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Ye Y, Sun Y, Hu J, Ren Z, Chen X, Chen C. A clinical-radiological predictive model for solitary pulmonary nodules and the relationship between radiological features and pathological subtype. Clin Radiol 2024; 79:e432-e439. [PMID: 38097460 DOI: 10.1016/j.crad.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 02/15/2024]
Abstract
AIM To develop a clinical-radiological model to predict the malignancy of solitary pulmonary nodules (SPNs) and to evaluate the accuracy of chest computed tomography imaging characteristics of SPN in diagnosing pathological type. MATERIALS AND METHODS The predictive model was developed using a retrospective cohort of 601 SPN patients (Group A) between July 2015 and July 2020. The established model was tested using a second retrospective cohort of 124 patients between August 2020 and August 2021 (Group B). The radiological characteristics of all adenocarcinomas in two groups were analysed to determine the correlation between radiological and pathological characteristics. RESULTS Malignant nodules were found in 78.87% of cases and benign in 21.13%. Two clinical characteristics (age and gender) and four radiological characteristics (calcification, vascular convergence, pleural retraction sign, and density) were identified as independent predictors of malignancy in patients with SPN using logistic regression analysis. The area under the receiver operating characteristic curve (0.748) of the present model was greater than the other two reported models. Diameter, spiculation, lobulation, vascular convergence, and pleural retraction signs differed significantly among pre-invasive lesions, minimally invasive adenocarcinoma, and invasive adenocarcinoma. Only diameter and density were significantly different among invasive adenocarcinoma subtypes. CONCLUSIONS Older age, male gender, no calcification, vascular convergence, pleural contraction sign, and lower density were independent malignancy predictors of SPNs. Furthermore, the pathological classification can be clarified based on the radiological characteristics of SPN, providing a new option for the prevention and treatment of early lung cancer.
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Affiliation(s)
- Y Ye
- Cancer Center, Department of Pulmonary and Critical Care Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
| | - Y Sun
- Cancer Center, Department of Pulmonary and Critical Care Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
| | - J Hu
- General Surgery, Cancer Center, Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
| | - Z Ren
- Cancer Center, Department of Pulmonary and Critical Care Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
| | - X Chen
- Cancer Center, Department of Medical Oncology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
| | - C Chen
- Cancer Center, Department of Pulmonary and Critical Care Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China.
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Guo M, Cao Z, Huang Z, Hu S, Xiao Y, Ding Q, Liu Y, An X, Zheng X, Zhang S, Zhang G. The value of CT shape quantification in predicting pathological classification of lung adenocarcinoma. BMC Cancer 2024; 24:35. [PMID: 38178062 PMCID: PMC10768264 DOI: 10.1186/s12885-023-11802-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE To evaluate whether quantification of lung GGN shape is useful in predicting pathological categorization of lung adenocarcinoma and guiding the clinic. METHODS 98 patients with primary lung adenocarcinoma were pathologically confirmed and CT was performed preoperatively, and all lesions were pathologically ≤ 30 mm in size. On CT images, we measured the maximum area of the lesion's cross-section (MA). The longest diameter of the tumor (LD) was marked with points A and B, and the perpendicular diameter (PD) was marked with points C and D, which was the longest diameter perpendicular to AB. and D, which was the longest diameter perpendicular to AB. We took angles A and B as big angle A (BiA) and small angle A (SmA). We measured the MA, LD, and PD, and for analysis we derived the LD/PD ratio and the BiA/SmA ratio. The data were analysed using the chi-square test, t-test, ROC analysis, and binary logistic regression analysis. RESULTS Precursor glandular lesions (PGL) and microinvasive adenocarcinoma (MIA) were distinguished from invasive adenocarcinoma (IAC) by the BiA/SmA ratio and LD, two independent factors (p = 0.007, p = 0.018). Lung adenocarcinoma pathological categorization was indicated by the BiA/SmA ratio of 1.35 and the LD of 11.56 mm with sensitivity of 81.36% and 71.79%, respectively; specificity of 71.79% and 74.36%, respectively; and AUC of 0.8357 (95% CI: 0.7558-0.9157, p < 0.001), 0.8666 (95% CI: 0.7866-0.9465, p < 0.001), respectively. In predicting the pathological categorization of lung adenocarcinoma, the area under the ROC curve of the BiA/SmA ratio combined with LD was 0.9231 (95% CI: 0.8700-0.9762, p < 0.001), with a sensitivity of 81.36% and a specificity of 89.74%. CONCLUSIONS Quantification of lung GGN morphology by the BiA/SmA ratio combined with LD could be helpful in predicting pathological classification of lung adenocarcinoma.
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Affiliation(s)
- Mingjie Guo
- Department of Thoracic Surgery, The First Affiliated Hospital of Henan University, Longting District, 475000, Kaifeng, Henan Province, China
| | - Zhan Cao
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, 450000, Zhengzhou, China
| | - Zhichao Huang
- Department of Thoracic Surgery, The First Affiliated Hospital of Henan University, Longting District, 475000, Kaifeng, Henan Province, China
| | - Shaowen Hu
- Department of Clinical Medicine, Medical School of Henan University, Kaifeng, China
| | - Yafei Xiao
- Department of Clinical Medicine, Medical School of Henan University, Kaifeng, China
| | - Qianzhou Ding
- Department of Thoracic Surgery, The First Affiliated Hospital of Henan University, Longting District, 475000, Kaifeng, Henan Province, China
| | - Yalong Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Henan University, Longting District, 475000, Kaifeng, Henan Province, China
| | - Xiaokang An
- Department of Thoracic Surgery, The First Affiliated Hospital of Henan University, Longting District, 475000, Kaifeng, Henan Province, China
| | - Xianjie Zheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Henan University, Longting District, 475000, Kaifeng, Henan Province, China
| | - Shuanglin Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Henan University, Longting District, 475000, Kaifeng, Henan Province, China
| | - Guoyu Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Henan University, Longting District, 475000, Kaifeng, Henan Province, China.
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Chen W, Wang R, Ma Z, Hua Y, Mao D, Wu H, Yang Y, Li C, Li M. A delta-radiomics model for preoperative prediction of invasive lung adenocarcinomas manifesting as radiological part-solid nodules. Front Oncol 2022; 12:927974. [DOI: 10.3389/fonc.2022.927974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
PurposeThis study aims to explore the value of the delta-radiomics (DelRADx) model in predicting the invasiveness of lung adenocarcinoma manifesting as radiological part-solid nodules (PSNs).MethodsA total of 299 PSNs histopathologically confirmed as lung adenocarcinoma (training set, n = 209; validation set, n = 90) in our hospital were retrospectively analyzed from January 2017 to December 2021. All patients underwent diagnostic noncontrast-enhanced CT (NCECT) and contrast-enhanced CT (CECT) before surgery. After image preprocessing and ROI segmentation, 740 radiomic features were extracted from NCECT and CECT, respectively, resulting in 740 DelRADx. A DelRADx model was constructed using the least absolute shrinkage and selection operator logistic (LASSO-logistic) algorithm based on the training cohort. The conventional radiomics model based on NCECT was also constructed following the same process for comparison purposes. The prediction performance was assessed using area under the ROC curve (AUC). To provide an easy-to-use tool, a radiomics-based integrated nomogram was constructed and evaluated by integrated discrimination increment (IDI), calibration curves, decision curve analysis (DCA), and clinical impact plot.ResultsThe DelRADx signature, which consisted of nine robust selected features, showed significant differences between the AIS/MIA group and IAC group (p < 0.05) in both training and validation sets. The DelRADx signature showed a significantly higher AUC (0.902) compared to the conventional radiomics model based on NCECT (AUC = 0.856) in the validation set. The IDI was significant at 0.0769 for the integrated nomogram compared with the DelRADx signature. The calibration curve of the integrated nomogram demonstrated favorable agreement both in the training set and validation set with a mean absolute error of 0.001 and 0.019, respectively. Decision curve analysis and clinical impact plot indicated that if the threshold probability was within 90%, the integrated nomogram showed a high clinical application value.ConclusionThe DelRADx method has the potential to assist doctors in predicting the invasiveness for patients with PSNs. The integrated nomogram incorporating the DelRADx signature with the radiographic features could facilitate the performance and serve as an alternative way for determining management.
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Minato H, Katayanagi K, Kurumaya H, Tanaka N, Fujimori H, Tsunezuka Y, Kobayashi T. Verification of the eighth edition of the UICC-TNM classification on surgically resected lung adenocarcinoma: Comparison with previous classification in a local center. Cancer Rep (Hoboken) 2021; 5:e1422. [PMID: 34169671 PMCID: PMC8789611 DOI: 10.1002/cnr2.1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The UICC 8th TNM classification of lung cancer has been changed dramatically, especially in measuring methods of T-desriptors. Different from squamous- or small-cell carcinomas, in which the solid- and the invasive-diameter mostly agree with each other, the diameter of the radiological solid part and that of pathological invasive part in adenocarcinomas often does not match. AIM We aimed to determine radiological and pathological tumor diameters of pulmonary adenocarcinomas with clinicopathological factors and evaluate the validity of the 8th edition in comparison with the 7th edition. METHODS AND RESULTS We retrospectively analyzed clinicopathological factors of 429 patients with surgically resected pulmonary adenocarcinomas. The maximum tumor and their solid-part diameters were measured using thin-sectioned computed tomography and compared with pathological tumor and invasive diameters. Overall survival (OS) rate was determined using the Kaplan-Meier method for different subgroups of clinicopathological factors. Akaike's information criteria (AIC) was used as a discriminative measure for the univariate Cox model for the 7th and 8th editions. Multivariate Cox regression analysis was performed to explore independent prognostic factors. Correlation coefficients between radiological and pathological diameters in the 7th and 8th editions were 0.911 and 0.888, respectively, without a significant difference. The major reasons for the difference in the 8th edition were the presence of intratumoral fibrosis and papillary growth pattern. The weighted kappa coefficients in the 8th edition were superior those in the 7th edition for both the T and Stage classifications. In the univariate Cox model, AIC levels were the lowest in the 8th edition. Multivariate analysis revealed that age, lymphovascular invasion, pT(8th), and stage were the most important determinants for OS. CONCLUSION The UICC 8th edition is a more discriminative classification than the 7th edition. For subsolid nodules, continuous efforts are necessary to increase the universality of the measurement of solid and invasive diameters.
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Affiliation(s)
- Hiroshi Minato
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Kazuyoshi Katayanagi
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Hiroshi Kurumaya
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Nobuhiro Tanaka
- Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Hideki Fujimori
- Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Yoshio Tsunezuka
- Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Takeshi Kobayashi
- Department of Diagnostic and Interventional Radiology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
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Yin J, Xi J, Liang J, Zhan C, Jiang W, Lin Z, Xu S, Wang Q. Solid Components in the Mediastinal Window of Computed Tomography Define a Distinct Subtype of Subsolid Nodules in Clinical Stage I Lung Cancers. Clin Lung Cancer 2021; 22:324-331. [PMID: 33789831 DOI: 10.1016/j.cllc.2021.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND We aimed to validate the clinicopathologic characteristics and prognostic value of the presence of solid components in the mediastinal window of computed tomography scan in clinical stage I pulmonary subsolid nodules (SSNs). METHODS We retrospectively evaluated patients with pulmonary SSNs resected between 2011 and 2016. We classified SSNs into heterogeneous ground-glass nodules (HGGNs) (solid component detected only in lung window) and part-solid nodules (PSNs) (solid component detected both in lung/mediastinal windows). RESULTS A total of 487 patients (216 PSNs) were included. PSNs were associated with higher frequencies of micropapillary or solid pathologic patterns (18.1% vs. 3.3%; P < .001), epidermal growth factor receptor gene mutation (39.4% vs. 32.8%), and other types of gene mutations (2.3% vs. 1.1%; P = .043). Logistic regression analysis revealed that male sex (odds ratio [OR], 2.58; 95% confidence interval [CI], 1.20-5.57; P = .016) and higher consolidation tumor ratio (CTR) (OR, 110.04; 95% CI, 8.56-1414.39; P < .001) remained independent for invasive adenocarcinomas with poor differentiation. Receiver operating characteristic analyses revealed that solid component size in the mediastinal window (area under the curve [AUC], 0.731; 95% CI, 0.653-0.808; P < .0001) showed a better predictive ability to poor differentiation compared with solid component size in the lung window and CTR. The 5-year recurrence-free survival (RFS) rate of PSNs was worse than that of HGGNs (94.6% vs. 99.1%; P = .019). Multivariate Cox regression revealed that positive lymph node status (hazard ratio, 22.99; 95% CI, 4.52-116.86; P < .001) indicated worse RFS for PSNs. CONCLUSION SSNs with solid components in mediastinal window demonstrated clinicopathologic and prognostic features different from those without in clinical stage I lung cancer. Solid components in mediastinal window was a strong predictor of poor differentiation.
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Affiliation(s)
- Jiacheng Yin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junjie Xi
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiaqi Liang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zongwu Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Songtao Xu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Ahn Y, Lee SM, Noh HN, Kim W, Choe J, Do KH, Seo JB. Use of a Commercially Available Deep Learning Algorithm to Measure the Solid Portions of Lung Cancer Manifesting as Subsolid Lesions at CT: Comparisons with Radiologists and Invasive Component Size at Pathologic Examination. Radiology 2021; 299:202-210. [PMID: 33529136 DOI: 10.1148/radiol.2021202803] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The solid portion size of lung cancer lesions manifesting as subsolid lesions is key in their management, but the automatic measurement of such lesions by means of a deep learning (DL) algorithm needs evaluation. Purpose To evaluate the performance of a commercially available DL algorithm for automatic measurement of the solid portion of surgically proven lung adenocarcinomas manifesting as subsolid lesions. Materials and Methods Surgically proven lung adenocarcinomas manifesting as subsolid lesions on CT images between January 2018 and December 2018 were retrospectively included. Five radiologists independently measured the maximal axial diameter of the solid portion of lesions. The DL algorithm automatically segmented and measured the maximal axial diameter of the solid portion. Reader measurements, software measurements, and invasive component size at pathologic examination were compared by using intraclass correlation coefficient (ICC) and Bland-Altman plots. Results A total of 448 patients (mean age, 63 years ± 10 [standard deviation]; 264 women) with 448 lesions were evaluated (invasive component size, 3-65 mm). The measurement agreements between each radiologist and the DL algorithm were very good (ICC range, 0.82-0.89). When a radiologist was replaced with the DL algorithm, the ICCs ranged from 0.87 to 0.90, with an ICC of 0.90 among five radiologists. The mean difference between the DL algorithm and each radiologist ranged from -3.7 to 1.5 mm. The widest 95% limit of agreement between the DL algorithm and each radiologist (-15.7 to 8.3 mm) was wider than pairwise comparisons of radiologists (-7.7 to 13.0 mm). The agreement between the DL algorithm and invasive component size at pathologic evaluation was good, with an ICC of 0.67. Measurements by the DL algorithm (mean difference, -6.0 mm) and radiologists (mean difference, -7.5 to -2.3 mm) both underestimated invasive component size. Conclusion Automatic measurements of solid portions of lung cancer manifesting as subsolid lesions by the deep learning algorithm were comparable with manual measurements and showed good agreement with invasive component size at pathologic evaluation. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Yura Ahn
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Korea
| | - Sang Min Lee
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Korea
| | - Han Na Noh
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Korea
| | - Wooil Kim
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Korea
| | - Jooae Choe
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Korea
| | - Kyung-Hyun Do
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Korea
| | - Joon Beom Seo
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Korea
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Choi Y, Kim SH, Kim KH, Choi Y, Park SG, Sohn I, Kim HS, Um SW, Lee HY. Clinical T category for lung cancer staging: A pragmatic approach for real-world practice. Thorac Cancer 2020; 11:3555-3565. [PMID: 33075213 PMCID: PMC7705618 DOI: 10.1111/1759-7714.13701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To determine which components should be measured and which window settings are appropriate for computerized tomography (CT) size measurements of lung adenocarcinoma (ADC) and to explore interobserver agreement and accuracy according to the eighth edition of TNM staging. METHODS A total of 165 patients with surgically resected lung ADC earlier than stage 3A were included in this study. One radiologist and two pulmonologists independently measured the total and solid sizes of components of tumors on different window settings and assessed solidity. CT measurements were compared with pathologic size measurements. RESULTS In categorizing solidity, 25% of the cases showed discordant results among observers. Measuring the total size of a lung adenocarcinoma predicted pathologic invasive components to a degree similar to measuring the solid component. Lung windows were more accurate (intraclass correlation [ICC] = 0.65-0.81) than mediastinal windows (ICC = 0.20-0.72) at predicting pathologic invasive components, especially in a part-solid nodule. Interobserver agreements for measurement of solid components were good with little significant difference (lung windows, ICC = 0.89; mediastinal windows, ICC = 0.91). A high level of interobserver agreement was seen between the radiologist and pulmonologists and between residents (from the division of pulmonology and critical care) versus a fellow (from the division of pulmonology and critical care) on different windows. CONCLUSIONS A considerable percentage (25%) of discrepancies was encountered in categorizing the solidity of lesions, which may decrease the accuracy of measurements. Lung window settings may be superior to mediastinal windows for measuring lung ADCs, with comparable interobserver agreement and moderate accuracy for predicting pathologic invasive components. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: Lung window settings are better for evaluating part-solid lung adenocarcinoma (ADC), with comparable interobserver agreement and moderate accuracy for predicting pathologic invasive components. The considerable percentage (25%) of discrepancies in categorizing solidity of the lesions may also have decreased the accuracy of measurements. WHAT THIS STUDY ADDS For accurate measurement and categorization of lung ADC, robust quantitative analysis is needed rather than a simple visual assessment.
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Affiliation(s)
- Yeonu Choi
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Hyung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hwan Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeonseok Choi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Goo Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Insuk Sohn
- Statistics and Data Center, Samsung Medical Center, Seoul, Korea
| | | | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Yun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Roberts JM, Greenlaw K, English JC, Mayo JR, Sedlic A. Radiological-pathological correlation of subsolid pulmonary nodules: A single centre retrospective evaluation of the 2011 IASLC adenocarcinoma classification system. Lung Cancer 2020; 147:39-44. [PMID: 32659599 DOI: 10.1016/j.lungcan.2020.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/01/2020] [Accepted: 06/25/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The 2011 IASLC classification system proposes guidelines for radiologists and pathologists to classify adenocarcinomas spectrum lesions as preinvasive, minimally invasive adenocarcinoma (MIA), or invasive adenocarcinoma (IA). IA portends the worst clinical prognosis, and the imaging distinction between MIA and IA is controversial. MATERIALS AND METHODS Subsolid pulmonary nodules resected by microcoil localization over a three-year period were retrospectively reviewed by three chest radiologists and a pulmonary pathologist. Nodules were classified radiologically based on preoperative computed tomography (CT), with the solid nodule component measured on mediastinal windows applied to high-frequency lung kernel reconstructions, and pathologically according to 2011 IASLC criteria. Radiology interobserver and radiological-pathological variability of nodule classification, and potential reasons for nodule classification discordance were assessed. RESULTS Seventy-one subsolid nodules in 67 patients were included. The average size of invasive disease focus at histopathology was 5 mm (standard deviation 5 mm). Radiology interobserver agreement of nodule classification was good (Cohen's Kappa = 0.604, 95 % CI: 0.447 to 0.761). Agreement between consensus radiological interpretation and pathological category was fair (Cohen's Kappa = 0.236, 95 % CI: 0.054-0.421). Radiological and pathological nodule classification were concordant in 52 % (37 of 71) of nodules. The IASLC proposed CT solid component cut-off of 5 mm to distinguish MIA and IA yielded a sensitivity of 59 % and specificity of 80 %. Common reasons for nodule classification discordance included multiple solid components within a nodule on CT, scar and stromal collapse at pathology, and measurement variability. CONCLUSION Solid component(s) within persistent part-solid pulmonary nodules raise suspicion for invasive adenocarcinoma. Preoperative imaging classification is frequently discordant from final pathology, reflecting interpretive and technical challenges in radiological and pathological analysis.
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Affiliation(s)
- James M Roberts
- Department of Radiology, Vancouver General Hospital, 910 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada.
| | - Kristin Greenlaw
- Department of Radiology, Vancouver General Hospital, 910 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada
| | - John C English
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, 910 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada
| | - John R Mayo
- Department of Radiology, Vancouver General Hospital, 910 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada
| | - Anto Sedlic
- Department of Radiology, Vancouver General Hospital, 910 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada
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A Subsolid Nodules Imaging Reporting System (SSN-IRS) for Classifying 3 Subtypes of Pulmonary Adenocarcinoma. Clin Lung Cancer 2020; 21:314-325.e4. [PMID: 32273256 DOI: 10.1016/j.cllc.2020.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/24/2019] [Accepted: 01/20/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To develop an imaging reporting system for the classification of 3 adenocarcinoma subtypes of computed tomography (CT)-detected subsolid pulmonary nodules (SSNs) in clinical patients. METHODS Between November 2011 and October 2017, 437 pathologically confirmed SSNs were retrospectively identified. SSNs were randomly divided 2:1 into a training group (291 cases) and a testing group (146 cases). CT-imaging characteristics were analyzed using multinomial univariable and multivariable logistic regression analysis to identify discriminating factors for the 3 adenocarcinoma subtypes (pre-invasive lesions, minimally invasive adenocarcinoma, and invasive adenocarcinoma). These factors were used to develop a classification and regression tree model. Finally, an SSN Imaging Reporting System (SSN-IRS) was constructed based on the optimized classification model. For validation, the classification performance was evaluated in the testing group. RESULTS Of the CT-derived characteristics of SSNs, qualitative density (nonsolid or part-solid), core (non-core or core), semantic features (pleural indentation, vacuole sign, vascular invasion), and diameter of solid component (≤6 mm or >6 mm), were the most important factors for the SSN-IRS. The total sensitivity, specificity, and diagnostic accuracy of the SSN-IRS was 89.0% (95% confidence interval [CI], 84.8%-92.4%), 74.6% (95% CI, 70.8%-78.1%), and 79.4% (95% CI, 76.5%-82.0%) in the training group and 84.9% (95% CI, 78.1%-90.3%), 68.5% (95% CI, 62.8%-73.8%), and 74.0% (95% CI, 69.6%-78.0%) in the testing group, respectively. CONCLUSIONS The SSN-IRS can classify 3 adenocarcinoma subtypes using CT-based characteristics of subsolid pulmonary nodules. This classification tool can help clinicians to make follow-up recommendations or decisions for surgery in clinical patients with SSNs.
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New T1 classification. Gen Thorac Cardiovasc Surg 2019; 68:665-671. [PMID: 31679135 DOI: 10.1007/s11748-019-01233-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
The IASLC staging and Prognostic Factor Committee proposed new changes to the descriptors for the 8th edition of the Tumour Node Metastasis Staging for Lung Cancer. The T1 descriptor changes include (1) T1 tumours are subclassified into T1a (< 1 cm), T1b (> 1 to < 2 cm), T1c (> 2 to < 3 cm). The corresponding changes are introduced to the overall staging: T1aN0M0 = Stage IA1; T1bN0M0 = Stage IA2; T1cN0M0 = Stage IA3. (2) The introduction of the pathological entities Adenocarcinoma-In-Situ (AIS), Minimally Invasive Adenocarcinoma, and Lepidic Predominant Adenocarcinoma. The corresponding changes on the T descriptor are as follows: Adenocarcinoma-in situ is coded as Tis (AIS); Minimally Invasive Adenocarcinoma is coded as T1a(mi). In this review, the basis for these changes will be described, and the implications on clinical practice will be discussed.
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Hamanaka K, Takayama H, Koyama T, Matsuoka S, Takeda T, Agatsuma H, Yamada K, Hyogotani A, Kawakami S, Ito KI. Interobserver size measurement variability in part-solid lung adenocarcinoma using pre-operative computed tomography. J Thorac Dis 2019; 11:2924-2931. [PMID: 31463121 DOI: 10.21037/jtd.2019.07.34] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background In the current lung cancer tumor-node-metastasis classification, solid tumor size is used for tumor diameter measurement as the dense component. However, measuring solid tumor size is sometimes difficult and inter-observer variability may increase, particularly in part-solid nodules with ground-glass opacity (GGO). This study aimed to investigate inter-observer size measurement variability in lung adenocarcinoma. Methods Of 47 patients with part-solid lung adenocarcinoma who had undergone surgery at our department from January to December 2016, five surgeons and one radiologist undertook unidimensional solid and total size tumor measurements using pre-operative axial computed tomography images, and we assessed inter-observer size measurement variability. Variability was then subclassified into five groups, according to computer tomography-identified tumor morphological characteristics, namely: (I) minimally invasive; (II) peribronchovascular; (III) spiculation/atelectasis; (IV) adjacent to cystic lesion, and; (V) diffuse consolidation and GGO. Results The mean inter-observer variability was 9.7 mm (solid size) and 7.7 mm (total size). Analysis of the maximum and minimum measurement size values for each patient undertaken showed that the most experienced surgeon and the radiologist measured the minimum size more frequently. To correct for differences in mean tumor diameter in each group, a comparison was made using a coefficient of variation (CV) calculated as the ratio of the standard deviation to the mean. Group I characteristics showed the largest coefficient value for variation in solid size measurement. Conclusions Inter-observer measurement variability for solid size was larger than for total size in lung adenocarcinoma. Large variability in group I indicated the difficulty of size measurement for low-grade malignant potential nodules such as adenocarcinoma in situ, minimally invasive adenocarcinoma, and early-stage invasive adenocarcinoma. The possibility of unavoidable size measurement variability should be recognized when deciding on surgical procedures for these diseases.
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Affiliation(s)
- Kazutoshi Hamanaka
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Hiroki Takayama
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Tsutomu Koyama
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Shunichiro Matsuoka
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Tetsu Takeda
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Hiroyuki Agatsuma
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Kyoko Yamada
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Akira Hyogotani
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Satoshi Kawakami
- Department of Radiology, Shinshu University School of Medicine, Nagano, Japan
| | - Ken-Ichi Ito
- Department of Thoracic Surgery, Shinshu University School of Medicine, Nagano, Japan
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Hutchinson BD, Shroff GS, Truong MT, Ko JP. Spectrum of Lung Adenocarcinoma. Semin Ultrasound CT MR 2019; 40:255-264. [DOI: 10.1053/j.sult.2018.11.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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13
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Yanagawa M, Niioka H, Hata A, Kikuchi N, Honda O, Kurakami H, Morii E, Noguchi M, Watanabe Y, Miyake J, Tomiyama N. Application of deep learning (3-dimensional convolutional neural network) for the prediction of pathological invasiveness in lung adenocarcinoma: A preliminary study. Medicine (Baltimore) 2019; 98:e16119. [PMID: 31232960 PMCID: PMC6636940 DOI: 10.1097/md.0000000000016119] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
To compare results for radiological prediction of pathological invasiveness in lung adenocarcinoma between radiologists and a deep learning (DL) system.Ninety patients (50 men, 40 women; mean age, 66 years; range, 40-88 years) who underwent pre-operative chest computed tomography (CT) with 0.625-mm slice thickness were included in this retrospective study. Twenty-four cases of adenocarcinoma in situ (AIS), 20 cases of minimally invasive adenocarcinoma (MIA), and 46 cases of invasive adenocarcinoma (IVA) were pathologically diagnosed. Three radiologists of different levels of experience diagnosed each nodule by using previously documented CT findings to predict pathological invasiveness. DL was structured using a 3-dimensional (3D) convolutional neural network (3D-CNN) constructed with 2 successive pairs of convolution and max-pooling layers, and 2 fully connected layers. The output layer comprises 3 nodes to recognize the 3 conditions of adenocarcinoma (AIS, MIA, and IVA) or 2 nodes for 2 conditions (AIS and MIA/IVA). Results from DL and the 3 radiologists were statistically compared.No significant differences in pathological diagnostic accuracy rates were seen between DL and the 3 radiologists (P >.11). Receiver operating characteristic analysis demonstrated that area under the curve for DL (0.712) was almost the same as that for the radiologist with extensive experience (0.714; P = .98). Compared with the consensus results from radiologists, DL offered significantly inferior sensitivity (P = .0005), but significantly superior specificity (P = .02).Despite the small training data set, diagnostic performance of DL was almost the same as the radiologist with extensive experience. In particular, DL provided higher specificity than radiologists.
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Affiliation(s)
- Masahiro Yanagawa
- Department of Radiology, Osaka University Graduate School of Medicine
| | | | - Akinori Hata
- Department of Radiology, Osaka University Graduate School of Medicine
| | - Noriko Kikuchi
- Department of Radiology, Osaka University Graduate School of Medicine
| | - Osamu Honda
- Department of Radiology, Osaka University Graduate School of Medicine
| | | | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita-city, Osaka
| | - Masayuki Noguchi
- Department of Diagnostic Pathology, University of Tsukuba, Tsukuba-city, Ibaraki
| | - Yoshiyuki Watanabe
- Department of Future Diagnostic Radiology, Osaka University Graduate School of Medicine
| | - Jun Miyake
- Global Center for Medical Engineering and Informatics, Osaka University, Suita-city, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine
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Abstract
PURPOSE OF REVIEW Ground glass nodules (GGNs) represent an indolent subset of lung nodules including preinvasive nonsmall-cell lung cancer associated with a favorable prognosis and low risk for progression. Increased performance of screening cat-scan (CT) for high-risk patients has identified an increasing number of GGNs. The management of these nodules is founded mostly on single institution data and currently no universally accepted recommendations help guide clinicians managing these patients. RECENT FINDINGS The solid component within a GGN is the key determinant of prognosis and is best defined by evaluating nodule density on mediastinal windows of a chest CT. When a GGN is small (<3 cm), associated with minimal change in size (<25% growth per year), and there is no demonstration of a significant solid component on mediastinal windows (<2 mm in diameter), patients can be safely observed with serially imaging. These imaging features also help distinguish patients that may harbor early-stage lung cancers that benefit from local treatment options. SUMMARY The majority of GGNs do not undergo significant progression during surveillance. Evidence of nodule progression on interval imaging may be a trigger for consideration of a local treatment option such as surgical resection. Large prospective studies are needed in the United States to validate the more robust data derived from Asian studies to help formulate formal recommendations for surveillance and treatment. Future improvements in imaging and the molecular characterization of these GGNs may further refine which patients are at risk for progression.
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Carter BW, Lichtenberger JP, Benveniste MK, de Groot PM, Wu CC, Erasmus JJ, Truong MT. Revisions to the TNM Staging of Lung Cancer: Rationale, Significance, and Clinical Application. Radiographics 2018. [PMID: 29528831 DOI: 10.1148/rg.2018170081] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer remains the leading cause of cancer-related mortality worldwide. To formulate effective treatment strategies and optimize patient outcomes, accurate staging is essential. Lung cancer staging has traditionally relied on a TNM staging system, for which the International Association for the Study of Lung Cancer (IASLC) has recently proposed changes. The revised classification for this eighth edition of the TNM staging system (TNM-8) is based on detailed analysis of a new large international database of lung cancer cases assembled by the IASLC for the purposes of this project. Fundamental changes incorporated into TNM-8 include (a) modifications to the T classification on the basis of 1-cm increments in tumor size; (b) grouping of lung cancers that result in partial or complete lung atelectasis or pneumonitis; (c) grouping of tumors with involvement of a main bronchus irrespective of distance from the carina; (d) reassignment of diaphragmatic invasion in terms of T classification; (e) elimination of mediastinal pleural invasion from the T classification; and (f) subdivision of the M classification into different descriptors on the basis of the number and site of extrathoracic metastases. In response to these revisions, established stage groups have been modified, and others have been created. In addition, recommendations for classifying patterns of disease that result in multiple sites of pulmonary involvement, including multiple primary lung cancers, lung cancers with separate tumor nodules, multiple ground-glass/lepidic lesions, and consolidation, as well as recommendations for lesion measurement, are addressed. Understanding the key revisions introduced in TNM-8 allows radiologists to accurately stage patients with lung cancer and optimize therapy. ©RSNA, 2018.
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Affiliation(s)
- Brett W Carter
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.K.B., P.M.d.G., C.C.W., J.J.E., M.T.T.); and the Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.)
| | - John P Lichtenberger
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.K.B., P.M.d.G., C.C.W., J.J.E., M.T.T.); and the Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.)
| | - Marcelo K Benveniste
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.K.B., P.M.d.G., C.C.W., J.J.E., M.T.T.); and the Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.)
| | - Patricia M de Groot
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.K.B., P.M.d.G., C.C.W., J.J.E., M.T.T.); and the Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.)
| | - Carol C Wu
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.K.B., P.M.d.G., C.C.W., J.J.E., M.T.T.); and the Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.)
| | - Jeremy J Erasmus
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.K.B., P.M.d.G., C.C.W., J.J.E., M.T.T.); and the Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.)
| | - Mylene T Truong
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.K.B., P.M.d.G., C.C.W., J.J.E., M.T.T.); and the Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.)
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Jiang G, Chen C, Zhu Y, Xie D, Dai J, Jin K, Shen Y, Wang H, Li H, Zhang L, Gao S, Chen K, Zhang L, Zhou X, Shi J, Wang H, Xie B, Jiang L, Fan J, Zhao D, Chen Q, Duan L, He W, Zhou Y, Liu H, Zhao X, Zhang P, Qin X. [Shanghai Pulmonary Hospital Experts Consensus on the Management of Ground-Glass Nodules Suspected as Lung Adenocarcinoma (Version 1)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:147-159. [PMID: 29587930 PMCID: PMC5973030 DOI: 10.3779/j.issn.1009-3419.2018.03.05] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
随着胸部计算机断层扫描(computed tomography, CT)检查,尤其是低剂量薄层CT筛查项目在中国的广泛开展,越来越多的无症状肺部磨玻璃结节(ground-glass nodules, GGNs)被发现。虽然国内及国际上已发布了一系列针对肺部GGNs的指南,但是这些指南的撰写者多来自呼吸、肿瘤及影像专业,可能缺乏对现代微创胸外科的充分认识,造成外科手术在肺部GGNs诊治中的作用不明确,甚至被低估;而且,肺部肿瘤相关的各学科对于早期肺癌,尤其是浸润前病变的处理也缺乏统一规范。因此,基于国内外现有文献及上海市肺科医院多年积累的经验,上海市肺科医院撰写了此诊疗共识。本共识推荐对于疑似肺腺癌的GGNs进行多学科评估,依据诊断,选择合理的处置方式。对于疑似原位腺癌,推荐进行胸部薄层CT随访,或在特定情况下进行不超过肺段切除的限制性肺切除;对于疑似微浸润腺癌,推荐进行限制性肺切除或肺叶切除;对于疑似浸润性腺癌,建议依据病灶是否含有磨玻璃成分、位置、大小、个数及患者躯体情况选择合理的手术方式;而肺多发结节的处理原则推荐为主病灶优先,兼顾次要病灶,综合选择治疗方案。
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Affiliation(s)
- Gening Jiang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Chang Chen
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Yuming Zhu
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Dong Xie
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Jie Dai
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Kaiqi Jin
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Yingran Shen
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Haifeng Wang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Hui Li
- Capital Medical University Affiliated Beijing Chao-Yang Hospital, Beijing 100020 , China
| | - Lanjun Zhang
- Sun Yat-sen University Cancer Center, Guangzhou 510060 , China
| | - Shugeng Gao
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Keneng Chen
- Peking University Cancer Hospital and Institute, Beijing 100142 , China
| | - Lei Zhang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Xiao Zhou
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Jingyun Shi
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Hao Wang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Boxiong Xie
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Lei Jiang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Jiang Fan
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Deping Zhao
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Qiankun Chen
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Liang Duan
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Wenxin He
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Yiming Zhou
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Hongcheng Liu
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Xiaogang Zhao
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Peng Zhang
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
| | - Xiong Qin
- Tongji University affiliated Shanghai Pulmonary Hospital, Shanghai 200043 , China
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CT diagnosis of pleural and stromal invasion in malignant subpleural pure ground-glass nodules: an exploratory study. Eur Radiol 2018; 29:279-286. [DOI: 10.1007/s00330-018-5558-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/23/2018] [Accepted: 05/23/2018] [Indexed: 12/19/2022]
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Li Q, Gu YF, Fan L, Li QC, Xiao Y, Liu SY. Effect of CT window settings on size measurements of the solid component in subsolid nodules: evaluation of prediction efficacy of the degree of pathological malignancy in lung adenocarcinoma. Br J Radiol 2018; 91:20180251. [PMID: 29791206 DOI: 10.1259/bjr.20180251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate the predictive value of size measurements of the solid components in pulmonary subsolid nodules with different CT window settings and to evaluate the degree of pathological malignancy in lung adenocarcinoma. Methods: The preoperative chest CT images and pathological data of 125 patients were retrospectively evaluated. The analysis included 127 surgically resected lung adenocarcinomas that manifested as subsolid nodules. All subsolid nodules were divided into two groups: 69 in group A, including 22 adenocarcinomas in situ (AIS) and 47 minimally invasive adenocarcinomas (MIA); 58 in group B that included invasive pulmonary adenocarcinomas (IPA). The size of the solid component in the pulmonary subsolid nodules were calculated in one dimensional, two dimensional and three dimensional views using lung and mediastinal windows that were recorded as 1D-SCLW, 2D-SCLW, 3D-SCLW, 1D-SCMW, 2D-SCMW and 3D-SCMW, respectively. Furthermore, the volume of solid component with a threshold of -300HU was measured using lung window (3D-SCT). All the quantitative features were evaluated by the Mann-Whitney U test. Multivariate analysis was used to identify the significant predictor of the degree of pathological malignancy. Results: The 1D-SCLW, 2D-SCLW, 3D-SCLW, 1D-SCMW, 2D-SCMW, 3D-SCMW and 3D-SCT views of group B were significantly larger than those of group A (p < 0.001). The multivariate logistic regression analysis indicated that 3D-SCT (OR = 1.018, 95%CI: 1.005 ~ 1.03, p <0.05=was the independent predictive factor. The larger SCT was significantly associated with IPAs. Conclusion: 3D-SCT of subsolid nodules during preoperative CT can be used to predict the degree of pathological malignancy in lung adenocarcinoma, which may provide a more objective and convenient selection criterion for clinical application. Advances in knowledge: Applying threshold of -300 HU with lung window setting would be better than other window setting for the evaluation of solid component in subsolid nodules. Computer-aided volumetry of the solid component in subsolid nodules can more accurately predict the degree of pathological malignancy than the other dimensional measurements.
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Affiliation(s)
- Qiong Li
- 1 Department of Radiology, Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Ya-Feng Gu
- 1 Department of Radiology, Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Li Fan
- 1 Department of Radiology, Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Qing-Chu Li
- 1 Department of Radiology, Changzheng Hospital, Second Military Medical University , Shanghai , China
| | | | - Shi-Yuan Liu
- 1 Department of Radiology, Changzheng Hospital, Second Military Medical University , Shanghai , China
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20
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Abstract
The incidental pulmonary nodule is commonly encountered when interpreting chest CTs. The management of pulmonary nodules requires a multidisciplinary approach entailing integration of nodule size and features, clinical risk factors, and patient preference and comorbidities. Guidelines have been issued for the management of both solid and subsolid nodules, with the Fleischner Society issuing revised guidelines in 2017. This article focuses on the CT imaging characteristics and clinical behavior of pulmonary nodules, with review of the current management guidelines that reflect this knowledge.
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Affiliation(s)
- Jane P Ko
- Department of Radiology, NYU Langone Health, New York, NY.
| | - Lea Azour
- Department of Radiology, NYU Langone Health, New York, NY
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Ground-glass nodule segmentation in chest CT images using asymmetric multi-phase deformable model and pulmonary vessel removal. Comput Biol Med 2018; 92:128-138. [PMID: 29175099 DOI: 10.1016/j.compbiomed.2017.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 11/01/2017] [Accepted: 11/14/2017] [Indexed: 12/17/2022]
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Yanagawa M, Kusumoto M, Johkoh T, Noguchi M, Minami Y, Sakai F, Asamura H, Tomiyama N. Radiologic-Pathologic Correlation of Solid Portions on Thin-section CT Images in Lung Adenocarcinoma: A Multicenter Study. Clin Lung Cancer 2017; 19:e303-e312. [PMID: 29307591 DOI: 10.1016/j.cllc.2017.12.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/05/2017] [Accepted: 12/11/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Measuring the size of invasiveness on computed tomography (CT) for the T descriptor size was deemed important in the 8th edition of the TNM lung cancer classification. We aimed to correlate the maximal dimensions of the solid portions using both lung and mediastinal window settings on CT imaging with the pathologic invasiveness (> 0.5 cm) in lung adenocarcinoma patients. MATERIALS AND METHODS The study population consisted of 378 patients with a histologic diagnosis of adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), invasive adenocarcinoma (IVA)-lepidic, IVA-acinar and/or IVA-papillary, and IVA-micropapillary and/or solid adenocarcinoma. A panel of 15 radiologists was divided into 2 groups (group A, 9 radiologists; and group B, 6 radiologists). The 2 groups independently measured the maximal and perpendicular dimensions of the solid components and entire tumors on the lung and mediastinal window settings. The solid proportion of nodule was calculated by dividing the solid portion size (lung and mediastinal window settings) by the nodule size (lung window setting). The maximal dimensions of the invasive focus were measured on the corresponding pathologic specimens by 2 pathologists. RESULTS The solid proportion was larger in the following descending order: IVA-micropapillary and/or solid, IVA-acinar and/or papillary, IVA-lepidic, MIA, and AIS. For both groups A and B, a solid portion > 0.8 cm in the lung window setting or > 0.6 cm in the mediastinal window setting on CT was a significant indicator of pathologic invasiveness > 0.5 cm (P < .001; receiver operating characteristic analysis using Youden's index). CONCLUSION A solid portion > 0.8 cm on the lung window setting or solid portion > 0.6 cm on the mediastinal window setting on CT predicts for histopathologic invasiveness to differentiate IVA from MIA and AIS.
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Affiliation(s)
- Masahiro Yanagawa
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology, National Cancer Center Hospital East, Chiba, Japan
| | - Takeshi Johkoh
- Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Hyogo, Japan
| | - Masayuki Noguchi
- Department of Diagnostic Pathology, University of Tsukuba, Ibaraki, Japan
| | - Yuko Minami
- Department of Pathology, National Hospital Organization Ibarakihigashi National Hospital, Center of Chest Diseases and Severe Motor and Intellectual Disabilities, Ibaraki, Japan
| | - Fumikazu Sakai
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
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Zhou J, Li Y, Zhang Y, Liu G, Tan H, Hu Y, Xiao J, Shi H. Solitary ground-glass opacity nodules of stage IA pulmonary adenocarcinoma: combination of 18F-FDG PET/CT and high-resolution computed tomography features to predict invasive adenocarcinoma. Oncotarget 2017; 8:23312-23321. [PMID: 28423576 PMCID: PMC5410306 DOI: 10.18632/oncotarget.15577] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 02/13/2017] [Indexed: 12/18/2022] Open
Abstract
To investigate the performance of combined 18F-FDG Positron Emission Tomography/Computed Tomography with high-resolution CT for differentiating invasive adenocarcinoma from adenocarcinoma in situ (pre-invasive lesion) or minimally invasive adenocarcinoma in stage IA lung cancer patients with solitary ground-glass opacity nodules. This retrospective study enrolled 58 consecutive stage IA pulmonary adenocarcinoma patients with solitary ground-glass opacity nodules. The characteristics and measurements of the ground-glass opacity nodules as pure ground-glass opacity nodules and mixed ground-glass opacity nodules in the pre-invasive or minimally invasive adenocarcinoma and invasive adenocarcinoma groups on Positron Emission Tomography/Computed Tomography and high-resolution CT were compared and analyzed. Ground-glass opacity nodules in the pre-invasive or minimally invasive adenocarcinoma group preferentially manifested as pure ground-glass opacity nodule (p < 0.01) compared to the invasive adenocarcinoma group. While cystic appearance was more common in the invasive adenocarcinoma group (p < 0.05). Significant differences were found in the diameter of the ground-glass opacity nodule itself and its solid component, and consolidation/tumor ratio between the two groups. The sensitivity in predicting invasive adenocarcinoma was higher with a combined consolidation/tumor ratio > 0.38 and SUVmax > 1.46 in mixed ground-glass opacity nodule when compared to those of SUVmax > 0.95 alone or consolidation/tumor ratio> 0.39 alone (both p > 0.05). For a mixed ground-glass opacity nodule combined consolidation/tumor ratio > 0.38 and SUVmax > 1.46 appears to better predict invasive adenocarcinoma in stage IA lung cancer patients with solitary ground-glass opacity nodules.
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Affiliation(s)
- Jun Zhou
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China 200032.,Nuclear Medicine Institute of Fudan University, Shanghai, China 200032.,Shanghai Institute of Medical Imaging, Shanghai, China 200032
| | - Yanli Li
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China 200032.,Nuclear Medicine Institute of Fudan University, Shanghai, China 200032.,Shanghai Institute of Medical Imaging, Shanghai, China 200032
| | - Yiqiu Zhang
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China 200032.,Nuclear Medicine Institute of Fudan University, Shanghai, China 200032.,Shanghai Institute of Medical Imaging, Shanghai, China 200032
| | - Guobing Liu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China 200032.,Nuclear Medicine Institute of Fudan University, Shanghai, China 200032.,Shanghai Institute of Medical Imaging, Shanghai, China 200032
| | - Hui Tan
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China 200032.,Nuclear Medicine Institute of Fudan University, Shanghai, China 200032.,Shanghai Institute of Medical Imaging, Shanghai, China 200032
| | - Yan Hu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China 200032.,Nuclear Medicine Institute of Fudan University, Shanghai, China 200032.,Shanghai Institute of Medical Imaging, Shanghai, China 200032
| | - Jie Xiao
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China 200032.,Nuclear Medicine Institute of Fudan University, Shanghai, China 200032.,Shanghai Institute of Medical Imaging, Shanghai, China 200032
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China 200032.,Nuclear Medicine Institute of Fudan University, Shanghai, China 200032.,Shanghai Institute of Medical Imaging, Shanghai, China 200032
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Bankier AA, MacMahon H, Goo JM, Rubin GD, Schaefer-Prokop CM, Naidich DP. Recommendations for Measuring Pulmonary Nodules at CT: A Statement from the Fleischner Society. Radiology 2017. [DOI: 10.1148/radiol.2017162894] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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25
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Chen C, Chen Z, Cao H, Yan J, Wang Z, Le H, Weng J, Zhang Y. A retrospective clinicopathological study of lung adenocarcinoma: Total tumor size can predict subtypes and lymph node involvement. Clin Imaging 2017; 47:52-56. [PMID: 28865329 DOI: 10.1016/j.clinimag.2017.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/10/2017] [Accepted: 08/22/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To analyze the predictive ability of total tumor size in lung adenocarcinoma subtype and lymph node involvement. MATERIALS AND METHODS 1018 patients, ≤3cm tumor, were enrolled. The maximum diameter and other variables of each tumor were measured. RESULTS The optimal cut-off value for total tumor size in differentiating AIS and MIA from IAC was <1.15cm, in distinguishing lymph node involvement, it was 1.65cm. CONCLUSIONS Total tumor size could be a reliable predictor of lung adenocarcinoma subtype and lymph node involvement irrespective of ground glass, part solid and solid characteristics.
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Affiliation(s)
- Cheng Chen
- Cardio-Thoracic Surgery Department, The Affiliated Zhoushan Hospital of Wenzhou Medical University, Zhoushan, Zhejiang, China
| | - Zhijun Chen
- Cardio-Thoracic Surgery Department, The Affiliated Zhoushan Hospital of Wenzhou Medical University, Zhoushan, Zhejiang, China
| | - Hanbo Cao
- Radiology Department, The Affiliated Zhoushan Hospital of Wenzhou Medical University, Zhoushan, Zhejiang, China
| | - Jinggang Yan
- Radiology Department, The Affiliated Zhoushan Hospital of Wenzhou Medical University, Zhoushan, Zhejiang, China
| | - Zhaoyu Wang
- Pathology Department, The Affiliated Zhoushan Hospital of Wenzhou Medical University, Zhoushan, Zhejiang, China
| | - Hanbo Le
- Cardio-Thoracic Surgery Department, The Affiliated Zhoushan Hospital of Wenzhou Medical University, Zhoushan, Zhejiang, China
| | - Jingjing Weng
- Cardio-Thoracic Surgery Department, The Affiliated Zhoushan Hospital of Wenzhou Medical University, Zhoushan, Zhejiang, China
| | - Yongkui Zhang
- Cardio-Thoracic Surgery Department, The Affiliated Zhoushan Hospital of Wenzhou Medical University, Zhoushan, Zhejiang, China.
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26
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Hutchinson BD, Moreira AL, Ko JP. Spectrum of Subsolid Pulmonary Nodules and Overdiagnosis. Semin Roentgenol 2017; 52:143-155. [PMID: 28734396 DOI: 10.1053/j.ro.2017.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Barry D Hutchinson
- Department of Radiology, NYU Langone Medical Center, NYU School of Medicine, New York, NY.
| | - Andre L Moreira
- Department of Pathology, NYU Langone Medical Center, NYU School of Medicine, New York, NY
| | - Jane P Ko
- Department of Radiology, NYU Langone Medical Center, NYU School of Medicine, New York, NY
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27
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Yanagawa M, Johkoh T, Noguchi M, Morii E, Shintani Y, Okumura M, Hata A, Fujiwara M, Honda O, Tomiyama N. Radiological prediction of tumor invasiveness of lung adenocarcinoma on thin-section CT. Medicine (Baltimore) 2017; 96:e6331. [PMID: 28296757 PMCID: PMC5369912 DOI: 10.1097/md.0000000000006331] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
To evaluate thin-section computed tomography (CT) (TSCT) features that differentiate adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IVA), and to determine the size of solid portion on CT that correlates to pathological invasive components. Forty-eight patients were included. Nodules were classified into ground-glass nodule (GGN), part-solid, solid, and heterogeneous. Visual density of GGNs was subjectively evaluated using reference standard images: faint GGN (Ga), <-700 Hounsfield unit (HU); intermediate GGN (Gb), from -700 to -400 HU; dense GGN (Gc), >-400 HU; and mixed (Ga + Gb, Ga + Gc, and Gb + Gc). The evaluated TSCT findings included margin of nodule, distribution of solid portion, distribution of air bronchiologram, and pleural indentation. The longest diameters of the solid portion and the entire tumor were measured. Invasive diameters were measured in pathological specimens. Twenty-two AISs (16 GGNs [7 Ga, 5 Gb, 2 Gc, 1 Ga + Gc, 1 Gb + Gc], 4 part-solids, and 2 heterogeneous), 6 MIAs (1 GGN [Gb + Gc], 3 part-solids, and 2 solids), and 20 IVAs (1 GGN [Gb], 3 part-solids, and 16 solid) were found. The longest diameter (mean ± standard deviation) of the solid portion and total tumor were 9.7 ± 9.7 and 18.9 ± 5.6 mm, respectively. Significant differences in TSCT findings between AIS and IVA were margin of nodule (Pearson chi-squared test, P = 0.004), distribution of air bronchiologram (P = 0.0148), and pleural indentation (P = 0.0067). A solid portion >5.3 mm on TSCT indicated MIA or IVA, and >7.3 mm indicated IVA (receiver operating characteristic analysis, P < 0.0001). Irregular margin, air bronchiologram with disruption and/or irregular dilatation, and pleural indentation may distinguish IVA from AIS. A 5.3 to 7.3 mm solid portion on TSCT indicates MIA/IVA, and a solid portion >7.3 mm on TSCT indicates IVA.
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Affiliation(s)
- Masahiro Yanagawa
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka
| | - Takeshi Johkoh
- Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo
| | - Masayuki Noguchi
- Department of Diagnostic Pathology, University of Tsukuba, Tsukuba, Ibaraki
| | | | - Yasushi Shintani
- Department of Respiratory Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Meinoshin Okumura
- Department of Respiratory Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Akinori Hata
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka
| | - Maki Fujiwara
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka
| | - Osamu Honda
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka
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Cohen JG, Reymond E, Jankowski A, Brambilla E, Arbib F, Lantuejoul S, Ferretti GR. Lung adenocarcinomas: correlation of computed tomography and pathology findings. Diagn Interv Imaging 2016; 97:955-963. [PMID: 27639313 DOI: 10.1016/j.diii.2016.06.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 12/13/2022]
Abstract
Adenocarcinoma is the most common histologic type of lung cancer. Recent lung adenocarcinoma classifications from the International Association for the Study of Lung cancer, the American Thoracic Society and the European Respiratory Society (IASLC/ETS/ERS, 2011) and World Health Organization (WHO, 2015) define a wide range of adenocarcinoma types and subtypes featuring different prognosis and management. This spectrum of lesions translates into various CT presentations and features, which generally show good correlation with histopathology, stressing the key role of the radiologist in the diagnosis and management of those patients. This review aims at helping radiologists to understand the basics of the up-to-date adenocarcinoma pathological classifications, radio-pathological correlations and how to use them in the clinical setting, as well as other imaging-related correlations (radiogenomics, quantitative analysis, PET-CT).
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Affiliation(s)
- J G Cohen
- Clinique universitaire de radiologie et imagerie médicale (CURIM), CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France; Université Grenoble-Alpes, 38000 Grenoble, France.
| | - E Reymond
- Clinique universitaire de radiologie et imagerie médicale (CURIM), CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France.
| | - A Jankowski
- Clinique universitaire de radiologie et imagerie médicale (CURIM), CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France.
| | - E Brambilla
- Université Grenoble-Alpes, 38000 Grenoble, France; Département d'anatomo-cytologie pathologie (DACP), CHU A.-Michallon, 38043 Grenoble, France; Inserm U 823, institut A.-Bonniot, 38000 Grenoble, France.
| | - F Arbib
- Clinique universitaire de pneumologie, pôle d'oncologie, CHU A.-Michallon, 38043 Grenoble, France.
| | - S Lantuejoul
- Université Grenoble-Alpes, 38000 Grenoble, France; Département d'anatomo-cytologie pathologie (DACP), CHU A.-Michallon, 38043 Grenoble, France; Inserm U 823, institut A.-Bonniot, 38000 Grenoble, France.
| | - G R Ferretti
- Clinique universitaire de radiologie et imagerie médicale (CURIM), CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France; Université Grenoble-Alpes, 38000 Grenoble, France; Département d'anatomo-cytologie pathologie (DACP), CHU A.-Michallon, 38043 Grenoble, France.
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29
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Yoo RE, Goo JM, Hwang EJ, Yoon SH, Lee CH, Park CM, Ahn S. Retrospective assessment of interobserver agreement and accuracy in classifications and measurements in subsolid nodules with solid components less than 8mm: which window setting is better? Eur Radiol 2016; 27:1369-1376. [DOI: 10.1007/s00330-016-4495-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 06/22/2016] [Accepted: 06/27/2016] [Indexed: 12/19/2022]
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30
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Travis WD, Asamura H, Bankier AA, Beasley MB, Detterbeck F, Flieder DB, Goo JM, MacMahon H, Naidich D, Nicholson AG, Powell CA, Prokop M, Rami-Porta R, Rusch V, van Schil P, Yatabe Y. The IASLC Lung Cancer Staging Project: Proposals for Coding T Categories for Subsolid Nodules and Assessment of Tumor Size in Part-Solid Tumors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2016; 11:1204-1223. [PMID: 27107787 DOI: 10.1016/j.jtho.2016.03.025] [Citation(s) in RCA: 465] [Impact Index Per Article: 58.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 12/15/2022]
Abstract
This article proposes codes for the primary tumor categories of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) and a uniform way to measure tumor size in part-solid tumors for the eighth edition of the tumor, node, and metastasis classification of lung cancer. In 2011, new entities of AIS, MIA, and lepidic predominant adenocarcinoma were defined, and they were later incorporated into the 2015 World Health Organization classification of lung cancer. To fit these entities into the T component of the staging system, the Tis category is proposed for AIS, with Tis (AIS) specified if it is to be distinguished from squamous cell carcinoma in situ (SCIS), which is to be designated Tis (SCIS). We also propose that MIA be classified as T1mi. Furthermore, the use of the invasive size for T descriptor size follows a recommendation made in three editions of the Union for International Cancer Control tumor, node, and metastasis supplement since 2003. For tumor size, the greatest dimension should be reported both clinically and pathologically. In nonmucinous lung adenocarcinomas, the computed tomography (CT) findings of ground glass versus solid opacities tend to correspond respectively to lepidic versus invasive patterns seen pathologically. However, this correlation is not absolute; so when CT features suggest nonmucinous AIS, MIA, and lepidic predominant adenocarcinoma, the suspected diagnosis and clinical staging should be regarded as a preliminary assessment that is subject to revision after pathologic evaluation of resected specimens. The ability to predict invasive versus noninvasive size on the basis of solid versus ground glass components is not applicable to mucinous AIS, MIA, or invasive mucinous adenocarcinomas because they generally show solid nodules or consolidation on CT.
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University, School of Medicine, Tokyo, Japan
| | - Alexander A Bankier
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mary Beth Beasley
- Department of Pathology, Ichan School of Medicine at Mount Sinai, New York, New York
| | - Frank Detterbeck
- Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Douglas B Flieder
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Heber MacMahon
- Department of Radiology, University of Chicago, Chicago, Illinois
| | - David Naidich
- Department of Radiology, New York University Langone Medical Center, New York University, New York, New York
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, United Kingdom
| | - Charles A Powell
- Pulmonary Critical Care and Sleep Medicine, Ichan School of Medicine, New York, New York
| | - Mathias Prokop
- Department of Radiology, Radboud University Nymegen Medical Center, Nymegen, The Netherlands
| | - Ramón Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain; CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain
| | - Valerie Rusch
- Thoracic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
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31
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Kakinuma R, Noguchi M, Ashizawa K, Kuriyama K, Maeshima AM, Koizumi N, Kondo T, Matsuguma H, Nitta N, Ohmatsu H, Okami J, Suehisa H, Yamaji T, Kodama K, Mori K, Yamada K, Matsuno Y, Murayama S, Murata K. Natural History of Pulmonary Subsolid Nodules: A Prospective Multicenter Study. J Thorac Oncol 2016; 11:1012-28. [PMID: 27089851 DOI: 10.1016/j.jtho.2016.04.006] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 03/27/2016] [Accepted: 04/06/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the natural course of the progression of pulmonary subsolid nodules (SSNs). MATERIALS AND METHODS Eight facilities participated in this study. A total of 795 patients with 1229 SSNs were assessed for the frequency of invasive adenocarcinomas. SSNs were classified into three categories: pure ground-glass nodules (PGGNs), heterogeneous GGNs (HGGNs) (solid component detected only in lung windows), and part-solid nodules. RESULTS The mean prospective follow-up period was 4.3 ± 2.5 years. SSNs were classified at baseline as follows: 1046 PGGNs, 81 HGGNs, and 102 part-solid nodules. Among the 1046 PGGNs, 13 (1.2%) developed into HGGNs and 56 (5.4%) developed into part-solid nodules. Among the 81 HGGNs, 16 (19.8%) developed into part-solid nodules. Thus, the SSNs at the final follow-up were classified as follows: 977 PGGNs, 78 HGGNs, and 174 part-solid nodules. Of the 977 PGGNs, 35 were resected (nine minimally invasive adenocarcinomas [MIAs], 21 adenocarcinomas in situ [AIS], and five atypical adenomatous hyperplasias). Of the 78 HGGNs, seven were resected (five MIAs and two AIS). Of the 174 part-solid nodules, 49 were resected (12 invasive adenocarcinomas, 26 MIAs, 10 AIS, and one adenomatous hyperplasia). For the PGGNs, the mean period until their development into part-solid nodules was 3.8 ± 2.0 years, whereas the mean period for the HGGNs was 2.1 ± 2.3 years (p = 0.0004). CONCLUSION This study revealed the frequencies and periods of development from PGGNs and HGGNs into part-solid nodules. Invasive adenocarcinomas were diagnosed only among the part-solid nodules, corresponding to 1% of all 1229 SSNs.
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Affiliation(s)
- Ryutaro Kakinuma
- Cancer Screening Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan; Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan; Department of Pulmonology, Tokyo General Hospital, Tokyo, Japan.
| | - Masayuki Noguchi
- Department of Pathology, University of Tsukuba, Faculty of Medicine, Tsukuba, Japan
| | - Kazuto Ashizawa
- Department of Clinical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keiko Kuriyama
- Department of Radiology, Osaka National Hospital, Osaka, Japan
| | | | - Naoya Koizumi
- Department of Radiology, Niigata Cancer Center, Niigata, Japan
| | - Tetsuro Kondo
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Haruhisa Matsuguma
- Department of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan
| | - Hironobu Ohmatsu
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Jiro Okami
- Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Hiroshi Suehisa
- Department of Thoracic Surgery, Shikoku Cancer Center, Matsuyama, Japan; Department of Thoracic Surgery, Iwakuni Clinical Center, Iwakuni, Japan
| | - Taiki Yamaji
- Epidemiology and Prevention Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan; Division of Epidemiology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Ken Kodama
- Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan; Department of Thoracic Surgery, Yao Municipal Hospital, Yao, Japan
| | - Kiyoshi Mori
- Department of Thoracic Oncology, Tochigi Cancer Center, Utsunomiya, Japan; Department of Pulmonology, Tsuboi Cancer Center Hospital, Koriyama, Japan
| | - Kouzo Yamada
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Sadayuki Murayama
- Department of Radiology, University of the Ryukyus, Faculty of Medicine, Okinawa, Japan
| | - Kiyoshi Murata
- Department of Radiology, Shiga University of Medical Science, Otsu, Japan
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