean,
54.2 ± 15.4 [SD] years
- 97 lesions (84 patients: one tumor in 71 patients and two tumors [one in each lobe] in 13 patients).
- Mean maximum axial diameter of lesions was 3.5 ± 1.5 cm (one SD),
ranging from 1.1 to 8.4 cm.
80 patients underwent complete tumor resection and 4 patients had near total tumor resection.
There was substantial agreement between the two radiologists.
|
Kappa
|
Intraluminal mass,
|
0.83
|
Degrees of tumor circumference
|
0.81
|
Tracheal shape
|
0.78
|
Tumor extension to the posterior membranous portion
|
0.78
|
Enhancement in the tracheal cartilage
|
0.68
|
Pearson's correlation coefficient was
0.99 (p < 0.001) for the maximum axial diameter of the tumors
0.96 (p < 0.001) for the distance of tracheal displacement
Imaging Parameters and their diagnostic accuracy Figure 2:
Imaging findings
|
TI (n = 43)
|
No TI (n = 54)
|
Univariate
P value
|
Multivariate
P value
|
Maximum tumor diameter (cm)
|
4.2 ± 1.5
|
2.7 ± 1.3
|
< 0.001
|
|
Tracheal dislocation (mm)
|
8.5 ± 5.0
|
4.2 ± 6.8
|
0.008
|
|
Posterior membranous portion extension
|
21
|
4
|
< 0.001
|
|
Intraluminal mass
|
12
|
0
|
|
0.001
|
Soft tissue in cartilage
|
33
|
2
|
< 0.001
|
0.001
|
Tracheal shapes
|
|
|
< 0.001
|
|
Normal
|
5
|
45
|
|
|
Locally straightened wall
|
16
|
6
|
|
|
Locally concave wall
|
22
|
3
|
|
|
Degrees of tumor circumference
|
|
|
< 0.001
|
0.001
|
0-89°
|
2
|
27
|
|
|
90-179°
|
14
|
21
|
|
|
180-269°
|
23
|
6
|
|
|
≥270°
|
4
|
0
|
|
|
SHIN
|
|
|
<0.001
|
|
0
|
0
|
50
|
|
|
I
|
12
|
3
|
|
|
II
|
11
|
1
|
|
|
III
|
8
|
0
|
|
|
IV
|
12
|
0
|
|
|
CT Findings and their Diagnostic accuracy:
CT Findings
|
Accuracy
|
Sensitivity
|
Specificity
|
PPV
|
NPV
|
Tumor within cartilage
|
88%
|
79%
|
96%
|
94%
|
85%
|
Intraluminal mass
|
68%
|
28%
|
100%
|
100%
|
63%
|
Degree of tumor circumference ≥180°
|
77%
|
63%
|
89%
|
81%
|
75%
|
SHIN
|
93%
|
95%
|
92%
|
91%
|
96%
|
Modified Shin classification
|
96%
|
98%
|
96%
|
95%
|
98%
|
Of the three factors,
- soft tissue in the cartilage was most accurate,
88% accuracy with 79% sensitivity.
- Intraluminal mass showed 100% specificity,
the sensitivity was low 28%.
- SHIN showed good accuracy 93% with upwards of 90% sensitivity and specificity.
Modified shin classification combined had a 96% accuracy.
Follow-Up data is presented in figure 3.
Strengths:
Uniform imaging acquisition.
Raw data for reconstruction was available
Patients were equally distributed.
1st time in literature imaging based shin classficiation
Limitations:
Retrospective nature of study.
Selection bias
Exact depth of invasion is not studied on pathology.
Adjuvant therapy and outcome data is limited.
Future plans: Prospectively
Compare the imaging findings with depth of invasion on pathological specimens
Study the impact of proposed classification for predicting TI on surgical management and overall outcomes.