1
|
Wang X, Yang C, Wang X, Wang D. Predicting invasiveness of ground-glass nodules in lung adenocarcinoma: based on preoperative 18F-fluorodeoxyglucose PET/computed tomography and high-resolution computed tomography. Nucl Med Commun 2024:00006231-990000000-00337. [PMID: 39290039 DOI: 10.1097/mnm.0000000000001898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
OBJECTIVE This study was conducted to explore the differential diagnostic value of PET/computed tomography (PET/CT) combined with high-resolution computed tomography (HRCT) in predicting the invasiveness of ground-glass nodules (GGNs). MATERIALS AND METHODS This retrospective analysis included 67 patients (mean age 62.5 ± 8.4, including 45 females and 22 males) with GGNs who underwent preoperative 18F-fluorodeoxyglucose (18F-FDG) PET/CT and HRCT examinations between January 2018 and October 2022. Based on the postoperative pathological results of lung adenocarcinoma, the patients were classified into two groups: invasive adenocarcinoma (IAC) and non-IAC. Besides, the clinical and imaging information of these patients was collected. HRCT signs include the existence of air bronchial signals, vascular convergence, pleural indentation, lobulation, and spiculation. Moreover, the diameter of solid components (DSolid), diameter of ground-glass nodules (DGGN), and computed tomography values of ground-glass nodules (CTGGN) were measured concurrently. Furthermore, the mean standardized uptake value, maximal standardized uptake value (SUVmax), metabolic tumor volume, and total lesion glycolysis were assessed during PET/CT. Associations between invasiveness and these factors were evaluated using univariate and multivariate analyses. RESULTS The results of logistic regression analysis demonstrated that DGGN, DSolid, consolidation tumor ratio (CTR), CTGGN, and SUVmax were independent predictors in the IAC group. The combined diagnosis based on these five predictors revealed that area under the curve was 0.825. CONCLUSION The DGGN, DSolid, CTR, CTGGN, and SUVmax in GGNs were independent predictors of IAC, and combining 18F-FDG PET/CT metabolic parameters with HRCT may improve the predictive value of pathological classification in lung adenocarcinoma.
Collapse
Affiliation(s)
- Ximei Wang
- Department of PET/CT, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | | | | | | |
Collapse
|
2
|
Sasaki T, Kuno H, Hiyama T, Oda S, Masuoka S, Miyasaka Y, Taki T, Nagasaki Y, Ohtani-Kim SJY, Ishii G, Kaku S, Shroff GS, Kobayashi T. 2021 WHO Classification of Lung Cancer: Molecular Biology Research and Radiologic-Pathologic Correlation. Radiographics 2024; 44:e230136. [PMID: 38358935 DOI: 10.1148/rg.230136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
The 2021 World Health Organization (WHO) classification system for thoracic tumors (including lung cancer) contains several updates to the 2015 edition. Revisions for lung cancer include a new grading system for invasive nonmucinous adenocarcinoma that better reflects prognosis, reorganization of squamous cell carcinomas and neuroendocrine neoplasms, and description of some new entities. Moreover, remarkable advancements in our knowledge of genetic mutations and targeted therapies have led to a much greater emphasis on genetic testing than that in 2015. In 2015, guidelines recommended evaluation of only two driver mutations, ie, epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) fusions, in patients with nonsquamous non-small cell lung cancer. The 2021 guidelines recommend testing for numerous additional gene mutations for which targeted therapies are now available including ROS1, RET, NTRK1-3, KRAS, BRAF, and MET. The correlation of imaging features and genetic mutations is being studied. Testing for the immune biomarker programmed death ligand 1 is now recommended before starting first-line therapy in patients with metastatic non-small cell lung cancer. Because 70% of lung cancers are unresectable at patient presentation, diagnosis of lung cancer is usually based on small diagnostic samples (ie, biopsy specimens) rather than surgical resection specimens. The 2021 version emphasizes differences in the histopathologic interpretation of small diagnostic samples and resection specimens. Radiologists play a key role not only in evaluation of tumor and metastatic disease but also in identification of optimal biopsy targets. ©RSNA, 2024 Test Your Knowledge questions in the supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
Collapse
Affiliation(s)
- Tomoaki Sasaki
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Hirofumi Kuno
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Takashi Hiyama
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Shioto Oda
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Sota Masuoka
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Yusuke Miyasaka
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Tetsuro Taki
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Yusuke Nagasaki
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Seiyu Jeong-Yoo Ohtani-Kim
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Genichiro Ishii
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Sawako Kaku
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Girish S Shroff
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| | - Tatsushi Kobayashi
- From the Departments of Diagnostic Radiology (T.S., H.K., T.H., S.O., S.M., Y.M., T.K.), Pathology and Clinical Laboratories (T.T., G.I.), and Thoracic Surgery (Y.N., S.J.Y.O.K.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan; Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan (S.K.); Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan (Y.N.); and Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (G.S.S.)
| |
Collapse
|
3
|
Ohno Y, Yui M, Yamamoto K, Ikedo M, Oshima Y, Hamabuchi N, Hanamatsu S, Nagata H, Ueda T, Ikeda H, Takenaka D, Yoshikawa T, Ozawa Y, Toyama H. Pulmonary MRI with ultra-short TE using single- and dual-echo methods: comparison of capability for quantitative differentiation of non- or minimally invasive adenocarcinomas from other lung cancers with that of standard-dose thin-section CT. Eur Radiol 2024; 34:1065-1076. [PMID: 37580601 DOI: 10.1007/s00330-023-10105-4] [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: 03/10/2023] [Revised: 06/05/2023] [Accepted: 06/25/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE The purpose of this study was thus to compare capabilities for quantitative differentiation of non- and minimally invasive adenocarcinomas from other of pulmonary MRIs with ultra-short TE (UTE) obtained with single- and dual-echo techniques (UTE-MRISingle and UTE-MRIDual) and thin-section CT for stage IA lung cancer patients. METHODS Ninety pathologically diagnosed stage IA lung cancer patients who underwent thin-section standard-dose CT, UTE-MRISingle, and UTE-MRIDual, surgical treatment and pathological examinations were included in this retrospective study. The largest dimension (Dlong), solid portion (solid Dlong), and consolidation/tumor (C/T) ratio of each nodule were assessed. Two-tailed Student's t-tests were performed to compare all indexes obtained with each method between non- and minimally invasive adenocarcinomas and other lung cancers. Receiver operating characteristic (ROC)-based positive tests were performed to determine all feasible threshold values for distinguishing non- or minimally invasive adenocarcinoma (MIA) from other lung cancers. Sensitivity, specificity, and accuracy were then compared by means of McNemar's test. RESULTS Each index showed significant differences between the two groups (p < 0.0001). Specificities and accuracies of solid Dlong for UTE-MRIDual2nd echo and CTMediastinal were significantly higher than those of solid Dlong for UTE-MRISingle and UTE-MRIDual1st echo and all C/T ratios except CTMediastinal (p < 0.05). Moreover, the specificities and accuracies of solid Dlong and C/T ratio were significantly higher than those of Dlong for each method (p < 0.05). CONCLUSION Pulmonary MRI with UTE is considered at least as valuable as thin-section CT for quantitative differentiation of non- and minimally invasive adenocarcinomas from other stage IA lung cancers. CLINICAL RELEVANCE STATEMENT Pulmonary MRI with UTE's capability for quantitative differentiation of non- and minimally invasive adenocarcinomas from other lung cancers in stage IA lung cancer patients is equal or superior to that of thin-section CT. KEY POINTS • Correlations were excellent for pathologically examined nodules with the largest dimensions (Dlong) and a solid component (solid Dlong) for all indexes (0.95 ≤ r ≤ 0.99, p < 0.0001). • Pathologically examined Dlong and solid Dlong obtained with all methods showed significant differences between non- and minimally invasive adenocarcinomas and other lung cancers (p < 0.0001). • Solid tumor components are most accurately measured by UTE-MRIDual2nd echo and CTMediastinal, whereas the ground-glass component is imaged by UTE-MRIDual1st echo and CTlung with high accuracy. UTE-MRIDual predicts tumor invasiveness with 100% sensitivity and 87.5% specificity at a C/T threshold of 0.5.
Collapse
Affiliation(s)
- Yoshiharu Ohno
- Department of Diagnostic Radiology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan.
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | - Masao Yui
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Kaori Yamamoto
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Masato Ikedo
- Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Yuka Oshima
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Nayu Hamabuchi
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Satomu Hanamatsu
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroyuki Nagata
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takahiro Ueda
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hirotaka Ikeda
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Daisuke Takenaka
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
- Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Takeshi Yoshikawa
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
- Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Yoshiyuki Ozawa
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
- Department of Radiology, Nagoya City University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
| |
Collapse
|
4
|
Liang X, Zhang C, Ye X. Overdiagnosis and overtreatment of ground-glass nodule-like lung cancer. Asia Pac J Clin Oncol 2024. [PMID: 38178320 DOI: 10.1111/ajco.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/03/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024]
Abstract
Lung cancer has had one of the highest incidences and mortality in the world over the last few decades, which has aided in the promotion and popularization of screening for lung ground-glass nodules (GGNs). People have great psychological anxiety about GGN because of the chance that it will develop into lung cancer, which makes clinical treatment of GGN a generally excessive phenomenon. Overdiagnosis in screening has recently been mentioned in the literature. An important research emphasis of screening is how to reduce the incidence of overdiagnosis and overtreatment. This paper discusses from different aspects how to characterize the occurrence of overdiagnosis and overtreatment, how to reduce overdiagnosis and overtreatment, and future screening, follow-up, and treatment approaches.
Collapse
Affiliation(s)
- Xinyu Liang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Chao Zhang
- Department of Oncology, Qujing No. 1 Hospital and Affiliated Qujing Hospital of Kunming Medical University, Qujing, China
| | - Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| |
Collapse
|
5
|
Yamada D, Matsusako M, Yoneoka D, Oikado K, Ninomiya H, Nozaki T, Ishiyama M, Makidono A, Otsuji M, Itoh H, Ojiri H. Ex-vivo 1.5T MR Imaging versus CT in Estimating the Size of the Pathologically Invasive Component of Lung Adenocarcinoma Spectrum Lesions. Magn Reson Med Sci 2024; 23:92-101. [PMID: 36529498 PMCID: PMC10838715 DOI: 10.2463/mrms.mp.2022-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/01/2022] [Indexed: 01/05/2024] Open
Abstract
PURPOSE The purpose of this study was to investigate whether ex-vivo MRI enables accurate estimation of the invasive component of lung adenocarcinoma. METHODS We retrospectively reviewed 32 patients with lung adenocarcinoma who underwent lung lobectomy. The specimens underwent MRI at 1.5T. The boundary between the lesion and the normal lung was evaluated on a 5-point scale in each three MRI sequences, and a one-way analysis of variance and post-hoc tests were performed. The invasive component size was measured histopathologically. The maximum diameter of each solid component measured on CT and MR T1-weighted (T1W) images and the maximum size obtained from histopathologic images were compared using the Wilcoxon signed-rank test. Inter-reader agreement was evaluated using intraclass correlation coefficients (ICC). RESULTS T1W images were determined to be optimal for the delineation of the lesions (P < 0.001). The histopathologic invasive area corresponded to the area where the T1W ex-vivo MR image showed a high signal intensity that was almost equal to the intravascular blood signal. The maximum diameter of the solid component on CT was overestimated compared with the maximum invasive size on histopathology (mean, 153%; P < 0.05), while that on MRI was evaluated mostly accurately without overestimation (mean, 108%; P = 0.48). The interobserver reliability of the measurements using CT and MRI was good (ICC = 0.71 on CT, 0.74 on MRI). CONCLUSION Ex-vivo MRI was more accurate than conventional CT in delineating the invasive component of lung adenocarcinoma.
Collapse
Affiliation(s)
- Daisuke Yamada
- Department of Radiology, St. Luke’s International University, Tokyo, Japan
| | - Masaki Matsusako
- Department of Radiology, St. Luke’s International University, Tokyo, Japan
| | - Daisuke Yoneoka
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Katsunori Oikado
- Diagnostic Imaging Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hironori Ninomiya
- Division of Pathology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St. Luke’s International University, Tokyo, Japan
| | - Mitsutomi Ishiyama
- Diagnostic Imaging Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akari Makidono
- Department of Diagnostic Radiology, Tokyo Metropolitan Children’s Medical Center, Fuchu, Tokyo, Japan
| | - Mizuto Otsuji
- Department of Thoracic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Harumi Itoh
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine and University Hospital, Tokyo, Japan
| |
Collapse
|
6
|
Kawaguchi M, Kato H, Hanamatsu Y, Suto T, Noda Y, Kaneko Y, Iwata H, Hyodo F, Miyazaki T, Matsuo M. Computed Tomography and 18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography Imaging Biomarkers of Lung Invasive Non-mucinous Adenocarcinoma: Prediction of Grade 3 Tumour Based on World Health Organization Grading System. Clin Oncol (R Coll Radiol) 2023; 35:e601-e610. [PMID: 37587000 DOI: 10.1016/j.clon.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 06/02/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023]
Abstract
AIMS To evaluate computed tomography (CT) and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) findings of invasive non-mucinous adenocarcinoma (INMA) of the lung as a predictor of histological tumour grade according to 2021 World Health Organization (WHO) classification. MATERIALS AND METHODS This retrospective study included consecutive patients with surgically resected INMA who underwent both preoperative CT and 18F-FDG-PET/CT. A three-tiered tumour grade was performed based on the fifth edition of the WHO classification of lung tumours. CT imaging features and the maximum standardised uptake value (SUVmax) were compared among the three tumour grades. RESULTS In total, 214 patients with INMA (median age 70 years; interquartile range 65-76 years; 123 men) were histologically categorised: 36 (17%) as grade 1, 102 (48%) as grade 2 and 76 (35%) as grade 3. Pure solid appearance was more frequent in grade 3 (83%) than in grades 1 (0%) and 2 (26%) (P < 0.001). The SUVmax of the entire tumour was higher in grade 3 than in grades 1 and 2 (P < 0.001). Multivariable analysis revealed that pure solid appearance (odds ratio = 94.0; P < 0.001), round/oval shape (odds ratio = 4.01; P = 0.001), spiculation (odds ratio = 2.13; P = 0.04), air bronchogram (odds ratio = 0.40; P = 0.03) and SUVmax (odds ratio = 1.45; P < 0.001) were significant predictors for grade 3 INMAs. CONCLUSION Pure solid appearance, round/oval shape, spiculation, absence of air bronchogram and high SUVmax were associated with grade 3 INMAs. CT and 18F-FDG-PET/CT were potentially useful non-invasive imaging methods to predict the histological grade of INMAs.
Collapse
Affiliation(s)
- M Kawaguchi
- Department of Radiology, Gifu University, Gifu, Japan.
| | - H Kato
- Department of Radiology, Gifu University, Gifu, Japan
| | - Y Hanamatsu
- Department of Pathology and Translational Research, Gifu University, Gifu, Japan
| | - T Suto
- Department of Radiology, Gifu University, Gifu, Japan
| | - Y Noda
- Department of Radiology, Gifu University, Gifu, Japan
| | - Y Kaneko
- Department of Radiology, Gifu University, Gifu, Japan
| | - H Iwata
- Department of General and Cardiothoracic Surgery, Gifu University, Gifu, Japan
| | - F Hyodo
- Department of Radiology, Frontier Science for Imaging, Gifu University, Gifu, Japan
| | - T Miyazaki
- Department of Pathology, Gifu University, Gifu, Japan
| | - M Matsuo
- Department of Radiology, Gifu University, Gifu, Japan
| |
Collapse
|
7
|
Bulutay P, Atasoy Ç, Erus S, Tanju S, Dilege Ş, Fırat P. Scrape cytology and radiological solid size correlation can be used in the intraoperative management of subsolid lung nodules. Diagn Cytopathol 2023; 51:239-250. [PMID: 36519435 DOI: 10.1002/dc.25089] [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: 10/10/2022] [Revised: 11/07/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The term radiologic subsolid lung nodule (SLN) represents a heterogeneous group of non-neoplastic and neoplastic lesions. Intraoperative evaluation (IO) is often required to differentiate and diagnose. The current study aims to investigate the feasibility and reliability of scrape cytology (SC) and radiologic solid size correlation for the IO diagnosis of SLNs. METHODS Sixty-eight patients with SLN signs were eligible to take part in the study due to intraoperatively prepared SC slides. We managed to complete the blind radiologic solid size measurement and cytologic evaluation retrospectively. Cases were grouped into three categories based on their cytological features: Group-0 (Benign), Group-1 (mild atypical features), and Group-2 (severe atypical features/unequivocally carcinoma). IO diagnoses were given by combining the radiologic solid size and cytological findings. RESULTS Cytological features of Group-1 were observed in 100%, 93%, 32.5%, and 17% of the AIS, MIA, IA, and benign lesions, respectively. Cytological features of Group-2 were observed in 67.5%, and 7% of the IA and MIA, respectively. By combining cytology with radiologic solid size, 100%, 85%, 71%, and 83% of the AIS, IA, MIA, and benign lesions respectively were diagnosed correctly. Fifteen (15%) percent of the IA cases were underdiagnosed as MIA since their radiological solid sizes were less than 0.5 cm with cytological features of Group-1. Conversely, 29% of the MIA cases were overdiagnosed as IA since their radiological solid sizes were greater than 0.5 cm. CONCLUSION SLNs should be handled with caution in terms of IO management. SC and radiologic solid size correlation both provide a practical and tissue-protecting approach for the IO evaluation of SLNs, ensuring a high consistency between IO and definitive diagnosis.
Collapse
Affiliation(s)
- Pınar Bulutay
- Department of Pathology, Koç University Hospital, Istanbul, Turkey
| | - Çetin Atasoy
- Department of Radiology, Koç University Hospital, Istanbul, Turkey
| | - Suat Erus
- Department of Thoracic Surgery, Koç University Hospital, Istanbul, Turkey
| | - Serhan Tanju
- Department of Thoracic Surgery, Koç University Hospital, Istanbul, Turkey
| | - Şükrü Dilege
- Department of Thoracic Surgery, Koç University Hospital, Istanbul, Turkey
| | - Pınar Fırat
- Department of Pathology, Koç University Hospital, Istanbul, Turkey
| |
Collapse
|
8
|
Beddok A, Chabi-Charvillat ML, Kennel T, de Wolf J, Pricopi C, Crequit P, Girard N, Otz J, Vallée A, Longchampt E, Sage E, Glorion M. Prospective Radiologic-Pathologic Correlation of Macroscopic Volume and Microscopic Extension of Nonsolid Lung Nodules on Thin-section CT Images for Sublobar Resection and Stereotactic Radiotherapy Planning. Clin Lung Cancer 2023; 24:98-106. [PMID: 36509664 DOI: 10.1016/j.cllc.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The objective of this study was to determine whether computed tomography (CT) could be a useful tool for nonsolid lung nodule (NSN) treatment planning, surgery or stereotactic body radiation therapy (SBRT), by assessing the macroscopic and microscopic extension of these nodules. METHODS The study prospectively included 23 patients undergoing anatomic resection at the Foch Hospital in 2020/2021 for NSN with a ground-glass component of more than 50%. Firstly, for each patient, both the macroscopic dimensions of the NSN were assessed on CT and during pathologic analysis. Secondly, the microscopic extension was assessed during pathologic examination. Wilcoxon sign rank tests were used to compare these dimensions. Spearman correlation test and Bland-Altman analysis were used to evaluate the agreement between radiological and pathologic measurements. RESULTS On CT, the median largest diameter and volume of NSN were 21 mm and 3780 cc, while on pathologic analysis, they were 15 mm and 1800 cc, respectively. Therefore, the largest diameter and volume of the NSN were significantly higher on CT than on pathological analysis. For microscopic extension, the median largest diameter and volume of NSN were 17 mm and 2040 cc, respectively. No significant difference was observed between the macroscopic size and the microscopic extension assessed during pathologic analysis. Moreover, correlation analysis and Bland-Altman plots showed that radiological and pathologic measurements could provide equivalent precision. CONCLUSION Our study showed that CT did not underestimate the macroscopic size and microscopic extension of NSN and confirmed that CT can be used for NSN treatment planning.
Collapse
Affiliation(s)
- Arnaud Beddok
- Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, Institut Curie, PSL Research University, Orsay, France; Laboratory of Translational Imaging in Oncology (LITO), Institut Curie, PSL Research University, University Paris Saclay, Inserm, Orsay, France.
| | | | - Titouan Kennel
- Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation (DRCI), Foch hospital, Suresnes, France
| | - Julien de Wolf
- Department of Thoracic Surgery, Hôpital Foch, Suresnes, France
| | - Ciprian Pricopi
- Department of Thoracic Oncology, Hôpital Foch, Suresnes, France
| | - Perrine Crequit
- Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation (DRCI), Foch hospital, Suresnes, France
| | | | - Joelle Otz
- Radiation Oncology Department, Institut Curie, Saint-Cloud, France
| | - Alexandre Vallée
- Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation (DRCI), Foch hospital, Suresnes, France
| | | | - Edouard Sage
- Department of Thoracic Surgery, Hôpital Foch, Suresnes, France
| | | |
Collapse
|
9
|
Nishimori M, Iwasa H, Nakaji K, Nitta N, Miyatake K, Yoshimatsu R, Yamanishi T, Matsumoto T, Kato M, Hayashi N, Toi M, Tamura M, Yamagami T. Predicting the pathological invasiveness of early lung adenocarcinoma prior to surgery using Deauville criteria: reliability and validity. Jpn J Radiol 2023:10.1007/s11604-023-01397-z. [PMID: 36752955 DOI: 10.1007/s11604-023-01397-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE This retrospective study aimed to investigate the validity and reliability of FDG-PET/CT visual assessment using Deauville criteria to predict pathological invasiveness of early lung adenocarcinoma prior to surgery. MATERIALS AND METHODS Between April 2020 and January 2022, 51 patients who underwent surgery for pathological stage 0/I lung adenocarcinoma were enrolled. The pulmonary lesions were divided into two groups according to pathological invasiveness: less invasive (including adenocarcinoma in situ and minimally invasive adenocarcinoma and invasive adenocarcinoma. We compared CT size (total and solid size), SUVmax, and Deauville score between the two groups. Furthermore, we investigated inter-rater and intra-rater agreements regarding the Deauville score. Receiver operating characteristic (ROC) curve analysis was performed to identify the diagnostic performance of each method. RESULTS Based on pathologic diagnoses, 51 lesions in the 51 patients were divided into 6 less invasive and 45 invasive adenocarcinoma lesions. According to quadratic-weighted Kappa statistics, inter-rater (k = 0.93) and intra-rater (k = 0.97) agreements among all five components of the Deauville score indicated high agreement. There was a statistically significant difference in CT solid size, SUVmax, and Deauville score between the two groups. There were no significant differences between CT solid size and FDG-PET/CT assessments (AUC = 0.93 for Deauville score and SUVmax, AUC = 0.84 for CT solid size). CONCLUSION FDG-PET/CT visual assessment using the Deauville score could assist in deciding upon minimally invasive surgery for early lung adenocarcinoma.
Collapse
Affiliation(s)
- Miki Nishimori
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan.
| | - Hitomi Iwasa
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Kosuke Nakaji
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Noriko Nitta
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Kana Miyatake
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Rika Yoshimatsu
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Tomoaki Yamanishi
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Tomohiro Matsumoto
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Mahiru Kato
- Center for Innovative and Translational Medicine, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Naoya Hayashi
- Division of Radiology, Department of Medical Technology, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Makoto Toi
- Department of Diagnostic Pathology, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Masaya Tamura
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Takuji Yamagami
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| |
Collapse
|
10
|
Li Z, Xu W, Gu T, Cao X, Wu W, Chen L. Tumor size, but not consolidation-to-tumor ratio, is an independent prognostic factor for part-solid clinical T1 non-small cell lung cancer. Thorac Cancer 2022; 14:602-611. [PMID: 36578128 PMCID: PMC9968594 DOI: 10.1111/1759-7714.14788] [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: 11/26/2022] [Revised: 12/13/2022] [Accepted: 12/17/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Tumor size and consolidation-to-tumor ratio (CTR) are crucial for non-small cell lung cancer (NSCLC) prognosis. However, the optimal CTR cutoff remains unclear. Whether tumor size and CTR are independent prognostic factors for part-solid NSCLC is under debate. Here, we aimed to evaluate the prognostic impacts of CTR and tumor size on NSCLC, especially on part-solid NSCLC. METHODS We reviewed 1366 clinical T1 NSCLC patients who underwent surgical treatment. Log-rank test and Cox regression analyses were adopted for prognostic evaluation. The "surv_cutpoint" function was used to identify the optimal CTR and tumor size cutoff values. RESULTS There were 416, 510, and 440 subjects with pure ground-glass opacity (pGGO), part-solid, and pure solid nodules. The 5-year overall survival (disease-free survival) for patients with pGGO, part-solid, and pure solid nodules were 99.5% (99.5%), 97.3% (95.8%), and 90.4% (78.9%), respectively. Multivariate Cox regression analysis indicated that CTR was an independent prognostic factor for the whole patients, and the optimal CTR cutoff was 0.99. However, for part-solid NSCLC, CTR was not independently associated with survival, even if categorized by the optimal cutoffs. The predicted optimal cutoffs of total tumor size and solid component size were 2.4 and 1.4 cm for part-solid NSCLC. Total tumor size (HR = 6.21, 95% CI: 1.58-24.34, p = 0.009) and solid component size (HR = 2.27, 95% CI: 1.04-5.92, p = 0.045) grouped by the cutoffs were significantly associated with part-solid NSCLC prognosis. CONCLUSIONS CTR was an independent prognostic factor for the whole NSCLC, but not for the part-solid NSCLC. Tumor size was still meaningful for part-solid NSCLC.
Collapse
Affiliation(s)
- Zhihua Li
- Department of Thoracic SurgeryJiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Wenzheng Xu
- Department of Thoracic SurgeryJiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Tianhao Gu
- Department of Thoracic SurgeryJiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Xincen Cao
- Department of Thoracic SurgeryJiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Weibing Wu
- Department of Thoracic SurgeryJiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Liang Chen
- Department of Thoracic SurgeryJiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| |
Collapse
|
11
|
Koezuka S, Sano A, Azuma Y, Sakai T, Matsumoto K, Shiraga N, Mikami T, Tochigi N, Murakami Y, Iyoda A. Combination of mean CT value and maximum CT value as a novel predictor of lepidic predominant lesions in small lung adenocarcinoma presenting as solid nodules. Sci Rep 2022; 12:5450. [PMID: 35361807 PMCID: PMC8971451 DOI: 10.1038/s41598-022-09173-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 03/15/2022] [Indexed: 11/09/2022] Open
Abstract
Lung adenocarcinomas presenting as solid nodules are occasionally diagnosed as lepidic predominant lesions. The aim of this study was to clarify the histological structure and to identify factors predictive of lepidic predominant lesions. We retrospectively reviewed 38 patients that underwent lobectomy for small (≤ 2 cm) adenocarcinoma presenting as solid nodules. Resected tumor slides were reviewed and histological components were evaluated. Clinical and radiological data were analyzed to identify factors predictive of lepidic predominant lesions. Of 38 solid nodules, 9 (23.7%) nodules were lepidic predominant lesions. Five-year disease-free survival (DFS) rates were 100% for lepidic predominant lesions (n = 9) and 74.6% for non-lepidic predominant lesions (n = 29). Mean CT values (p = 0.039) and maximum CT values (p = 0.015) were significantly lower in lepidic predominant lesions compared with non-lepidic predominant lesions. For the prediction of lepidic predominant lesions, the sensitivity and specificity of mean CT value (cutoff, - 150 HU) were 77.8% and 82.8%, respectively, and those of maximum CT value (cutoff, 320 HU) were 77.8% and 72.4%, respectively. A combination of mean and maximum CT values (cutoffs of - 150 HU and 380 HU for mean CT value and maximum CT value, respectively) more accurately predicted lepidic predominant lesions, with a sensitivity and specificity of 77.8% and 86.2%, respectively. The prognosis of lepidic predominant lesions was excellent, even for solid nodules. The combined use of mean and maximum CT values was useful for predicting lepidic predominant lesions, and may help predict prognosis.
Collapse
Affiliation(s)
- Satoshi Koezuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Atsushi Sano
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Yoko Azuma
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Takashi Sakai
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Keiko Matsumoto
- Department of Radiology, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Nobuyuki Shiraga
- Department of Radiology, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Tetuo Mikami
- Department of Pathology, Toho University School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Naobumi Tochigi
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Yoshitaka Murakami
- Departmant of Medical Statistics, Toho University, 5-21-16 Omori-nishi. Ota-ku, Tokyo, 143-8540, Japan
| | - Akira Iyoda
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.
| |
Collapse
|
12
|
Zhou S, Cai D, Chen C, Luo J, Wang R. Preoperative Changes of Lung Nodule on Computed Tomography and Their Relationship With Pathological Outcomes. Front Surg 2022; 9:836924. [PMID: 35372466 PMCID: PMC8965753 DOI: 10.3389/fsurg.2022.836924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundWhether changes of lung nodules on computed tomography could bring us helpful information related to their pathological outcomes remained unclear.Materials and MethodsThis retrospective study was carried out among 1,185 cases of lung nodules in Shanghai Chest Hospital from January 2015 to April 2017, which did not shrink or disappear after preoperative follow-up over three months. Their imaging features, changes, and clinical characteristics were collected. A separate analysis was performed in nodules with or without growth in long-axis diameter after follow-up, searching significant changes related to nodule malignancy and the median interval of follow-up for reference. Further study was performed similarly in malignant nodules for discrimination of malignant grading.ResultsMost nodules were stable (n = 885, 75%), whereas others grew (n = 300, 25%). For predicting nodule malignancy, increase in density (>10 Hounsfield units, median follow-up of 549 days) played an important role in growing group whereas it failed in stable group, and the increase in size was less significant in growing group. For discrimination of malignant grading, increase in density (>70 Hounsfield units, median follow-up of 366 days) showed its significance in stable group, and so did increase in size in growing group (maximum diameter growth >3.3 mm, median follow-up of 549 days, or average diameter growth >3.1 mm, median follow-up of 625 days).ConclusionsThere were significant changes of lung nodules by follow-up on computed tomography, related to their pathological outcomes. The predictive power of increase in density or size varied in different situations, whereas all referred to a long-time preoperative follow-up.
Collapse
|
13
|
Wang Q, Tan X, Ma L, Liu C. Dual Windows Are Significant: Learning from Mediastinal Window and Focusing on Lung Window. ARTIF INTELL 2022. [DOI: 10.1007/978-3-031-20497-5_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
14
|
Sugawara H, Watanabe H, Kunimatsu A, Abe O, Watanabe SI, Yatabe Y, Kusumoto M. Adenocarcinoma in situ and minimally invasive adenocarcinoma in lungs of smokers: image feature differences from those in lungs of non-smokers. BMC Med Imaging 2021; 21:172. [PMID: 34798844 PMCID: PMC8603503 DOI: 10.1186/s12880-021-00705-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE We aimed to examine the characteristics of imaging findings of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) in the lungs of smokers compared with those of non-smokers. MATERIALS AND METHODS We included seven cases of AIS and 20 cases of MIA in lungs of smokers (pack-years ≥ 20) and the same number of cases of AIS and MIA in lungs of non-smokers (pack-years = 0). We compared the diameter of the entire lesion and solid component measured on computed tomography (CT) images, pathological size and invasive component diameter measured from pathological specimens, and CT values of the entire lesion and ground-glass opacity (GGO) portions between the smoker and non-smoker groups. RESULTS The diameters of AIS and MIA on CT images and pathological specimens of the smoker group were significantly larger than those of the non-smoker group (p = 0.036 and 0.008, respectively), whereas there was no significant difference in the diameter of the solid component on CT images or invasive component of pathological specimens between the two groups. Additionally, mean CT values of the entire lesion and GGO component of the lesions in the smoker group were significantly lower than those in the non-smoker group (p = 0.036 and 0.040, respectively). CONCLUSION AIS and MIA in smoker's lung tended to have larger lesion diameter and lower internal CT values compared with lesions in non-smoker's lung. This study calls an attention on smoking status in CT-based diagnosis for early stage adenocarcinoma.
Collapse
Affiliation(s)
- Haruto Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
- Department of Radiology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
| | - Hirokazu Watanabe
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akira Kunimatsu
- Department of Radiology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| |
Collapse
|
15
|
Tan X, Liu B. [Radiofrequency Ablation for Lung Ground-glass Nodule]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 24:677-682. [PMID: 34696540 PMCID: PMC8560985 DOI: 10.3779/j.issn.1009-3419.2021.101.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
背景与目的 随着计算机断层扫描(computed tomography, CT)广泛应用于肺癌筛查,越来越多的肺磨玻璃结节(ground-glass nodule, GGN)被发现,尽早干预有利于提高肺癌患者的生存率。射频消融(radiofrequency ablation, RFA)是治疗原发性或转移性肺部恶性肿瘤的一种替代方法。本研究旨在探讨RFA治疗肺GGN的安全性和临床疗效。 方法 选择我院2016年6月-2021年3月收治的24例肺GGN患者,共计28枚结节,接受RFA治疗,其中男性13例,女性11例,平均年龄为(69.4±11.1)岁。接受RFA的GGN大小为(1.30±0.56)cm;消融范围为(2.50±0.63)cm;消融时间为(15.00±8.68)min。 结果 全部结节手术顺利,所有患者无围术期死亡,术中无严重并发症发生。中位随访时间为25个月。1例术后2个月因心梗去世。28个结节均无局部进展,局部控制率为100.0%。Kaplan-Meier分析患者1年、2年的总体生存率分别为95.8%、95.8%;肿瘤特异生存率分别为100.0%、100.0%。 结论 RFA是治疗肺GGN安全有效的微创技术。
Collapse
Affiliation(s)
- Xiaogang Tan
- Department of Thoracic Surgery, Xuan Wu Hospital of Capital Medical University, Beijing 100053, China
| | - Baodong Liu
- Department of Thoracic Surgery, Xuan Wu Hospital of Capital Medical University, Beijing 100053, China
| |
Collapse
|
16
|
Prognostic Impact of the Histologic Lepidic Component in Pathologic Stage IA Adenocarcinoma. J Thorac Oncol 2021; 17:67-75. [PMID: 34634451 DOI: 10.1016/j.jtho.2021.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/13/2021] [Accepted: 09/02/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Because several articles have reported a prognostic association with the radiologic features of ground-glass opacity, we explored whether the histologic presence of a lepidic component had similar significance. METHODS We retrospectively evaluated 380 consecutive surgically resected lung adenocarcinomas (ADCs) of pathologic (p)stage IA. The tumors were classified into lepidic-positive and lepidic-negative ADCs. Clinicopathologic characteristics, radiographic ground-glass opacity status, and disease-free survival were compared between lepidic-positive and lepidic-negative ADCs and between part-solid and solid nodules on computed tomography images. RESULTS Of the 380 cases, 176 (46.3%) were lepidic-positive ADCs. Of the overall patients with pT1, lepidic-positive ADCs were found to have significantly better recurrence-free survival (5 y, 95.4% versus 87.0%, p = 0.005), but this significance was not reproduced in pT1 subcategories (pT1a, pT1b, and pT1c). Furthermore, the presence of the lepidic component was not an independent prognostic factor in the multivariate analysis (hazard ratio = 0.46 [95% confidence interval: 0.19-1.14], p = 0.09). We also analyzed the extent of the lepidic component with 10% incremental valuables. Although we found that a 10% or greater extent of lepidic component made the recurrence-free survival difference the largest, a clear prognostic impact was not obtained with this cutoff point. CONCLUSIONS Although lepidic-positive ADCs tended to have a favorable outcome, the lepidic component was not a clear independent prognostic factor in pstage I ADC.
Collapse
|
17
|
Tumor size in patients with severe pulmonary emphysema might be underestimated on preoperative CT. Eur Radiol 2021; 32:163-173. [PMID: 34132872 DOI: 10.1007/s00330-021-08105-3] [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: 10/30/2020] [Revised: 05/07/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the effect of emphysema on tumor diameter measured on preoperative computed tomography (CT) images versus pathological specimens. MATERIALS AND METHODS We investigated patients who underwent primary lung cancer surgery: 55 patients (57 tumors) with severe emphysema and 57 patients (57 tumors) without emphysema. The tumor diameters measured in the postoperative pathological specimens were compared with those measured on the axial CT images and on multiplanar reconstruction (MPR) CT images by two independent radiologists; a subgroup analysis according to tumor size was also performed. A paired or unpaired t test was performed, depending on the tested subjects. RESULTS In the emphysema group, the mean axial CT diameter was significantly smaller than the mean pathological diameter (p = 0.025/0.001 for reader 1/2), whereas in the non-emphysema group, the mean axial CT diameter was not significantly different from the pathological one for both readers. The difference between CT axial diameter and pathological diameter (= CT diameter - pathological diameter) was significantly smaller (i.e., had a stronger tendency toward underestimation on radiological measurements) in the emphysema group compared with the non-emphysema group (p = 0.014/0.008 for reader 1/2), and the difference was significantly smaller in tumors sized > 30 mm than tumors sized ≤ 20 mm in both groups. CONCLUSIONS Tumor size is significantly smaller on preoperative CT in patients with severe emphysema compared to patients without emphysema, especially in the case of large tumors. MPR measurement using the widest of three dimensions should be used to select T-stage for patients with severe emphysema. KEY POINTS • The presence of emphysema affects the accuracy of tumor size measurements on CT. • Compared to patients without emphysema, the tumor size in severe emphysema patients tends to be measured smaller in preoperative CT than the pathological specimen. • This trend is more evident when large tumors are measured on axial CT images alone.
Collapse
|
18
|
Ye X, Fan W, Wang Z, Wang J, Wang H, Wang J, Wang C, Niu L, Fang Y, Gu S, Tian H, Liu B, Zhong L, Zhuang Y, Chi J, Sun X, Yang N, Wei Z, Li X, Li X, Li Y, Li C, Li Y, Yang X, Yang W, Yang P, Yang Z, Xiao Y, Song X, Zhang K, Chen S, Chen W, Lin Z, Lin D, Meng Z, Zhao X, Hu K, Liu C, Liu C, Gu C, Xu D, Huang Y, Huang G, Peng Z, Dong L, Jiang L, Han Y, Zeng Q, Jin Y, Lei G, Zhai B, Li H, Pan J. [Expert Consensus for Thermal Ablation of Pulmonary Subsolid Nodules (2021 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 24:305-322. [PMID: 33896152 PMCID: PMC8174112 DOI: 10.3779/j.issn.1009-3419.2021.101.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
局部热消融技术在肺部结节治疗领域正处在起步与发展阶段,为了肺结节热消融治疗的临床实践和规范发展,由“中国医师协会肿瘤消融治疗技术专家组”“中国医师协会介入医师分会肿瘤消融专业委员会”“中国抗癌协会肿瘤消融治疗专业委员会”“中国临床肿瘤学会消融专家委员会”组织多学科国内有关专家,讨论制定了“热消融治疗肺部亚实性结节专家共识(2021年版)”。主要内容包括:①肺部亚实性结节的临床评估;②热消融治疗肺部亚实性结节技术操作规程、适应证、禁忌证、疗效评价和相关并发症;③存在的问题和未来发展方向。
Collapse
Affiliation(s)
- Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
| | - Weijun Fan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510050, China
| | - Zhongmin Wang
- Department of Interventional Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China
| | - Hui Wang
- Interventional Center, Jilin Provincial Cancer Hospital, Changchun 170412, China
| | - Jun Wang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
| | - Chuntang Wang
- Department of Thoracic Surgery, Dezhou Second People's Hospital, Dezhou 253022, China
| | - Lizhi Niu
- Department of Oncology, Affiliated Fuda Cancer Hospital, Jinan University, Guangzhou 510665, China
| | - Yong Fang
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Shanzhi Gu
- Department of Interventional Radiology, Hunan Cancer Hospital, Changsha 410013, China
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Baodong Liu
- Department of Thoracic Surgery, Xuan Wu Hospital Affiliated to Capital Medical University, Beijing 100053, China
| | - Lou Zhong
- Thoracic Surgery Department, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Yiping Zhuang
- Department of Interventional Therapy, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Jiachang Chi
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Xichao Sun
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Nuo Yang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Zhigang Wei
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
| | - Xiao Li
- Department of Interventional Therapy, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiaoguang Li
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, Beijing 100730, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, China
| | - Chunhai Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Yan Li
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Afliated to Shandong First Medical University, Jinan 250101, China
| | - Wuwei Yang
- Department of Oncology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing 100071, China
| | - Po Yang
- Interventionael & Vascular Surgery, The Fourth Hospital of Harbin Medical University, Harbin 150001, China
| | - Zhengqiang Yang
- Department of Interventional Therapy, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yueyong Xiao
- Department of Radiology, Chinese PLA Gneral Hospital, Beijing 100036, China
| | - Xiaoming Song
- Department of Thoracic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
| | - Kaixian Zhang
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou 277500, China
| | - Shilin Chen
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Weisheng Chen
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian 350011, China
| | - Zhengyu Lin
- Department of Intervention, The First Affiliated Hospital of Fujian Medical University, Fujian 350005, China
| | - Dianjie Lin
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Zhiqiang Meng
- Minimally Invasive Therapy Center, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Xiaojing Zhao
- Department of Thoracic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Kaiwen Hu
- Department of Oncology, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100078, China
| | - Chen Liu
- Department of Interventional Therapy, Beijing Cancer Hospital, Beijing 100161, China
| | - Cheng Liu
- Department of Radiology, Shandong Medical Imaging Research Institute, Jinan 250021, China
| | - Chundong Gu
- Department of Thoracic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Dong Xu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310022, China
| | - Yong Huang
- Department of Imaging, Affiliated Cancer Hospital of Shandong First Medical University, Jinan 250117, China
| | - Guanghui Huang
- Department of Oncology, Shandong Provincial Hospital Afliated to Shandong First Medical University, Jinan 250101, China
| | - Zhongmin Peng
- Department of Thoracic Surgery , Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Liang Dong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
| | - Lei Jiang
- Department of Radiology, The Convalescent Hospital of East China, Wuxi 214063, China
| | - Yue Han
- Department of Interventional Therapy, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qingshi Zeng
- Department of Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
| | - Yong Jin
- Interventionnal Therapy Department, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Guangyan Lei
- Department of Thoracic Surgery, Shanxi Provincial Cancer Hospital, Xi'an 710061, China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Hailiang Li
- Department of Interventional Radiology, Henan Cancer Hospital, Zhengzhou 450003, China
| | - Jie Pan
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | | | | | | | | |
Collapse
|
19
|
Saeki Y, Kitazawa S, Yanagihara T, Kobayashi N, Kikuchi S, Goto Y, Ichimura H, Sato Y. Consolidation volume and integration of computed tomography values on three-dimensional computed tomography may predict pathological invasiveness in early lung adenocarcinoma. Surg Today 2021; 51:1320-1327. [PMID: 33547958 DOI: 10.1007/s00595-021-02231-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the relationship between three-dimensional computed tomography (3D-CT) findings and pathological invasiveness in lung adenocarcinoma. METHODS We retrospectively evaluated 95 patients who underwent surgical resection of lung adenocarcinoma of ≤ 20 mm. The diameters, volumes, and CT values of tumor consolidation were analyzed. We defined the modified CT value by setting air as 0 and water as 1000 and assumed a correlation with pathological invasiveness. Pre-invasive lesions and minimally invasive adenocarcinomas were classified as non-invasive adenocarcinoma. We compared the clinico-radiological features with pathological invasiveness. Receiver operator characteristic (ROC) curves and recurrence-free survival curves were constructed. RESULTS Twenty-six non-invasive adenocarcinomas and 69 invasive adenocarcinomas were evaluated. The multivariate analysis revealed that the consolidation volume and the integration of modified CT values were the most important predictors of pathological invasion. The area under the ROC curve and the cut-off values of the consolidation volume were 0.868 and 75 mm3, respectively. The area under the ROC curve and the cut-off values of the integration of modified CT values were 0.871 and 80,000, respectively. There was no recurrence in cases with values below the cut-off across all parameters. CONCLUSION The consolidation volume and integration of modified CT values were shown to be highly predictive of pathological invasiveness.
Collapse
Affiliation(s)
- Yusuke Saeki
- Department of General Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shinsuke Kitazawa
- Department of General Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takahiro Yanagihara
- Department of General Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Naohiro Kobayashi
- Department of General Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shinji Kikuchi
- Department of General Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukinobu Goto
- Department of General Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hideo Ichimura
- Department of General Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukio Sato
- Department of General Thoracic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| |
Collapse
|
20
|
Abstract
Most focal persistent ground glass nodules (GGNs) do not progress over 10 years. Research suggests that GGNs that do not progress, those that do, and solid lung cancers are fundamentally different diseases, although histologically they seem similar. Surveillance of GGNs to identify those that gradually progress is safe and does not risk losing a window. GGNs with 5 mm solid component or less than 10 mm consolidation (mediastinal and lung windows, respectively, on thin slice CT) are highly curable with resection. The optimal type of resection is unclear; sublobar resection is reasonable but an adequate margin is critically important.
Collapse
Affiliation(s)
- Vincent J Mase
- Department of Surgery, Division of Thoracic Surgery, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520-8062, USA
| | - Frank C Detterbeck
- Department of Surgery, Division of Thoracic Surgery, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520-8062, USA.
| |
Collapse
|
21
|
Lynch DA, Oh AS. High-Spatial-Resolution CT Offers New Opportunities for Discovery in the Lung. Radiology 2020; 297:472-473. [DOI: 10.1148/radiol.2020203473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David A. Lynch
- From the Department of Radiology, National Jewish Health, 1400 Jackson St, Denver, CO 80206
| | - Andrea S. Oh
- From the Department of Radiology, National Jewish Health, 1400 Jackson St, Denver, CO 80206
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Azour L, Ko JP, Naidich DP, Moore WH. Shades of Gray: Subsolid Nodule Considerations and Management. Chest 2020; 159:2072-2089. [PMID: 33031828 PMCID: PMC7534873 DOI: 10.1016/j.chest.2020.09.252] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/16/2020] [Accepted: 09/27/2020] [Indexed: 12/15/2022] Open
Abstract
Subsolid nodules are common on chest CT imaging and may be either benign or malignant. Their varied features and broad differential diagnoses present management challenges. Although subsolid nodules often represent lung adenocarcinomas, other possibilities are common and influence management. Practice guidelines exist for subsolid nodule management for both incidentally and screening-detected nodules, incorporating patient and nodule characteristics. This review highlights the similarities and differences among these algorithms, with the intent of providing a resource for comparison and aid in choosing management options.
Collapse
Affiliation(s)
- Lea Azour
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY.
| | - Jane P Ko
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
| | - David P Naidich
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
| | - William H Moore
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
| |
Collapse
|
24
|
Yanagawa M, Tsubamoto M, Satoh Y, Hata A, Miyata T, Yoshida Y, Kikuchi N, Kurakami H, Tomiyama N. Lung Adenocarcinoma at CT with 0.25-mm Section Thickness and a 2048 Matrix: High-Spatial-Resolution Imaging for Predicting Invasiveness. Radiology 2020; 297:462-471. [PMID: 32897161 DOI: 10.1148/radiol.2020201911] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background High-spatial-resolution (HSR) CT provides detailed information and clear delineation of lung anatomy and disease states. HSR CT may have high diagnostic performance for predicting invasiveness of lung adenocarcinoma. Purpose To examine the diagnostic performance of HSR CT in predicting the invasiveness of lung adenocarcinoma. Materials and Methods In this retrospective study, 89 consecutive patients with adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), or invasive adenocarcinoma (IVA) were included who underwent surgery for lung cancer between January 2018 and December 2019. All patients underwent HSR CT with 0.25-mm section thickness and a 2048 matrix. Two independent observers evaluated the images for the presence or absence of the following HSR CT findings: lobulation, spiculation, pleural indentation, vessel convergence, homogeneity of ground-glass opacity, reticulation, irregularity and centrality of solid portion, and air bronchiologram (irregularity, disruption, or dilatation). The total diameter (≤1.6 cm or >1.6 cm) and the longest diameter of the solid portion (≤0.8 cm or >0.8 cm) were evaluated. Logistic regression models were used to identify findings associated with MIA plus IVA. Receiver operating characteristic analysis was performed to determine diagnostic performance. Results Eighty-nine patients (mean, 69 years ± 11 [standard deviation]; 49 men) were evaluated. The size of the nodules with invasion was a mean of 2.5 cm ± 1.2. Univariable analysis revealed lobulation, spiculation, pleural indentation, irregular and central solid portion, air bronchiologram with disruption and/or irregular dilatation, and total and solid portion diameters as associated with MIA plus IVA (all, P < .05). After adjustment for age, sex, and pack-years of smoking, disruption of air bronchogram and solid portion diameter greater than 0.8 cm remained as predictors of invasiveness (P = .001 and P = .02, respectively). The diagnostic performance of these two findings combined were as follows: sensitivity of 97% (59 of 61 patients; 95% confidence interval: 94%, 100%) and specificity of 86% (19 of 22 patients; 95% confidence interval: 65%, 97%), with an area under the curve of 0.94. Conclusion Using high-spatial-resolution CT, disruption of air bronchiologram and a solid portion greater than 0.8 cm were independently associated with a greater likelihood of invasiveness in lung adenocarcinoma. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Lynch and Oh in this issue.
Collapse
Affiliation(s)
- Masahiro Yanagawa
- From the Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-city, Osaka 565-0871, Japan (M.Y., M.T., Y.S., A.H., T.M., Y.Y., N.K., N.T.); and Department of Medical Innovation, Osaka University, Suita-city, Osaka, Japan (H.K.)
| | - Mitsuko Tsubamoto
- From the Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-city, Osaka 565-0871, Japan (M.Y., M.T., Y.S., A.H., T.M., Y.Y., N.K., N.T.); and Department of Medical Innovation, Osaka University, Suita-city, Osaka, Japan (H.K.)
| | - Yukihisa Satoh
- From the Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-city, Osaka 565-0871, Japan (M.Y., M.T., Y.S., A.H., T.M., Y.Y., N.K., N.T.); and Department of Medical Innovation, Osaka University, Suita-city, Osaka, Japan (H.K.)
| | - Akinori Hata
- From the Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-city, Osaka 565-0871, Japan (M.Y., M.T., Y.S., A.H., T.M., Y.Y., N.K., N.T.); and Department of Medical Innovation, Osaka University, Suita-city, Osaka, Japan (H.K.)
| | - Tomo Miyata
- From the Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-city, Osaka 565-0871, Japan (M.Y., M.T., Y.S., A.H., T.M., Y.Y., N.K., N.T.); and Department of Medical Innovation, Osaka University, Suita-city, Osaka, Japan (H.K.)
| | - Yuriko Yoshida
- From the Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-city, Osaka 565-0871, Japan (M.Y., M.T., Y.S., A.H., T.M., Y.Y., N.K., N.T.); and Department of Medical Innovation, Osaka University, Suita-city, Osaka, Japan (H.K.)
| | - Noriko Kikuchi
- From the Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-city, Osaka 565-0871, Japan (M.Y., M.T., Y.S., A.H., T.M., Y.Y., N.K., N.T.); and Department of Medical Innovation, Osaka University, Suita-city, Osaka, Japan (H.K.)
| | - Hiroyuki Kurakami
- From the Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-city, Osaka 565-0871, Japan (M.Y., M.T., Y.S., A.H., T.M., Y.Y., N.K., N.T.); and Department of Medical Innovation, Osaka University, Suita-city, Osaka, Japan (H.K.)
| | - Noriyuki Tomiyama
- From the Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-city, Osaka 565-0871, Japan (M.Y., M.T., Y.S., A.H., T.M., Y.Y., N.K., N.T.); and Department of Medical Innovation, Osaka University, Suita-city, Osaka, Japan (H.K.)
| |
Collapse
|
25
|
Impact of tumor disappearance ratio on the prognosis of lung adenocarcinoma ≤2 cm in size: A retrospective cohort study. J Formos Med Assoc 2020; 120:874-882. [PMID: 32891489 DOI: 10.1016/j.jfma.2020.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/PURPOSE Lung cancer patients can have advanced-stages at diagnosis, even the tumor size is ≤2 cm. We aimed to study the relationship between image characteristics, clinical, and patholoigcal results. METHODS We retrospectively enrolled patients with lung adenocarcinoma at Taichung Veterans General Hospital and Chang Gung Memorial Hospital from 2007 to 2015, who were diagnosed with treatment naïve primary tumor lesions at sizes less than 2 cm, as measured by computed tomography (CT) scans. The patient was analyzed for lymph node (LN) and distant metastasis evaluation, with clinicopathological characteristics, including tumor-disappearance ratio (TDR) (tumor diameter at the mediastinal/lung window) over chest CT scans, pathological diagnosis, disease-free survival (DFS), and overall survival (OS). RESULTS Totally 280 patients were surveyed initially and showed significantly increase of clinical LN involvement and distant metastasis when TDR ≤75% compared with >75% (21.6% vs 0% for LN involvement; 27.1% vs 0% for distant metastasis; both p < 0.001). We included 199 patients having surgical treatment and follow-up for the survival analysis. With a TDR ≤75%, significantly worse DFS (HR, 19.23; 95% CI, 2.60-142.01; p = 0.004) and a trend of worse OS (HR, 4.97; 95% CI, 0.61-40.61; p = 0.134) were noted by Kaplan-Meier method. TDR ≤75% revealed more advanced pathological stage, and more tumors containing micropapillary or solid subtypes when diagnosed adenocarcinoma. CONCLUSION For lung cancer patients with primary tumor ≤2 cm, TDR ≤75% was related to more advanced stages, the presence of micropapillary or solid components of adenocarcinoma subtypes, worse DFS, and a trend of worse OS.
Collapse
|
26
|
de Margerie-Mellon C, Gill RR, Salazar P, Oikonomou A, Nguyen ET, Heidinger BH, Medina MA, VanderLaan PA, Bankier AA. Assessing invasiveness of subsolid lung adenocarcinomas with combined attenuation and geometric feature models. Sci Rep 2020; 10:14585. [PMID: 32883973 PMCID: PMC7471897 DOI: 10.1038/s41598-020-70316-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/13/2020] [Indexed: 01/22/2023] Open
Abstract
The aim of this study was to develop and test multiclass predictive models for assessing the invasiveness of individual lung adenocarcinomas presenting as subsolid nodules on computed tomography (CT). 227 lung adenocarcinomas were included: 31 atypical adenomatous hyperplasia and adenocarcinomas in situ (class H1), 64 minimally invasive adenocarcinomas (class H2) and 132 invasive adenocarcinomas (class H3). Nodules were segmented, and geometric and CT attenuation features including functional principal component analysis features (FPC1 and FPC2) were extracted. After a feature selection step, two predictive models were built with ordinal regression: Model 1 based on volume (log) (logarithm of the nodule volume) and FPC1, and Model 2 based on volume (log) and Q.875 (CT attenuation value at the 87.5% percentile). Using the 200-repeats Monte-Carlo cross-validation method, these models provided a multiclass classification of invasiveness with discriminative power AUCs of 0.83 to 0.87 and predicted the class probabilities with less than a 10% average error. The predictive modelling approach adopted in this paper provides a detailed insight on how the value of the main predictors contribute to the probability of nodule invasiveness and underlines the role of nodule CT attenuation features in the nodule invasiveness classification.
Collapse
Affiliation(s)
| | - Ritu R Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Anastasia Oikonomou
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Elsie T Nguyen
- Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Benedikt H Heidinger
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Mayra A Medina
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Alexander A Bankier
- Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
27
|
The Use of Artificial Intelligence in the Differentiation of Malignant and Benign Lung Nodules on Computed Tomograms Proven by Surgical Pathology. Cancers (Basel) 2020; 12:cancers12082211. [PMID: 32784681 PMCID: PMC7464412 DOI: 10.3390/cancers12082211] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 01/23/2023] Open
Abstract
The purpose of this work was to evaluate the performance of an existing commercially available artificial intelligence (AI) software system in differentiating malignant and benign lung nodules. The AI tool consisted of a vessel-suppression function and a deep-learning-based computer-aided-detection (VS-CAD) analyzer. Fifty patients (32 females, mean age 52 years) with 75 lung nodules (47 malignant and 28 benign) underwent low-dose computed tomography (LDCT) followed by surgical excision and the pathological analysis of their 75 nodules within a 3 month time frame. All 50 cases were then processed by the AI software to generate corresponding VS images and CAD outcomes. All 75 pathologically proven lung nodules were well delineated by vessel-suppressed images. Three (6.4%) of the 47 lung cancer cases, and 11 (39.3%) of the 28 benign nodules were ignored and not detected by the AI without showing a CAD analysis summary. The AI system/radiologists produced a sensitivity and specificity (shown in %) of 93.6/89.4 and 39.3/82.1 in distinguishing malignant from benign nodules, respectively. AI sensitivity was higher than that of radiologists, though not statistically significant (p = 0.712). Specificity obtained by the radiologists was significantly higher than that of the VS-CAD AI (p = 0.003). There was no significant difference between the malignant and benign lesions with respect to age, gender, pure ground-glass pattern, the diameter and location of the nodules, or nodules <6 vs. ≥6 mm. However, more part-solid nodules were proven to be malignant than benign (90.9% vs. 9.1%), and more solid nodules were proven to be benign than malignant (86.7% vs. 13.3%) with statistical significance (p = 0.001 and <0.001, respectively). A larger cohort and prospective study are required to validate the AI performance.
Collapse
|
28
|
Na KJ, Park IK, Park S, Kang CH, Kim YT. Efficacy and Cost-effectiveness of Surgical Biopsy for Histologic Diagnosis of Indeterminate Nodules Suspected for Early Stage Lung Cancer: Comparison with Percutaneous Needle Biopsy. J Korean Med Sci 2020; 35:e261. [PMID: 32686374 PMCID: PMC7371454 DOI: 10.3346/jkms.2020.35.e261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/25/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Indeterminate pulmonary nodules (IPN) suspected for early stage lung cancer mandate accurate diagnosis. Both percutaneous needle biopsy (PCNB) and surgical biopsy (SB) are valuable options. The present study aimed to compare the efficacy and cost-effectiveness between PCNB and SB for IPN suspected for early stage lung cancer. METHODS During January-November 2018, patients who underwent operation for IPN suspected for early stage lung cancer (SB group, n = 245) or operation after PCNB (PCNB group, n = 113) were included. Patient-level cost data were extracted from medical bills from the institution. Propensity score matching was performed between the two groups from a retrospectively-collected database. RESULTS Fifteen patients (11.5%) had complications after PCNB; thirteen (11.5%) were not confirmed to have lung cancer through PCNB but underwent operation for IPN. In SB group, 172 (70.2%) and 7 (2.9%) patients underwent wedge resection and segmentectomy for SB, respectively; 66 patients (26.9%) underwent direct lobectomy without SB. After propensity score matching, 58 paired samples were produced. Most patients in PCNB group were admitted twice (n = 55, 94.8%). The average hospital stay was longer in PCNB group (12.9 ± 5.3 vs. 7.3 ± 3.0, P < 0.001). Though the cost of the operation was comparable (USD 12,509 ± 2,909 vs. 12,669 ± 3,334; P = 0.782), the total cost was higher for PCNB group (USD 14,403 ± 3,085 vs. 12,669 ± 3,334; P = 0.006). The average subcategory cost, which increases proportional to hospital stay, was higher in PCNB group, whereas the cost of operation and surgical materials were comparable between the two groups. CONCLUSION Lung cancer operation following SB for IPN was associated with lesser cost, shorter hospital stays, and lesser admission time than lung cancer operation after PCNB. The increased cost and longer hospital stay appear largely related to the admission for PCNB.
Collapse
Affiliation(s)
- Kwon Joong Na
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea.
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
29
|
Lee JH, Park CM. Differentiation of persistent pulmonary subsolid nodules with a solid component smaller than 6 mm: to be invasive adenocarcinoma or not to be? J Thorac Dis 2020; 12:1754-1757. [PMID: 32642078 PMCID: PMC7330336 DOI: 10.21037/jtd-20-1645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Jong Hyuk Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
30
|
Funai K, Kawase A, Mizuno K, Koyama S, Shiiya N. 8th Edition Tumor, Node, and Metastasis T-Stage Prognosis Discrepancies: Solid Component Diameter Predicts Prognosis Better than Invasive Component Diameter. Cancers (Basel) 2020; 12:cancers12061577. [PMID: 32549242 PMCID: PMC7353035 DOI: 10.3390/cancers12061577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/25/2022] Open
Abstract
The biggest change in the 8th edition of the tumor, lymph node, and metastasis (TNM) classification is the recommendation of the solid component diameter and invasive size for determining the clinical and pathological T-factor, respectively. Here, we validated new proposals for the Lung Cancer TNM classification’s revision and compared clinical and pathological T-stages. We retrospectively analyzed 177 cases of non-small cell lung cancers without lymph node metastasis, and involving complete resection, that occurred in our department between January 2017 and March 2019. We reviewed the overall tumor diameter, solid component diameter, and clinical T-factor on computed tomography (CT), and the pathological tumor diameter, pathological invasion diameter, pathological T-factor, and prognosis. The difference between the pathological invasive size and solid size on CT was within 5 mm in 99 cases (56%). At a two-year recurrence-free survival rate, the clinical T-stage demonstrated a better prognostic outcome than the pathological T-stage. Despite including the benign findings, the solid component diameter was better correlated with prognosis than the invasive size. Therefore, in cases of discrepancies of clinically and pathologically detected tumor size, the solid CT size should also be used for the pathological T classification.
Collapse
Affiliation(s)
- Kazuhito Funai
- Correspondence: ; Tel.: +81-53-435-2276; Fax: +81-53-435-2272
| | | | | | | | | |
Collapse
|
31
|
Lung Cancer Incidence and Mortality with Extended Follow-up during Screening. J Thorac Oncol 2020; 14:1692-1694. [PMID: 31558228 DOI: 10.1016/j.jtho.2019.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 10/25/2022]
|
32
|
Chang C, Sun X, Zhao W, Wang R, Qian X, Lei B, Wang L, Liu L, Ruan M, Xie W, Shen J. Minor components of micropapillary and solid subtypes in lung invasive adenocarcinoma (≤ 3 cm): PET/CT findings and correlations with lymph node metastasis. Radiol Med 2019; 125:257-264. [PMID: 31823295 DOI: 10.1007/s11547-019-01112-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/13/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the PET/CT findings in lung invasive adenocarcinoma with minor components of micropapillary or solid contents and its association with lymph node metastasis. MATERIALS AND METHODS A total of 506 lung invasive adenocarcinoma (≤ 3 cm) patients who underwent a PET/CT examination and resection surgery were included. According to the proportion of solid/micropapillary components, the patients were classified into three groups: solid/micropapillary-negative (SMPN) (n = 258), solid/micropapillary-minor (SMPM; > 5% not predominant) (n = 158) and solid/micropapillary-predominant (SMPP; > 5% most dominant) (n = 90). The patients' PET/CT findings, including SUVmax, MTV, TLG and CT characteristics, and other clinical factors were compared by one-way ANOVA test. Logistic regression analysis was done to identify the most predictive findings for lymph node metastasis. RESULTS The value of SUVmax, MTV, TLG and tumor size was highest in SMPP group, followed by SMPM and SMPN group (P < 0.001).The areas under the curve for SUVmax, MTV and TLG for node metastasis were 0.822, 0.843 and 0.835, respectively. Univariate analysis found that the SMPP and SMPM group had more lymph node metastasis than the SMPN group (P < 0.001). Furthermore, the lymph node metastasis group had higher CEA, SUVmax, MTV, TLG, tumor size and more pleural invasion (P < 0.001). Logistic regression analysis found that SMPP pathological type, SMPM pathological type, higher CEA and male patients were risk factors for lymph node metastasis (P < 0.01). CONCLUSIONS Lung invasive adenocarcinoma with micropapillary or solid contents had higher SUVmax, MTV, TLG and tumor size and was associated with lymph node metastasis, even if they were not predominant.
Collapse
Affiliation(s)
- Cheng Chang
- Department of Radiology, Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Gusu District, Suzhou, 215000, Jiangsu, China.,Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Xiaoyan Sun
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Wenlu Zhao
- Department of Radiology, Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Gusu District, Suzhou, 215000, Jiangsu, China
| | - Rui Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Xiaohua Qian
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Bei Lei
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Lihua Wang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Liu Liu
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Maomei Ruan
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China
| | - Wenhui Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road, Shanghai, 200030, China.
| | - Junkang Shen
- Department of Radiology, Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Gusu District, Suzhou, 215000, Jiangsu, China.
| |
Collapse
|
33
|
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.
Collapse
|
34
|
Samejima J, Ito H, Nakayama H, Nagashima T, Osawa J, Inafuku K, Suzuki M, Yokose T, Yamada K, Masuda M. Which Window Setting Is Best for Estimating Pathologic Invasive Size and Invasiveness? Ann Thorac Surg 2019; 108:384-391. [DOI: 10.1016/j.athoracsur.2019.03.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 12/20/2022]
|
35
|
Iwano S, Umakoshi H, Kamiya S, Yokoi K, Kawaguchi K, Fukui T, Naganawa S. Postoperative recurrence of clinical early-stage non-small cell lung cancers: a comparison between solid and subsolid nodules. Cancer Imaging 2019; 19:33. [PMID: 31174613 PMCID: PMC6555755 DOI: 10.1186/s40644-019-0219-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/26/2019] [Indexed: 12/25/2022] Open
Abstract
Background For subsolid non-small cell lung cancers (NSCLCs), solid size (SS), which is the maximal diameter of the solid component, correlates more accurately with tumor prognosis than the total size, which is the maximal diameter of the entire tumor, including ground-glass opacity. We reviewed the propriety of the TNM staging based on the SS for early-stage NSCLCs. Methods We retrospectively reviewed the preoperative radiological reports, clinical records, and pathological reports of NSCLC cases in our hospital between 2010 and 2013, and clinical stage (c-Stage) 0 and I tumors were selected. Disease-free survival (DFS), based on survival analysis, was used to assess the tumor characteristics that predicted the prognosis. Results A total of 247 NSCLC diagnoses in 231 patients (88 women and 143 men; age, 67 ± 7 years) were included in our cohort. They were classified into solid (n = 131) and subsolid (n = 116) nodules. The DFS curves indicated that prognosis was significantly worse in the following order: c-Stage 0, c-Stage IA, and c-Stage IB tumors (p = 0.016). Patients with solid nodules showed a significantly worse prognosis than patients with subsolid nodules (p < 0.001). A multivariate Cox proportional hazards model showed that the significant predictive factors for DFS were c-Stage (hazard ratio, 1.600; p = 0.020) and solid nodules (hazard ratio, 3.077; p = 0.031). Conclusions For early-stage NSCLCs, the c-Stage based on the SS in subsolid nodules was useful for predicting postoperative DFS. In addition, whether nodules were solid or subsolid was another independent prognostic factor.
Collapse
Affiliation(s)
- Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Hiroyasu Umakoshi
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Department of Radiology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Shinichiro Kamiya
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Kawaguchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| |
Collapse
|
36
|
Utility of Metabolic Parameters on FDG PET/CT in the Classification of Early-Stage Lung Adenocarcinoma. Clin Nucl Med 2019; 44:560-565. [DOI: 10.1097/rlu.0000000000002591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
37
|
Rizzo S, Savoldi F, Rossi D, Bellomi M. Radiogenomics as association between non-invasive imaging features and molecular genomics of lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:447. [PMID: 30603635 DOI: 10.21037/atm.2018.11.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Stefania Rizzo
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, IT, Italy
| | - Filippo Savoldi
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, IT, Italy
| | - Duccio Rossi
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, IT, Italy
| | - Massimo Bellomi
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, IT, Italy.,Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, IT, Italy
| |
Collapse
|
38
|
Patil PD, Sultan S, Hahn MF, Roy SB, Ross MD, Abdelrazek H, Bremner RM, Thawani N, Walia R, Panchabhai TS. Incidental extensive adenocarcinoma in lungs explanted from a transplant recipient with an idiopathic pulmonary fibrosis flare-up: A clinical dilemma. Respir Med Case Rep 2018; 25:45-48. [PMID: 29942737 PMCID: PMC6011045 DOI: 10.1016/j.rmcr.2018.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 01/06/2023] Open
Abstract
Patients under consideration for lung transplantation as treatment for end-stage lung diseases such as idiopathic pulmonary fibrosis (IPF) often have risk factors such as a history of smoking or concomitant emphysema, both of which can predispose the patient to lung cancer. In fact, IPF itself increases the risk of lung cancer development by 6.8% to 20%. Solid organ malignancy (non-skin) is an established contraindication for lung transplantation. We encountered a clinical dilemma in a patient who presented with an IPF flare-up and underwent urgent evaluation for lung transplantation. After transplant, the patient's explanted lungs showed extensive adenocarcinoma in situ, with the foci of invasion and metastatic adenocarcinoma in N1-level lymph nodes, as well as usual interstitial pneumonia. Retrospectively, we saw no evidence to suggest malignancy in addition to the IPF flare-up. Clinical diagnostic dilemmas such as this emphasize the need for new noninvasive testing that would facilitate malignancy diagnosis in patients too sick to undergo invasive tissue biopsy for diagnosis. Careful pathological examination of explanted lungs in patients with IPF is critical, as it can majorly influence immunosuppressive regimens, surveillance imaging, and overall prognosis after lung transplant.
Collapse
Affiliation(s)
- Pradnya D. Patil
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir Sultan
- Department of Pulmonary and Critical Care Medicine, University of Arizona College of Medicine, Banner University Medical Center, Phoenix, AZ, USA
| | - M. Frances Hahn
- Department of Pathology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Sreeja Biswas Roy
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Mitchell D. Ross
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Hesham Abdelrazek
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Ross M. Bremner
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Nitika Thawani
- Department of Radiation Oncology, University of Arizona Cancer Center at St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Rajat Walia
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Tanmay S. Panchabhai
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
- Corresponding author. Department of Pulmonology, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Rd., Suite 500, Phoenix, AZ 85013, USA.
| |
Collapse
|