目的：分析CT定义的肺实质胸膜侵犯（CT-VPI）在早期肺腺癌中的诊断表现和预后价值。在临床I期肺腺癌患者中，随机选择一半患者进行诊断性研究，由五位胸部放射科医师确定CT-VPI的存在。使用深度学习（DL）获得CT-VPI的概率。计算和比较受试者工作特征曲线下面积（AUC）和二值诊断指标。评估评价者之间的一致性。对所有患者，使用Cox回归分析研究了两位放射科医师和DL（使用高灵敏度和高特异性截断）的CT-VPI的预后价值。方法：对681名患者（中位年龄65岁，四分位距58-71岁；男性299名，女性382名）进行了病理阴性与阳性肺实质胸膜侵犯检测。对于诊断研究（n = 339），五位放射科医师的汇总AUC与DL相似（0.78与0.79；p = 0.76）。放射科医师的二值诊断表现不稳定（敏感性45.3-71.9％，特异性71.6-88.7％）。评价者间的一致性适中（加权Fleiss κ率0.51，95％CI：0.43-0.55）。对于总生存（n = 680），放射科医师（调整风险比[HR] 1.27和0.99，95％CI：0.84-1.92和0.63-1.56；p = 0.26和0.97）或DL（HR 1.44和1.06，95％CI：0.86-2.42和0.67-1.68；p = 0.17和0.80）的CT-VPI无预测价值。仅在放射学检测到的实质性肿瘤中，一个医师确定的CT-VPI有预测价值（HR 1.82，95％CI：1.07-3.07；p = 0.03）。结论：在临床I期肺腺癌中，CT-VPI的诊断表现和预后价值有限。但对于放射学检测到的实质性肿瘤，此特征可能适用，但需要克服评估者间的差异。尽管在临床I期肺腺癌中，CT-VPI的诊断表现和预后价值有限，但在放射学检测到的实质性肿瘤中可以应用此参数，但应注意评估者之间的差异性。在临床分期中使用CT定义的肺实质胸膜侵犯应谨慎，因为CT定义的肺实质胸膜侵犯的预后价值尚未探讨。CT定义的肺实质胸膜侵犯的诊断表现和预后价值在不同的放射医师和深度学习中存在差异。CT定义的肺实质胸膜侵犯在临床分期中的作用可能仅限于放射学检测到的实质性肿瘤。 ©2023. The Author(s), under exclusive licence to European Society of Radiology.

To analyze the diagnostic performance and prognostic value of CT-defined visceral pleural invasion (CT-VPI) in early-stage lung adenocarcinomas.Among patients with clinical stage I lung adenocarcinomas, half of patients were randomly selected for a diagnostic study, in which five thoracic radiologists determined the presence of CT-VPI. Probabilities for CT-VPI were obtained using deep learning (DL). Areas under the receiver operating characteristic curve (AUCs) and binary diagnostic measures were calculated and compared. Inter-rater agreement was assessed. For all patients, the prognostic value of CT-VPI by two radiologists and DL (using high-sensitivity and high-specificity cutoffs) was investigated using Cox regression.In 681 patients (median age, 65 years [interquartile range, 58-71]; 382 women), pathologic VPI was positive in 130 patients. For the diagnostic study (n = 339), the pooled AUC of five radiologists was similar to that of DL (0.78 vs. 0.79; p = 0.76). The binary diagnostic performance of radiologists was variable (sensitivity, 45.3-71.9%; specificity, 71.6-88.7%). Inter-rater agreement was moderate (weighted Fleiss κ, 0.51; 95%CI: 0.43-0.55). For overall survival (n = 680), CT-VPI by radiologists (adjusted hazard ratio [HR], 1.27 and 0.99; 95%CI: 0.84-1.92 and 0.63-1.56; p = 0.26 and 0.97) or DL (HR, 1.44 and 1.06; 95%CI: 0.86-2.42 and 0.67-1.68; p = 0.17 and 0.80) was not prognostic. CT-VPI by an attending radiologist was prognostic only in radiologically solid tumors (HR, 1.82; 95%CI: 1.07-3.07; p = 0.03).The diagnostic performance and prognostic value of CT-VPI are limited in clinical stage I lung adenocarcinomas. This feature may be applied for radiologically solid tumors, but substantial reader variability should be overcome.Although the diagnostic performance and prognostic value of CT-VPI are limited in clinical stage I lung adenocarcinomas, this parameter may be applied for radiologically solid tumors with appropriate caution regarding inter-reader variability.• Use of CT-defined visceral pleural invasion in clinical staging should be cautious, because prognostic value of CT-defined visceral pleural invasion remains unexplored. • Diagnostic performance and prognostic value of CT-defined visceral pleural invasion varied among radiologists and deep learning. • Role of CT-defined visceral pleural invasion in clinical staging may be limited to radiologically solid tumors.© 2023. The Author(s), under exclusive licence to European Society of Radiology.