Correlations between thin-section CT findings, histopathological and clinical findings of small pulmonary adenocarcinomas

Curative Effects of Dianthus orientalis against Paracetamol Triggered Oxidative Stress, Hepatic and Renal Injuries in Rabbit as an Experimental Model

The aim of the present study investigates the hepatoprotective, nephroprotective and hematopoietic and antioxidant effects of Dianthus orientalis leaves aqueous extract (DO.AQ) in rabbits intoxicated with paracetamol. Different experimental groups were formed, i.e., group N, group T, group ELD, group EMD, group EHD and group SM. The groups with leaves aqueous extract of Dianthus orientalis of 200 and 400 mg/kg body weight, i.e., group EMD and group EHD, showed remedial effects; however, a high dose extract significantly (p < 0.05) reduced the elevated serum levels of alanine transaminase ALT, aspartate transaminase AST and alkaline phosphatase ALP and renal related indices such as serum creatinine, urea and uric acid, and serum electrolytes such as Ca, Mg, P, Na and K, as well as the total count of RBC, WBC, platelets and hemoglobin Hb concentration, mean corpuscular hemoglobin MCH concentration and hematocrit HCT values. Additionally, the extract showed positive effects on the lipid profile, i.e., decreasing levels of cholesterol, triglycerides and LDL and increasing levels of HDL. The levels of thiobarbituric acid reactive substances TBARS, glutathione GSH and radical scavenging activity were also evaluated in liver and kidney homogenates. Paracetamol fed animals had high levels of thiobarbituric acid reactive substances and low levels of glutathione GSH and radical scavenging activity (RSA). Extract ingestion caused a significant increase in glutathione and radical scavenging activity RSA levels, while reducing the (TBARS) levels, showing that the extracts have antioxidant potentials. The antioxidant capacity of the Dianthus orientalis leaves aqueous extract at various dosages demonstrated an increased inhibition of DPPH, i.e., 2, 2-diphenyl-1-picrylehydrazyle free radical. The histological study of the liver and kidney supports the protective activity of Dianthus orientalis leaves aqueous extract against paracetamol intoxication with optimistic effects regarding oxidative stress condition and serum electrolytes balance.

Risk of adenocarcinoma in patients with a suspicious ground-glass opacity: a retrospective review

BACKGROUND

Both primary lung adenocarcinoma and benign processes can have a ground-glass opacity (GGO) appearance on imaging. This study evaluated the incidence of and risk factors for malignancy in a diverse cohort of patients who underwent resection of a GGO suspicious for lung cancer.

METHODS

All patients who underwent resection of a pulmonary nodule with a GGO component and suspected to be primary lung cancer at a single institution from 2001-2017 were retrospectively reviewed. Risk factors for malignancy were evaluated using multivariable logistic regression analysis that included nodule size, age, sex, and race as potential predictors.

RESULTS

The incidence of pulmonary adenocarcinoma in the 243 patients who met inclusion criteria was 86% (n=208). The most common pathologic findings in 35 patients with a benign pathology was granulomatous inflammation (n=14, 40%). Risk factors for adenocarcinoma in multivariable logistic regression were age [odds ratio (OR) 1.06, P=0.003], GGO size (OR 2.76, P<0.001), female sex (OR 4.47, P=0.002), and Asian race (OR 8.35, P=0.002). In this cohort, adenocarcinoma was found in 100% (44/44) of Asian females, 86% (25/29) of Asian males, 84% (98/117) of non-Asian females, and 77% (41/53) of non-Asian males.

CONCLUSIONS

The likelihood of adenocarcinoma in lung nodules with a ground-glass component is influenced by sex and race. Asian females with a GGO have a much higher likelihood of having adenocarcinoma than men and non-Asians. This data can be used when deciding whether to pursue nodule resection or surveillance in a patient with a GGO.

Managing screening-detected subsolid nodules-the Asian perspective

The broad application of low-dose computed tomography (CT) screening has resulted in the detection of many small pulmonary nodules. In Asia, a large number of these detected nodules with a radiological ground glass pattern are reported as lung adenocarcinomas or premalignant lesions, especially among female non-smokers. In this review article, we discuss controversial issues and conditions involving these subsolid pulmonary nodules that we often face in Asia, including a lack or insufficiency of current guidelines; the roles of preoperative biopsy and imaging; the location of lesions; appropriate selection of localization techniques; the roles of dissection and sampling of frozen sections and lymph nodes; multifocal lesions; and the roles of non-surgical treatment modalities. For these complex issues, we have tried to present up-to-date evidence and our own opinions regarding the management of subsolid nodules. It is our hope that this article helps surgeons and physicians to manage the complex issues involving ground glass nodules (GGNs) in a balanced manner in their daily practice and provokes further discussion towards better guidelines and/or algorithms.

Comparison of histological and computed tomographic measurements of pig lung bronchi

Aim

Light microscopy is used as template in the evaluation and further development of medical imaging methods. Tissue shrinkage caused by histological processing is known to influence lung tissue dimensions. In diagnosis of COPD, computed tomography (CT) is widely used for automated airway measurement. The aim of this study was to compare histological and computed tomographic measurements of pig lung bronchi.

Methods

Airway measurements of pig lungs were performed after freezing under controlled inflation pressure in a liquid nitrogen bath. The wall thickness of seven bronchi was measured via Micro-CT and CT using the integral-based method (IBM) and the full-width-at-half-maximum method (FWHM) automatically and histologically on frozen and paraffin sections. Statistical analysis was performed using the Wilcoxon test, Pearson's correlation coefficient with a significance level at p<0.05, scatter plots and Bland–Altman plots.

Results

Bronchial wall thickness was smallest in frozen sections (median 0.71 mm) followed by paraffin sections (median 0.75 mm), Micro-CT (median 0.84 mm), and CT measurements using IBM (median 0.68 mm) and FWHM (median 1.69 mm). Statistically significant differences were found among all tested groups (p<0.05) except for CT IBM and paraffin and frozen sections and Micro-CT. There was high correlation between all parameters with statistical significance (p<0.05).

Conclusions

Significant differences in airway measurement were found among the different methods. The absolute measurements with CT IBM were closest to the histological results followed by Micro-CT, whereas CT FWHM demonstrated a distinct divergence from the other groups.

Automated measurement techniques advance diagnosis of lung diseases. Pig bronchi wall size varies between Micro-CT, CT IBM, CT FWHM and histology. CT IBM is closest to histological results, followed by Micro-CT. CT FWHM differs highly from all other groups.https://bit.ly/3iRXSrv

Clinical adjustability of radiological tools in patients with surgically resected cT1N0-staged non-small-cell lung cancer from the long-term survival evaluation

Background

Various radiological tools have been introduced to determine the malignancy or prognosis of lung carcinomas. We retrospectively summarized the clinical outcomes to evaluate whether radiological tools such as consolidation-to-tumor ratio (CTR), tumor disappearance ratio (TDR), and mediastinal diameter (MD) are suitable for surgically resected non-small-cell lung cancer (NSCLC).

Methods

This retrospective study included 260 patients (128 men and 132 women; median age, 64 years) with cT1N0-staged NSCLC who underwent thoracotomy. Disease-free survival (DFS) and overall survival (OS) outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazards model.

Results

When the adjusted hazard ratios (HRs) with reference to cT1a/1 mi were calculated, significant differences were observed in cT1b and cT1c for DFS (P=0.04 and P<0.01, respectively) and in cT1c for OS (P=0.01). For HRs with reference to CTR (≤0.5), a significant difference was only observed in CTR (>0.5) for DFS (P=0.01). For HRs with reference to TDR (≤25%), significant differences were observed in TDR (>75%) for DFS (P=0.02) and OS (P=0.02). For HRs with reference to MD (≤5 mm), significant differences were observed in 6–20 mm (P=0.04) and >20 mm (P=0.02) for DFS and in >20 mm (P=0.02) for OS.

Conclusions

All radiological tools revealed significant correlations with prognosis in the patients with cT1N0-staged NSCLCs. We recommend the use of MD in a clinical context. However, further investigation of this issue is needed.

Impact of tumor disappearance ratio on the prognosis of lung adenocarcinoma ≤2 cm in size: A retrospective cohort study

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.

The role of the ground-glass opacity ratio in resected lung adenocarcinoma

OBJECTIVES

The goal of this study was to investigate the role of the ground-glass opacity (GGO) ratio in lung adenocarcinoma in predicting surgical outcomes.

METHODS

Patients who underwent surgical resection for pulmonary adenocarcinoma between January 2004 and December 2013 were reviewed. The clinical data, imaging characteristics of nodules, surgical approaches and outcomes were analysed with a mean follow-up of 87 months.

RESULTS

Of 789 enrolled patients, 267 cases were categorized as having a GGO ratio ≥0.75; 522 cases were categorized as having a GGO ratio <0.75. The gender, tumour differentiation, epidermal growth factor receptor mutation, smoking habits, lymphovascular space invasion, tumour size, maximum standard uptake value and carcinoembryonic antigen levels were significantly different in the 2 groups. In the group with a GGO ratio ≥0.75, 63.3% of the patients underwent sublobar resection (18.8% with a GGO ratio < 0.75, P <0.001). These patients had fewer relapses (2.2% for GGO ratio ≥0.75, 26.8% for GGO ratio <0.75, P < 0.001) and a better 5-year survival rate (95.5% for GGO ratio ≥0.75, 77.4% for GGO ratio <0.75, P < 0.001). None of the patients with a GGO ratio ≥0.75 had lymph node involvement. The multivariable Cox regression analysis revealed that a GGO ratio <0.75 was an independent factor for postoperative relapse with a hazard ratio of 3.96.

CONCLUSIONS

A GGO ratio ≥0.75 provided a favourable prognostic prediction in patients with resected lung adenocarcinoma. Sublobar resection and lymph node sampling revealed a fair outcome regardless of tumour size. However, anatomical resection is still the standard approach for patients with tumours with a GGO ratio <0.75, size >2 cm.

Radiologic-Pathologic Correlation of Solid Portions on Thin-section CT Images in Lung Adenocarcinoma: A Multicenter Study

BACKGROUND

Measuring the size of invasiveness on computed tomography (CT) for the T descriptor size was deemed important in the 8th edition of the TNM lung cancer classification. We aimed to correlate the maximal dimensions of the solid portions using both lung and mediastinal window settings on CT imaging with the pathologic invasiveness (> 0.5 cm) in lung adenocarcinoma patients.

MATERIALS AND METHODS

The study population consisted of 378 patients with a histologic diagnosis of adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), invasive adenocarcinoma (IVA)-lepidic, IVA-acinar and/or IVA-papillary, and IVA-micropapillary and/or solid adenocarcinoma. A panel of 15 radiologists was divided into 2 groups (group A, 9 radiologists; and group B, 6 radiologists). The 2 groups independently measured the maximal and perpendicular dimensions of the solid components and entire tumors on the lung and mediastinal window settings. The solid proportion of nodule was calculated by dividing the solid portion size (lung and mediastinal window settings) by the nodule size (lung window setting). The maximal dimensions of the invasive focus were measured on the corresponding pathologic specimens by 2 pathologists.

RESULTS

The solid proportion was larger in the following descending order: IVA-micropapillary and/or solid, IVA-acinar and/or papillary, IVA-lepidic, MIA, and AIS. For both groups A and B, a solid portion > 0.8 cm in the lung window setting or > 0.6 cm in the mediastinal window setting on CT was a significant indicator of pathologic invasiveness > 0.5 cm (P < .001; receiver operating characteristic analysis using Youden's index).

CONCLUSION

A solid portion > 0.8 cm on the lung window setting or solid portion > 0.6 cm on the mediastinal window setting on CT predicts for histopathologic invasiveness to differentiate IVA from MIA and AIS.

Natural History of Pulmonary Subsolid Nodules: A Prospective Multicenter Study

INTRODUCTION

The purpose of this study was to evaluate the natural course of the progression of pulmonary subsolid nodules (SSNs).

MATERIALS AND METHODS

Eight facilities participated in this study. A total of 795 patients with 1229 SSNs were assessed for the frequency of invasive adenocarcinomas. SSNs were classified into three categories: pure ground-glass nodules (PGGNs), heterogeneous GGNs (HGGNs) (solid component detected only in lung windows), and part-solid nodules.

RESULTS

The mean prospective follow-up period was 4.3 ± 2.5 years. SSNs were classified at baseline as follows: 1046 PGGNs, 81 HGGNs, and 102 part-solid nodules. Among the 1046 PGGNs, 13 (1.2%) developed into HGGNs and 56 (5.4%) developed into part-solid nodules. Among the 81 HGGNs, 16 (19.8%) developed into part-solid nodules. Thus, the SSNs at the final follow-up were classified as follows: 977 PGGNs, 78 HGGNs, and 174 part-solid nodules. Of the 977 PGGNs, 35 were resected (nine minimally invasive adenocarcinomas [MIAs], 21 adenocarcinomas in situ [AIS], and five atypical adenomatous hyperplasias). Of the 78 HGGNs, seven were resected (five MIAs and two AIS). Of the 174 part-solid nodules, 49 were resected (12 invasive adenocarcinomas, 26 MIAs, 10 AIS, and one adenomatous hyperplasia). For the PGGNs, the mean period until their development into part-solid nodules was 3.8 ± 2.0 years, whereas the mean period for the HGGNs was 2.1 ± 2.3 years (p = 0.0004).

CONCLUSION

This study revealed the frequencies and periods of development from PGGNs and HGGNs into part-solid nodules. Invasive adenocarcinomas were diagnosed only among the part-solid nodules, corresponding to 1% of all 1229 SSNs.

Microscopic Invasions, Prognoses, and Recurrence Patterns of Stage I Adenocarcinomas Manifesting as Part-Solid Ground-Glass Nodules: Comparison With Adenocarcinomas Appearing as Solid Nodules After Matching Their Solid Parts' Size

The purpose of the present study was to compare the frequency of microscopic invasions, disease-free-survival (DFS), and the frequency and pattern of disease recurrence between stage I pulmonary adenocarcinomas appearing as solid nodules and those appearing as part-solid ground-glass nodules (GGNs) after matching their solid parts' size (D(solid)) and patients' age. Among 501 patients who underwent curative surgery for stage I pulmonary adenocarcinomas between 2003 and 2011, 172 patients (86 with solid nodules [M: F = 36: 50; mean age, 62.8 years] and 86 with part-solid GGNs [M:F = 30:56; mean age, 63.0 years]) matched for D(solid) and patients' age were included. DFS, frequency of microscopic invasions, recurrence, and recurrence pattern were compared between the two groups. No significant difference was observed in the frequency of microscopic invasions between the two groups (visceral pleural invasion, 30.23% vs. 29.07%, P = 0.867; lymphatic invasion, 5.81% vs. 3.49%, P = 0.720; vascular invasion, 1.16% vs. 0%, P = 1.000; solid nodules vs. part-slid GGNs, respectively) and DFS (estimated 5-year DFS, 83.6% vs. 81.9%, P = 0.744; solid nodules vs. part-slid GGNs, respectively). As for recurrence and recurrence pattern, there were no significant differences between the solid nodule group (14/86), and part-solid GGN group (12/86) (P = 0.670). Lung parenchymal nodules were the most frequent pattern of disease recurrence in both groups, followed by pleural seeding. In conclusion, after matching D(solid) and patients' age, there was no significant difference in the frequency of microscopic invasions, DFS, and the frequency and pattern of recurrence between stage I pulmonary adenocarcinomas appearing as solid nodules and part-solid GGNs.

Mixed squamous cell and glandular papilloma of the lung resembling early adenocarcinoma: A case report

Introduction

An extremely rare case of mixed squamous cell and glandular papilloma of the lung is reported. The correlation between the radiological and the pathological features as well as the clinical pitfall in making a diagnosis is discussed.

Presentation of case

An asymptomatic 68-year-old female with a cigarette smoking habit presented with a small nodule in her peripheral lung. A wedge resection was performed though it failed on-site diagnosis which was instead obtained following pathological scrutiny. The postsurgical course was excellent with no recurrence of disease.

Discussion

A small ground glass nodule gradually enlarged and transformed to a partially solid nodule a year and a half later. This transformation falsely made us suspect an early adenocarcinoma development. Eventually, the extremely rare subtype of pulmonary papilloma, with biphasic glandular and squamous cells, had been demonstrated to obstruct the peripheral bronchiole; and the adjoining alveoli had filled with a large volume of mucus. These pathological features seemed to have constituted the inner solid portion and the marginal ground glass portion respectively in the CT images, mimicking invasive lepidic adenocarcinoma.

Conclusion

Both pre- and intra-operative diagnoses are difficult mainly because of the rareness of the disease, however, mixed squamous cell and glandular papilloma may be considered in case the presence of primary adenocarcinoma is not validated.

•

Mixed squamous cell and glandular subtype is extremely rare pulmonary papilloma.

•

Initial presentation of this benign tumor had resembled early adenocarcinoma.

•

This disease should be taken into account in making a differential diagnosis.

Correlations Between the EGFR Mutation Status and Clinicopathological Features of Clinical Stage I Lung Adenocarcinoma

Advanced lung cancers with epidermal growth factor receptor (EGFR) exon 19 deletions (Ex19s) and EGFR exon 21 L858R point mutations (Ex21s) exhibit different clinical behavior. However, these differences are unclear in resectable primary lung tumors.The clinicopathological features of 88 (20.9%) Ex19, 124 (29.4%) Ex21, and 198 (46.9%) EGFR wild-type (Wt) clinical stage I primary adenocarcinomas resected between January 1, 2012 and October 31, 2014 were compared by using Chi-square tests, residual error analysis, analysis of variance, and Tukey tests.Ex21 lesions occurred more frequently in women and never-smokers and had a higher tumor disappearance rate (TDR: 59.6% vs 43.9%; P < 0.001) and lower maximum standardized uptake value (maxSUV: 2.0 vs 3.5; P < 0.01) than Wt lesions; Ex19 lesions had intermediate values (52.8% and 2.6). There was a low frequency of vascular invasion in Ex21 lesions (12.1%; P < 0.05) and a high frequency in Wt lesions (22.7%; P < 0.05). Most Ex19 lesions were intermediate-grade adenocarcinoma (lepidic, acinar, and papillary predominant: 73.9%; P < 0.05). Wt and Ex21 lesions were predominately high-grade (micropapillary or solid predominant, mucinous variant) and low-grade (adenocarcinoma in situ and minimally invasive adenocarcinoma) adenocarcinoma, respectively. Wt lesions had smaller lepidic components (42.1% vs 56.3%; P < 0.001) and larger papillary and solid components (papillary: 15.5% vs 9.0%; P < 0.05; solid: 13.2% vs 3.2%; P < 0.001) than Ex21 lesions. Most Ex19 lesions had intermediate component rates.Most Ex21 lesions were low-grade adenocarcinoma with lepidic growth patterns. Wt high-grade adenocarcinomas included solid and papillary components with vascular invasion. Ex19 lesions were intermediate grade between Ex21 and Wt.

Prognostic significance of clinical/pathological stage IA non-small-cell lung cancer showing partially solid or solid tumours on radiological exam

PURPOSE

Although curative resection is expected to be effective in patients with clinical (c-) stage IA/pathological (p-) stage IA non-small-cell lung cancers, recurrence is often observed. Hence, the aim of this study was to identify predictors of recurrence.

METHODS

Between 2005 and 2009, 138 patients with c-stage IA/p-stage IA non-small-cell lung cancers underwent resection. Recurrence and recurrence-free survival (RFS) were compared with clinical, radiographic and pathological findings.

RESULTS

The 5-year cancer-specific survival rate was 97% and the RFS rate was 89% at a median follow-up time of 91 months. Recurrence was observed in 10 patients (7.2%). Significant differences were observed in RFS according to tumour dimensions on the mediastinal window image (>1.5 cm), serum carcinoembryonic antigen levels (>5.0 ng/mL), maximum standardised uptake values (SUVmax >2.5) and angiolymphatic invasion. Patients were grouped according to the number of risk factors for poor RFS. Patients with 0-1 of the identified risk factors had an RFS of 97%, where those with 2-4 factors had an RFS of 68% (p <0.001).

CONCLUSION

Prognosis of patients exhibiting more than two of these risk factors is considerably poor. Thus, close observation and individualised adjuvant therapy may be beneficial to these patients.

The revised lung adenocarcinoma classification-an imaging guide

Advances in our understanding of the pathology, radiology and clinical behaviour of peripheral lung adenocarcinomas facilitated a more robust terminology and classification of these lesions. The International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) classification introduced new terminology to better reflect this heterogeneous group of adenocarcinomas formerly known as bronchoalveolar cell carcinoma (BAC). There is now a clear distinction between pre-invasive, minimally invasive and frankly invasive lesions. The radiographic appearance of these ranges from pure ground glass nodules to solid mass lesions. Radiologists must be aware of the new classification in order to work alongside multidisciplinary colleagues to allow accurate staging and treatment. This article reviews the new classification of lung adenocarcinomas. Management options of these lesions with particular focus on radiological implications of the new classification will be reviewed.

Clinical and radiologic features of extraskeletal myxoid chondrosarcoma including initial presentation, local recurrence, and metastases

Background

The aim of the study was to evaluate the clinical and imaging features of extraskeletal myxoid chondrosarcoma (EMC) including initial presentation, recurrence, and metastases.

Patients and methods.

In this institutional review board-approved retrospective study, imaging features of 13 patients with pathologically proven EMC seen from August 1995 to December 2011 were analyzed. The group included 3 women and 10 men and the mean age was 54 years (range 29–73 years). Imaging studies were evaluated by two radiologists in consensus. Location, size, and imaging features of primary tumors were recorded as well as the presence of recurrent disease and location of metastases.

Results

Among 13 patients, 3 died during the timeframe of this study. Nine patients had primary tumor in the lower extremity, and average tumor size was 9.3 cm (range 3.3–18 cm). On MRI, primary tumors were hyperintense on T2, isointense to muscle on T1, and demonstrated peripheral/septal enhancement. Three patients had local recurrence and 12 had metastatic disease, with lung involvement being the most common. Tumor density on contrast enhanced CT ranged from 8.2 to 82.9 Hounsfield unit (HU). FDG-PET/CT imaging was performed in 3 patients. One patient had no FDG avid disease and 2 patients had metastatic disease with standard uptake values (SUV) of 2.8 and 7.4. The patient with intense FDG uptake demonstrated more solid appearing tumor burden and had the shortest survival.

Conclusions

EMC is a rare tumor that often occurs in the lower extremities and frequently metastasizes to the lungs. Increased tumor density and increased FDG uptake may be related to more aggressive disease.

Pulmonary metastasectomy for gastric cancer: a 13-year single-institution experience

PURPOSE

Pulmonary metastases from gastric cancer are rare, and the role of surgery is unclear. The purpose of this study was to determine which patients with metachronous metastatic gastric cancer (MGC) might benefit from pulmonary resection.

METHODS

Between 1998 and 2011, 12 patients underwent 14 pulmonary resections for MGC. We reviewed their clinical courses and evaluated their radiological findings.

RESULTS

Solitary pulmonary lesions were identified for 11 metastases, and the remaining three showed multiple pulmonary lesions. Six patients received treatment for the metastases before pulmonary resection. Lobectomy was performed for five lesions and wedge resection was performed for the remaining nine lesions. At the median follow-up time of 23.0 months, four patients were alive without disease, and the median DFS following pulmonary resection was 6.6 months. The overall 5-year survival rate following pulmonary resection was 58.4 %. In a univariate analysis, the number of lesions and the tumor doubling time (TDT) were significant predictors of the DFS, although prior treatment was not a significant predictor of the DFS.

CONCLUSION

Pulmonary resection for MGC might be an effective therapeutic option when there is a solitary metastatic lesion that has a long TDT, even if the patient has been previously treated for metastases.

Radiologic implications of the 2011 classification of adenocarcinoma of the lung

Now the leading subtype of lung cancer, adenocarcinoma received a new classification in 2011. For tumors categorized previously as bronchioloalveolar carcinoma (BAC), criteria and terminology had not been uniform, so the 2011 classification provided four new terms: (a) adenocarcinoma in situ (AIS), representing histopathologically a small (≤3-cm), noninvasive lepidic growth, which at computed tomography (CT) is usually nonsolid; (b) minimally invasive adenocarcinoma, representing histopathologically a small (≤3-cm) and predominantly lepidic growth that has 5-mm or smaller invasion, which at CT is mainly nonsolid but may have a central solid component of up to approximately 5 mm; (c) lepidic predominant nonmucinous adenocarcinoma, representing histopathologically invasive adenocarcinoma that shows predominantly lepidic nonmucinous growth, which at CT is usually part solid but may be nonsolid or occasionally have cystic components; and (d) invasive mucinous adenocarcinoma, histopathologically showing lepidic growth as its predominant component, which at CT varies widely from solid to mostly solid to part solid to nonsolid and may be single or multiple (when multifocal, it was formerly called multicentric BAC). In addition, new histopathologic subcategories of acinar, papillary, micropapillary, and solid predominant adenocarcinoma are now described, all as nonmucinous, predominantly invasive, may include a small lepidic component, and at CT are usually solid but may include a small nonsolid component. The micropapillary subtype has a poorer prognosis than the other subtypes. In addition, molecular genetic correlations for the subcategories of adenocarcinoma of the lung are now a topic of increasing interest. As the new classification enters common use, further descriptions of related correlations can be anticipated.

Prognostic value of the ratio of ground glass opacity on computed tomography in small lung adenocarcinoma: A meta-analysis

INTRODUCTION

Lung cancer is the leading cause of cancer-associated death. In many countries, adenocarcinoma is the most common histologic type in lung cancer. Previously, few factors are identified to be prognostic indicators for the patients with small lung adenocarcinoma. Recently, the ground glass opacity (GGO) area found on high-resolution computed tomography (HRCT) scanning was identified as a prognostic indicator in some studies. But no clear consensus has been defined.

METHODS

The PubMed/MEDLINE, EMBASE, Cochrane library and SpringerLink electronic databases were searched for articles related to ground glass opacity on computed tomography in patients with small lung adenocarcinoma. Data was extracted and analyzed independently by two investigators. An estimate of the hazard ratio (HR) for comparing high GGO ratio with low GGO ratio was extracted. The respective HRs was combined into a pooled HR, and 95% confidence interval (CI) was calculated for each study. The publication heterogeneity was assessed graphically using performing Beggs' funnel plot. All the statistical tests used in our meta-analysis were performed with STATA version 11.

RESULTS

Thirteen studies, encompassing 2,027 patients, were included in our meta-analysis. Ten of these studies revealed that the GGO ratio in small lung adenocarcinoma is a good prognostic indicator. Seven studies were combined in a meta-analysis using overall survival (OS) as the end point of interest. The weighted HR of 7 studies was 0.85, with relative 95% CI ranging from 0.78 to 0.93 (P=0.009). For the surgical patient population, the primary endpoint of relapse-free survival (RFS) was superior with high GGO area on computed tomography (The combined HR 0.82, 95% CI 0.74-0.90; P=0.007).

CONCLUSIONS

The result of our meta-analysis suggested that the GGO area measured on HRCT had a prognostic value of overall survival and relapse-free survival in small lung adenocarcinoma. The GGO ratio may be an independent prognostic factor for small lung adenocarcinoma.

Correlation between dynamic CT findings and pathological prognostic factors of small lung adenocarcinoma

PURPOSE

To compare pathological prognostic factors of small lung adenocarcinomas with findings of contrast-enhanced dynamic computed tomography (CT) scans.

MATERIALS AND METHODS

We evaluated 108 patients with lung adenocarcinomas ≤ 30 mm in diameter who underwent dynamic CT scans (80-96 ml of contrast material, 2.5-3 ml/s injection) and tumor resections. Attenuation values of both the early phase (20-36 s after injection) and delayed phase (91-95 s) of enhanced CT minus baseline plain CT attenuation were defined as ΔEarly and ΔDelay. The early enhancement ratio was defined as ΔEarly/ΔDelay×100 (%). We statistically compared the early enhancement ratios between the presence and absence of each pathological finding (lymph node metastasis, lymphatic permeation, vascular invasion, and pleural involvement). Patients were divided into 2 groups based on early enhancement ratios: ratio ≥50% (n = 41) and ratio <50% (n = 67) and we statistically compared these 2 groups.

RESULTS

The early enhancement ratios in the group with lymph node metastasis, lymphatic permeation, and vascular invasion were significantly lower than in the group without these findings (24.9% vs 48.6%; P < 0.001, 30.0% vs 47.5%; P = 0.002, and 26.5% vs 47.0%; P = 0.002, respectively). Lymph node metastasis, lymphatic permeation, and vascular invasion were significantly more frequent in tumors with a ratio <50% than in tumors with ratio ≥50% (P < 0.001, P = 0.008, and P = 0.005, respectively).

CONCLUSIONS

There was a significant correlation between the early enhancement ratio of enhanced dynamic CT and the pathological prognostic factors in small lung adenocarcinomas.

Small peripheral lung adenocarcinoma: CT and histopathologic characteristics and prognostic implications

Since the introduction of computed tomography (CT), detection of small lung cancer, especially small peripheral adenocarcinoma, is common. Recently, the morphological characteristics, including thin-section CT and pathologic findings, and prognosis of small peripheral lung adenocarcinomas have been studied extensively. The radiologic and microscopic findings correlate well with each other and are closely associated with tumour prognosis. Most importantly, some subtypes of small lung adenocarcinomas with specific CT or pathologic features are curable. Therefore, all defining characteristics (CT, pathologic and prognostic) of this kind of tumour should be integrated to improve our understanding, provide guidelines for management and accurately assess its prognosis.

Predictive factors of pathologically proven noninvasive tumor characteristics in T1aN0M0 peripheral non-small cell lung cancer

BACKGROUND

We retrospectively analyzed preoperative factors that may predict pathologically invasive tumor characteristics, including lymph node involvement, and pleural and vessel invasion in patients with cT1aN0M0 peripheral non-small cell lung cancer (NSCLC), in an attempt to identify candidates for pulmonary resection less than lobectomy.

METHODS

We reviewed the charts of 363 patients in whom cT1aN0M0 lung cancer in the lung periphery had been diagnosed or was suspected, based on high-resolution CT scan of 1- or 2-mm-slice intervals, within 1 month of surgical resection, and examined the relationships between preoperative clinical information and pathologic invasive tumor characteristics, corresponding to lymph node involvement and pleural and vessel invasion.

RESULTS

Multivariate analysis showed that a tumor disappearance ratio (TDR) < 0.5, the presence of spiculation, and an absence of air bronchograms were statistically significant independent predictors of pathologic invasiveness. Most TDR ≥ 0.5 tumors were noninvasive (98.7%), and only one patient had a recurrence within 5 years after surgical resection. Of the tumors with a TDR ≥ 0.5 without spiculation, 98.3% were noninvasive, and all those patients remained recurrence-free for 5 years after surgery.

CONCLUSION

The combination of a TDR ≥ 0.5 and the absence of spiculation was highly predictive of noninvasive or minimally invasive NSCLC. Future studies should evaluate whether limited resection of these tumors provides acceptable outcomes.