A Multicenter Study of Volumetric Computed Tomography for Staging Malignant Pleural Mesothelioma Valerie W. Rusch, MD, Ritu Gill, MD, Alan Mitchell,

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A Multicenter Study of Volumetric Computed Tomography for Staging Malignant Pleural Mesothelioma Valerie W. Rusch, MD, Ritu Gill, MD, Alan Mitchell, MS, David Naidich, MD, David C. Rice, MB, BCh, Harvey I. Pass, MD, Hedy L. Kindler, MD, Marc De Perrot, MD, MS, Joseph Friedberg, MD Valerie W. Rusch, MD, Michelle Ginsberg, MD, Ritu Gill, MD, David C. Rice, MB, BCh, Jeremy Erasmus, MD, Harvey I. Pass, MD, David Naidich, MD, Hedy L. Kindler, MD, Samuel Armato, PhD, Christopher Strauss, MD, Wickii Vigneshwaran, MD, MBA, Joseph Friedberg, MD, Sharyn Katz, MD, Marc de Perrot, MD, MS, Demetrios Patios, MD, BA, Dori Giroux, MS, Lynn Shemanski, PhD, Alan Mitchell, MS Valerie W. Rusch, MD, Ritu Gill, MD, Alan Mitchell, MS, David Naidich, MD, David C. Rice, MB, BCh, Harvey I. Pass, MD, Hedy L. Kindler, MD, Marc De Perrot, MD, MS, Joseph Friedberg, MD Valerie W. Rusch, MD, Michelle Ginsberg, MD, Ritu Gill, MD, David C. Rice, MB, BCh, Jeremy Erasmus, MD, Harvey I. Pass, MD, David Naidich, MD, Hedy L. Kindler, MD, Samuel Armato, PhD, Christopher Strauss, MD, Wickii Vigneshwaran, MD, MBA, Joseph Friedberg, MD, Sharyn Katz, MD, Marc de Perrot, MD, MS, Demetrios Patios, MD, BA, Dori Giroux, MS, Lynn Shemanski, PhD, Alan Mitchell, MS The Annals of Thoracic Surgery Volume 102, Issue 4, Pages 1059-1066 (October 2016) DOI: 10.1016/j.athoracsur.2016.06.069 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Study schema shows data flow for this multicenter study of volumetric computed tomography (CT) for staging malignant pleural mesothelioma (MPM). (AG Mednet, www.agmednet.com; DICOM = Digital Imaging and Communications in Medicine [National Electrical Manufacturers Association, Rosslyn, VA]; IASLC = International Association for the Study of Lung Cancer; IMIG = International Mesothelioma Interest Group.) The Annals of Thoracic Surgery 2016 102, 1059-1066DOI: (10.1016/j.athoracsur.2016.06.069) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Correlation between tumor volume on volumetric computed tomography (VolCT) and pathologic T stage. There were too few T1 cases to provide reliable estimates for this group, but otherwise, the data suggest that tumor volume increases with pathologic T category. (B) Correlation between tumor volume and pathologic N stage. Only N0, N2, and NX had sufficient numbers to provide reliable estimates, but results indicate that volume measurements for N2 tumors are larger than those measured for N0 tumors. The horizontal line in the middle of each box indicates the median, the top and bottom borders of the box mark the 75th and 25th percentiles, respectively, the whiskers mark the maximum and minimum, respectively, and the ○ and + indicate outliers. The Annals of Thoracic Surgery 2016 102, 1059-1066DOI: (10.1016/j.athoracsur.2016.06.069) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Initial separation of tumor volumes into quartiles shows that the best correlation between tumor volume and overall survival is seen with three groups of average volume measurements (91.2, 245.35, and 511.35 cm3). (Q = quartile; VolCT = volumetric computed tomography.) The Annals of Thoracic Surgery 2016 102, 1059-1066DOI: (10.1016/j.athoracsur.2016.06.069) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions