A Practical Guide of the Southwest Oncology Group to Measure Malignant Pleural Mesothelioma Tumors by RECIST and Modified RECIST Criteria Anne S. Tsao,

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Presentation transcript:

A Practical Guide of the Southwest Oncology Group to Measure Malignant Pleural Mesothelioma Tumors by RECIST and Modified RECIST Criteria Anne S. Tsao, MD, Linda Garland, MD, Mary Redman, MD, Kemp Kernstine, MD, PhD, David Gandara, MD, Edith M. Marom, MD Journal of Thoracic Oncology Volume 6, Issue 3, Pages 598-601 (March 2011) DOI: 10.1097/JTO.0b013e318208c83d Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Example of well formulated and erroneous measurements using modified RECIST. A, Good measurement: the pleural disease has a short-axis measurement of 3.2 cm. The short axis is always measured perpendicular, or 90 degrees, to the chest wall or mediastinum and is the measurement between the point the pleural disease touches the chest wall/mediastinum and the point where the pleural disease touches normal lung. B, Malpositioned caliper: although this measurement takes a short path to the chest wall, perpendicular to the chest wall, it does not pass entirely through the tumor before meeting the chest wall and is therefore an erroneous measurement. C, Malpositioned caliper: although the measurement goes through tumor tissue, the path is not the shortest going to the chest wall, i.e., perpendicular. It forms an acute angle to the point where the pleural disease interfaces with the mediastinum and is therefore incorrect. Journal of Thoracic Oncology 2011 6, 598-601DOI: (10.1097/JTO.0b013e318208c83d) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Examples of pleural disease interfaces with the chest wall or mediastinum. A, Example of a good interface to measure. There is a clear, well-marginated differentiation between the pleural tumor and the normal mediastinal fat (arrow). B, Example of a poor interface to measure. The border of the pleural tumor compared with normal tissues is not clear or distinct (circle). C, If choosing to measure the interface seen in B, measurements may erroneously underestimate tumor burden. D, If choosing to measure the interface seen in B, measurements may erroneously overestimate tumor burden. Journal of Thoracic Oncology 2011 6, 598-601DOI: (10.1097/JTO.0b013e318208c83d) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Comparison of tumor measurements using the updated RECIST criteria version 1.1 (i, iii, v) and the modified RECIST criteria (ii, iv, vi). *Although additional measurements were made of the pleural tumor in the patient example (see Figure 3i.); by RECIST version 1.1, only the 2 longest measurements of the pleural tumor are used in calculating the total RECIST v. 1.1 measurement. For the example, this patient had pleural tumor measurements of 5.3 cm, 6.1 cm, 10.9 cm, and 8.2 cm. The 2 longest measurements (10.9 cm, 8.2 cm) were chosen to be added together for the total RECIST v1.1 measurement (19.1 cm). Journal of Thoracic Oncology 2011 6, 598-601DOI: (10.1097/JTO.0b013e318208c83d) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 Lymph node measurements. Schematic representation of a horizontally oriented (A) or vertically oriented (B) lymph node and an enlarged subcarinal lymph node on contrast enhanced chest computed tomography (CT) at the level of the right pulmonary artery (C). Arrow denotes the short axis of the lymph nodes in A and B, and in the caliper measurements of the short axis of the 33.4 mm subcarinal lymph node seen in C. As an example, the measurements of the lymph node in C would be added to the pleural measurements obtained in Figure 3. RECIST method v1.1: total measurement = pleura (10.9 + 8.2 = 19.1 cm) + lymph node (3.3 cm) = 22.4 cm. Modified RECIST: total measurement = pleura (3.2 + 3.3 + 2.2 + 3.8 + 2.5 + 3.8 = 18.8 cm) + lymph node (3.3 cm) = 22.1 cm. Journal of Thoracic Oncology 2011 6, 598-601DOI: (10.1097/JTO.0b013e318208c83d) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions