{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T18:13:56Z","timestamp":1779387236425,"version":"3.53.1"},"reference-count":21,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Background: Computed tomography (CT) is routinely used to estimate tumor size before lung resection, whereas pathologic examination provides the reference tissue-based measurement after surgery. This study aimed to compare CT-derived and pathologic tumor size and to evaluate correlation, agreement, proportional bias, clinically defined accuracy, and size-based T-category concordance, with particular attention to the effect of ground-glass opacity (GGO). Methods: This retrospective single-center study included 96 patients who underwent lung resection between January 2023 and December 2025 and had complete preoperative CT and pathologic tumor measurements. Maximum tumor diameter was defined as the largest of three orthogonal measurements for each modality. Correlation was assessed using Spearman\u2019s rank correlation coefficient, reliability using the intraclass correlation coefficient (ICC), and agreement using Bland\u2013Altman analysis. Proportional bias was evaluated by regression of the paired difference on the paired mean. Subgroup, size category, regression and size-based T-category concordance analyses were also performed. Results: CT and pathologic maximum diameters showed strong correlation (Spearman\u2019s \u03c1 = 0.952, p &lt; 0.0001) and excellent reliability (ICC = 0.959, 95% CI, 0.939\u20130.973). The paired comparison was not statistically significant (p = 0.175), and the mean bias was \u22120.76 mm. However, the 95% limits of agreement ranged from \u221213.66 mm to +12.13 mm. Significant proportional bias was observed, with increasing CT underestimation as tumor size increased (slope = \u22120.093, p = 0.0014). In tumors with GGO, CT pathology differences shifted toward overestimation (+8.91 \u00b1 7.30 mm vs. \u22121.64 \u00b1 5.80 mm without GGO; p = 0.0003). Accuracy within \u00b15 mm and \u00b110 mm was 68.8% and 88.5%, respectively, but was lower in the GGO subgroup. CT-derived and pathology-derived size-based T-categories were concordant in 60 patients (62.5%), while pathology-based upstaging occurred in 23 patients (24.0%) and pathology-based downstaging in 13 patients (13.5%). Conclusions: CT-based tumor size showed strong overall correlation with pathologic measurements, but agreement at the individual patient level was more limited than correlation metrics alone would suggest. GGO and tumor size appeared to be important modifiers of measurement performance; however, the GGO-related findings should be interpreted cautiously because of the small subgroup size. These findings support cautious interpretation of CT-derived whole-lesion diameter, particularly in subsolid tumors and larger lesions.<\/jats:p>","DOI":"10.3390\/tomography12050067","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T16:46:18Z","timestamp":1779381978000},"page":"67","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Computed Tomography Versus Pathologic Tumor Size in Resected Lung Tumors: High Correlation, Limited Agreement, and the Impact of Ground-Glass Opacity"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7366-2772","authenticated-orcid":false,"given":"Omer","family":"Yavuz","sequence":"first","affiliation":[{"name":"Thoracic Surgery Department, Basaksehir \u00c7am ve Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reyhan","family":"Ertan","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department, Basaksehir \u00c7am ve Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammet","family":"Kertmen","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department, Basaksehir \u00c7am ve Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9210-5851","authenticated-orcid":false,"given":"Mehlika","family":"Iscan","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department, Basaksehir \u00c7am ve Sakura City Hospital, 34480 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1097\/JTO.0000000000000559","article-title":"The IASLC lung cancer staging project: Proposals for the revisions of the T descriptors in the forthcoming eighth edition of the TNM classification for lung cancer","volume":"10","author":"Bolejack","year":"2015","journal-title":"J. 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